WELLFLEET — The first mobile methadone clinic on Cape Cod won the approval of the Wellfleet Zoning Board of Appeals and could arrive as soon as September at the parking lot of the Outer Cape Health Services Pharmacy on Route 6.
Though finding sites for clinics that serve people with drug addiction disorder has often been a Not-in-My-Back-Yard challenge, the ZBA on Aug. 11 approved a special permit for operation of the van after hearing from 10 supporters of the proposal. Two people spoke in opposition. The 23-foot van will be in Wellfleet daily from 6 to 9 a.m. once the U.S. Drug Enforcement Agency (DEA) issues a permit.
The ZBA received letters of support for the clinic from the Wellfleet police, fire, and health depts.; from Eastham Town Administrator Jacqueline Beebe; and from state Rep. Sarah Peake and state Sen. Julian Cyr. Provincetown Health Agent Lezli Rowell and the co-chairs of the Barnstable County Regional Substance Addiction Council also sent letters describing the importance of providing better access to methadone.
“The nearest methadone clinic to residents of the Outer Cape is in Yarmouth, meaning that residents in need of this therapy must commute several hours every day to the clinic to receive medication and counseling,” the letter from Peake and Cyr stated. “This fact, coupled with our often-frustrating transportation system, makes this challenging for patients who need their medication but also want to work or have family responsibilities. No patient in Massachusetts should have to choose between continuing lifesaving medication and their livelihood. If we reduce this barrier to care, more patients will be able to stay engaged in treatment and counseling.”
First licensed in 1973 for addiction treatment, methadone is used to reduce cravings, ease withdrawal symptoms, and stabilize the lives of people addicted to heroin and opioid-based prescription painkillers. Because of federal regulations, most patients must be given single doses daily to prevent overdose and diversion.
Brianne Smith, a licensed clinical social worker at Outer Cape Health Services, said, “I work with patients who have to go to Yarmouth every single day. … I know how this impacts their lives.”
“The ability for people on the Lower Cape to get medically assisted treatment is absolutely essential,” Wellfleet resident Dennis Cunningham, a nurse, told the ZBA. “I think it would be a dereliction of duty not to do this. I cannot speak strongly enough for the recovery community who need this support.”
Acadia Healthcare, which owns the South Yarmouth clinic, will operate the van daily at 2700 Route 6, parking at the back of the pharmacy parking lot, said Acadia’s attorney, Sarah Turano-Flores. The mental health and behavioral treatment company is based in Nashville, Tenn.
An estimated 5 to 10 patients will come to the clinic at predetermined times to receive medication in the van. The driver of the van will double as security guard. To prevent noise and loitering, patients will be required to stay in their cars until the security guard escorts them to the van, one or two at a time. Then they will have to leave immediately, said Matt Davis, Acadia’s regional vice president. The van itself will return to South Yarmouth at 9 a.m. each day.
“All our patients are put through a very strict orientation,” Davis said. “Patients will be in their cars and not allowed to intermingle with each other.”
Acadia operates a mobile clinic in Quincy where they enforce a “good neighbor” policy, Davis said. Patients who violate it risk getting removed from the program, he told the ZBA.
During the next few years, as the clinic’s caseload increases, 100 to 150 patients are expected to receive medication from the mobile van, Davis said. Not all of them, however, will need to come every day. Once they are stable, longtime patients can receive take-home doses lasting weeks or months, he said.
The opposition to the proposal from neighbors Peter and Laura Lindberg of Old Kings Highway and Larry and Irene Giangregorio of Barnabas Young Road was focused on traffic and parking.
“I don’t think we would have access to the pharmacy at 8 a.m.,” Irene Giangregorio said. The pharmacy opens at 8 a.m., so there will be one hour overlap with the van’s operation. “The spaces are usually full,” she said. “Are there any sites that offer a less insane driving situation?”
Why not find a more “spacious area,” Larry Giangregorio asked. “I would encourage a formal traffic study to observe what happens in that area.”
“I am opposed to the location, not the concept,” said Laura Lindberg. “I would say there are a lot of cars parking before 9 a.m.”
She added that the police and fire depts. have a traffic signal at Route 6 and larger parking areas, making those lots preferable to the pharmacy’s.
Martha Gordon, who facilitates a recovery support group in Wellfleet, countered that “people in the recovery community won’t feel quite as comfortable in the police or even the fire station.”
Methadone, Gordon continued, eliminates fatal overdoses because the users are not taking unknown toxic street drugs that may contain fentanyl or other unpredictable and deadly substances.
“We need this,” Gordon said. “People in the recovery community have been asking for this for easily 5 or 10 years. I heartily encourage moving forward.”
The ZBA granted the special permit for the mobile van pending completion of OCHS renovations to the parking lot, currently underway, so that the pharmacy can open a drive-through window in September, Alan Hall, OCHS director facilities told the ZBA.
The DEA permit for the van should be granted in 45 to 60 days, Davis said.