Between 2015 and 2019, 73 people from Middletown died of a drug overdose, more deaths per capita than in New Haven or Bridgeport. At least 17 Middletown residents have died so far in 2020.
By comparison, New Haven has five clinics that dispense methadone – one of three drugs commonly used in medication-assisted treatment of opioid use disorders — Bridgeport has three. There are no dispensaries anywhere in Middlesex County and since 1989, zoning regulations have prohibited methadone clinics from operating in Middletown.
The Root Center for Advanced Recovery, which offers methadone and other medication-assisted treatment for drug addiction at locations in nine Connecticut cities, plans to be the first.
And after his election in 2019, Mayor Ben Florsheim introduced a zoning rule change that could allow that to happen. The town’s Planning and Zoning Commission passed the measure 7-0 in April.
But while mental health professionals have been vocal in their support of the clinic, the proposal has been met with opposition from neighboring residents, property owners and business owners of the Washington Street location who worry that it’s too near to their homes, businesses and the Wesleyan University campus.
Neighbors criticize location
If approved by the Planning and Zoning Commission, the Root Center clinic would replace Fine Tunes Auto Repair, about three-quarters of a mile from Main Street, in a strip of businesses that are separated by a row of houses from the primary Washington Street commercial center to the west.
Owners of businesses and rental properties nearby to the proposed site have told the commission that the center could attract crime and hurt their businesses. Residents have also questioned the traffic impact on a stretch of Washington Street known already for rush-hour congestion and a stretch of steep hill where they say drivers tend to speed.
Some opponents of the plan acknowledge the need for opioid treatment, but suggest alternate locations, including the medical corridor on Saybrook Road where Root Center already has a clinic.
Steve Zuckerman, Root Center president and CEO, says that zoning rules and available property limit where they can build.
“It was like a needle in a haystack,” Zuckerman said. “I actually never thought we were going to find something.”
According to Zuckerman, the clinic would see most of its patients between 5:30 a.m. and 9 a.m., when they stop in before going to work.
A traffic study, presented by the engineering firm Fuss & O’Neill to the town’s Planning and Zoning Commission during its public hearing on Sept. 9, calculated that the clinic would result in six additional vehicle trips on that section of road during the peak morning hour, and two fewer in the peak afternoon hour compared to the existing auto shop.
“If we were opening up a clinic at that same location to treat diabetic patients who had to get their insulin every day, you probably wouldn’t even be calling me, because it would have been a non-issue,” Zuckerman said. “There’s a lot of stigma and myths associated with our clients, and it’s just not fair.”
The Root Center still needs approval from the Planning and Zoning commission for a special exception. The commission continued the public hearing it began on Sept. 9 to its meeting on Wednesday, Sept. 23.
“Absolutely, positively a need”
According to Zuckerman, his organization already treats about 150 patients from Middletown at its other clinics in Hartford and New Britain. The Middletown clinic is meant to “bring them home,” and serve patients from Cromwell, Portland, down the Route 9 corridor toward Old Saybrook.
Zuckerman said he expects the Middletown clinic would serve about 500 patients, though that would not mean 500 patients coming to the clinic every day.
“It’s one thing if there’s no one who wants to do the work, and then you have no choice, but to travel. But when you have providers willing to do the work, and you’re in the midst of record-breaking overdose deaths — that Middletown is not immune from — it just has to be done,” Zuckerman said.
Dr. J. Craig Allen, medical director of the Rushford clinic in Meriden, said there is “absolutely, positively” a need for methadone services in the Middletown and Meriden area.
Like Middletown, Meriden has more per capita deaths from drug overdose than either Bridgeport or New Haven.
Allen said that Rushford is not licensed to dispense methadone, but the clinic is working with the state to develop strategies for using methadone in its residential and detox programs.
“We’ve used methadone in our withdrawal management program for years, and there’s a program where we can start people on methadone in our withdrawal management program and transition them to an [opioid treatment program], but that is not in Middletown,” Allen said. “So we’re working to become a [treatment program] that can maintain people and we wouldn’t have to send them out of the area.”
If his patients can’t get methadone through Rushford, he’ll send them to whoever is providing it in the area, Allen said.
According to Joanne Montgomery, chief clinical and outreach officer at Liberation Programs, which provides substance abuse treatment, including methadone, in Fairfield County, there is a strong correlation between how close someone is to their treatment and how successful the treatment is.
In the early stages of methadone treatment, the patient visits the clinic every day to receive a daily dose. A patient is more likely to succeed if they’re staying in town instead of traveling half-an-hour or longer each way to the nearest clinic. There are a lot of complications when a patient has to travel for treatment, like transportation and child care, said Montgomery.
“It’s burdensome for someone who is trying to hold down a job or trying to take care of their children,” Montgomery said. “They’re trying to re-enter society and have a lot of things going on in their life.”
Daily visits allow the provider to check in, and also conduct random breathalyzer and urinalysis screenings to make sure the patient hasn’t relapsed, Montgomery said. They also help ground the patients in a routine, which Allen said is important, given that addictions can affect a person’s ability to organize their life, make appointments and follow through.
“Everything becomes, ‘I need that drug,’ if your brain is hijacked by this reward pathway,” Allen said.
While there are forms of opioid treatment that don’t use medication, Montgomery said medication-assisted treatment is the most common and effective way to treat an opioid use disorder.
“In my opinion, anyone with an opiate misuse disorder should be placed on medication assisted treatment to get them away from using fentanyl,” Montgomery said.
The number of people dying from drug overdose across Connecticut in 2020 is on pace to pass the record number of deaths recorded in 2019. Fentanyl is increasingly driving those deaths. Fentanyl accounted for 82 percent of overdose deaths in Connecticut and 2019, and almost 87 percent of overdose deaths in 2020 through July, according to the Connecticut Office of the Chief Medical Examiner.