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Zac Talbott sees the irony of running an opioid treatment program in an old doctor’s office.
“The funny thing is, a lot of patients are like, ‘This is where I first started getting prescribed pain pills,’” Talbott says, chuckling.
Now, the Tennessee native says the same people are coming to his clinic in Chatsworth, Georgia, a small city about a half-hour south of the Tennessee border, to fight their addiction to those very pills.
Outpatient clinics like the one Talbott co-owns dispense drugs like methadone and buprenorphine, which are legal synthetic opioids that block cravings and withdrawal symptoms. Federal health officials say this medication-assisted treatment, coupled with counseling, is the best way to treat an addiction to prescription painkillers or heroin. Patients are required to show up a set number of times a week, depending how long they’ve been receiving treatment, to take their medicine in front of a nurse.
Talbott’s clinic, Counseling Solutions, started treating patients in February, but he says it’s already treating 150 people in a space that’s fit for about 200. He says there’s such a need in this part of the state, he’s already making expansion plans.
The Centers for Disease Control and Prevention says more than 1,200 people died of an overdose in Georgia in 2014, a 10 percent increase over the previous year. So Talbott is outraged that, starting Wednesday, Georgia will put a one-year moratorium on issuing licenses to clinics that use medicine to treat people addicted to heroin or painkillers.
“We’re in the middle of an opioid addiction and overdose epidemic,” Talbott says. “You just think about that for a minute.”
Too Many Clinics?
The reason for the moratorium, according to state Sen. Jeff Mullis, is the state needs to figure out why so many opioid treatment programs have opened in Georgia. The Chickamauga Republican sponsored the legislation that created the freeze on new clinics. The bill, now law, also sets up a study committee to look into the issue.
Mullis says in his district, which borders Tennessee, a few clinics have opened just across the state line. He says people are driving from all over the South to get treatment there.
“Why are they in Georgia if Tennessee has these clinics as well?” Mullis asks. “In fact, if you go to the parking lot of any of these clinics in northwest Georgia you’ll see as many Tennessee, Alabama, North Carolina, Kentucky tags as you do Georgia tags.”
According to the Federal Substance Abuse and Mental Health Services Administration, Georgia has 67 opioid treatment programs, more than any other southeastern state.
By contrast, Tennessee has 12, Alabama has 24, and Mississippi has one. Only Florida comes close, with 65 clinics, but its population is nearly double Georgia’s.
While individuals in Georgia still have to fulfill multiple licensing requirements and approvals from both the state and federal governments, Mullis says it’s too easy for clinics to open here because, unlike other surrounding states, Georgia doesn’t have a Certificate of Need program for narcotic treatment centers. CONs limit entry or expansion of some health care facilities by requiring operators to show there’s a need for it. For opioid treatment programs in Georgia, it’s open competition.
“I don’t want to take these facilities away from people who need it, but we need to manage, and govern, and regulate the ones that are here, and the ones that are coming here,” Mullis says.
There’s also stigma around the addiction drugs used at opioid treatment centers because the drugs dispensed are opioids themselves. Critics say drugs like methadone are replacing one addiction with another.
Tapering off these drugs is optional, and some can stay on them all their lives, according to the U.S. Department of Health and Human Services.
Jonathan Connell, who heads the Opioid Treatment Providers of Georgia, an advocacy group for state providers, says pushing people off of medication-assisted treatment shouldn’t be the focus of lawmakers’ efforts.
“If someone stays on a medication, that’s not really the issue,” he says. “People can still be dependent on something, but not live an active addiction.”
Connell, who operates three opioid treatment programs in southwest Georgia, rejects Mullis’ claim that Georgia clinics lack regulations. However, he does support the moratorium.
He says the problem is that regulations are not enforced properly by the Georgia Department of Community Health, which oversees the clinics.
“We have had some clinics open up, some people with limited knowledge of the field,” Connell says. “They have not received surveys. How do we know they’re functioning correctly?”
The Department of Community Health says it only has three people to keep track of the 67 clinics, with another person currently in training. An agency spokesman says its rules and regulations also do not specify how frequently treatment centers should be inspected, but that re-licensure surveys are conducted every two years.
A Nationwide Treatment Shortage
The clinic moratorium is the exact opposite of what the federal government wants states to do.
In March, President Barack Obama came to Atlanta to highlight a nationwide treatment shortage. He talked about his $1 billion budget request to expand access to programs like the ones Georgia has put a hold on.
“We’ve got to make sure that in every county across America, that’s available, and the problem we have right now is that treatment is greatly underfunded,” the president said.
A shortage in other states means Georgia’s clinics are filling a need other Southern states are failing to provide, Talbott says.
He knows because he’s in long-term recovery to for an opiate addiction.
While getting his master’s degree in social work eight years ago, Talbott was prescribed painkillers for some lower back pain. He says things spiraled from there.
“It wasn’t long before, and I still recall to this day, learning how to help people with behavioral conditions in class, and then going to the bathroom to shoot pills and/or heroin,” Talbott says.
He says there were long wait lists at the three Tennessee clinics closest to him. Rather than wait, he drove four hours back and forth just outside Knoxville to a clinic in Rossville, Georgia nearly every day for six months to get treatment.
He says he’s grateful for that Georgia clinic.
“The old Zac, that Zac that was in that graduate program for clinical social work, quickly came back,” he says.
Talbott says his recovery inspired him to get into patient advocacy. He now sits on the board of the National Alliance for Medication Assisted Recovery, and acts as the director of the northwest Georgia and Tennessee chapters.
As the co-owner of a clinic, though, Talbott knows he has to battle perceptions. His office alarm code won’t work on the clinic’s pharmacy. He can’t sign for medicine deliveries, and he can’t open the safes that house the drugs.
Talbott says when he shares his story at conferences, people ask him if he’s still using medicine to treat his addiction. It’s a question he doesn’t like to answer.
“I like to leave the suspense out there,” Talbott says, “because the point is that, you know, you can’t tell.”