Do sick people have a right to be treated in their own community? Do residents have a right to say who gets care nearby?
The questions have a familiar ring in Northeast Philadelphia, where residents have repeatedly opposed new methadone maintenance clinics, forcing hundreds of their neighbors to travel across the city for care. A new chapter in the debate will open Wednesday, when State Rep. Kevin J. Boyle (D., Phila.) holds a hearing in Mayfair on a bill that would give communities more power over the approval process.
"People [here] want people who are victims of addiction to get help. But only if it is done in a responsible way," said Boyle, who argued that more local involvement would lead to better care.
Some say it would lead to none. "There has been a real concerted effort to keep a methadone clinic out of that community," said Beverly Haberle, executive director of the Council of Southeast Pennsylvania, an affiliate of the National Council on Alcoholism and Drug Dependence. "It's stigma."
Methadone maintenance is among the oldest and - when combined with intensive therapy and support - best treatments for opioid addiction. By attaching to the brain's opiate receptors, it prevents the withdrawal symptoms that can cause patients to quit treatment while simultaneously blocking the pleasures of heroin if they slip up. Many stay on it for years as they retrain parts of the brain that were changed by addiction.
Methadone is also a narcotic that is so tightly regulated that most patients must visit a clinic daily to receive each dose.
Brittan Auletto said she left her house at Cottman Avenue and the Boulevard daily at 6:15 a.m. to ride three buses and the El to a program in West Philadelphia. Nothing was available near her home.
"It saved me," said Auletto, 30. Without 21 months of methadone, she said, she would have kept up a seven-year heroin habit that she fostered in "any way possible." Now, nearly three years later, she works full time and attends Drexel University.
City records show that 514 people from the Far Northeast alone now travel elsewhere for methadone, and thousands more need care but can't get it. There is one clinic there and another in Bridesburg/Frankford; both, like many of the 11 others in the city, are full. Money exists for a new one in the Northeast if a community will have it.
State law reserves for Harrisburg the power to license medical facilities. No community input is required, but local zoning applies.
Boyle's bill, which died in the last session and is slated to be reintroduced soon, would require that the state consider parking, notify elected officials, and hold a hearing.
It was drafted after an uproar when the community discovered two years ago that medical offices rising in an old banquet hall on Frankford Avenue and Decatur Street would house a methadone clinic. It was "shrouded in mystery," said Mia Hylan, a Mayfair Civic Association board member. She was concerned about traffic and would object to narcotics being dispensed by anyone, including a pain doctor, in a residential area.
Care advocates do not entirely disagree. Roland Lamb, head of the city's Office of Addiction Services, said he would not support a clinic without adequate parking and acceptance at a public meeting. But his office lacks authority unless public health insurance is involved.
Healing Way, the proposed Frankford Avenue program whose opening has been held up by community legal challenges, did not seek Medicaid reimbursement. Nor did SOAR, the Far Northeast's only clinic, which Lamb said also "opened in the middle of the night."
But with Boyle's bill, which adds restrictions not put on other medical offices, "all you are doing is continuing . . . stigma," Lamb said.
Four years ago, when his office backed and held hearings on plans by a respected program to open at Grant Avenue and the Boulevard, wide opposition forced the nonprofit and the city to stop during a packed meeting. (That provider, NorthEast Treatment Centers, now hopes to open in an old factory on State Road. It faces opposition there, too.)
Lamb said it was only after that defeat, with scores of residents unable to get treated nearby, that the city approved Medicaid reimbursement for SOAR.
John Carroll, who oversees NorthEast's methadone program on Bridge Stree, says he thinks politics - nearly all elected officials oppose new clinics - and fear feed off a few bad apples so that good programs get "a lot of negativity."
Lawmakers have tried to restrict clinics in the past, with the courts rejecting some measures as discriminatory. Last month, State Sen. Kim Ward (R., Westmoreland) said she planned to offer a bill that would limit Medicaid coverage for methadone maintenance to 30 months.
Pete Specos, president of the Frankford Civic Association, said his community was "saturated with so-called drug rehabs that take people's money." He said they were "bringing more drug traffic back into the neighborhood," and crime, too. That charge was disputed, at least for methadone clinics in Baltimore, by a recent study that found crime did not rise near them but did near convenience stores.
Carl Primavera, Healing Way's lawyer, said such distinctions are discriminatory, which is why he expects a judge to let the clinic open.
Boyle's hearing will be at 10 a.m. Wednesday at the Mayfair Community Center. State Rep. Gene DiGirolamo (R., Bucks), chair of the Human Services Committee, supports addiction services but agrees that communities should have a say.
Meanwhile, more than 30 Northeast residents travel daily to Addiction Medicine and Health Advocates in Center City, some arriving at 6 a.m. to get methadone before work. More are on waiting lists. Many will die without care, said executive director Robert Holmes. "These are people from these communities. What are you going to do with them? Send them to other communities? It is a dilemma."