Expansion of methadone services in Bangor, which seems inevitable given the current demand, may not draw the same level of protest that led to months of meetings in 2000, but it should concern city leaders. Though their authority to officially act on the issue is limited, they have an obligation to make plenty of noise short term and advocate for a legislative change to clinic siting long term.

The nonprofit Acadia Hospital opened its methadone services for the treatment of those addicted to heroin and other opiates in 2001, and by all accounts has done a fine job. It currently serves 140 clients, near its maximum, though anecdotal evidence suggests it could be serving far more. The threatened crime wave that opponents said would arrive with methadone has not appeared, but the opponents were correct in saying that many more clients than the 100 or 150 discussed would eventually be in the city. Operators of the for-profit Discovery House, which has clinics in southern and central Maine, sees a need for 250 more patient slots and has filed an application with the state for a license for that amount.

Were it to receive its license, which is based merely on meeting standards it already meets in its other clinics, Discovery House would be able to open shop in Bangor, provided it can find someone to lease space to the business. The city may not interfere. Acadia, which also is interested in expanding, receives a grant from the state to offer care to the indigent – Discovery House doesn’t provide that care – but the state is in no position to increase the grant.

Several things could happen: Acadia may find enough funding to expand its current mission or it may expand but limit the added clients to those able to pay. Discovery House likely will find a place to provide care, though might be less interested if Acadia expands. Either way, with Bangor’s authority over the clinics virtually nil, the city will depend on the skill of the operators of the clinic to expand in a responsible and medically appropriate manner.

One thing ought to happen: There is no certificate-of-need process for treatment clinics and very limited means for the state to direct clinics to areas with high levels of drug abuse. This means that while the region’s top three counties for drug abuse – Washington (where levels have flattened and may be declining), Hancock and Waldo – are struggling with this problem there are no clinics in any of them. The state, which provides direct care in many areas, does not want to get involved in this one and the for-profits have yet to see it in their interests, either.

A certificate-of-need process, one with more authority than the current medical CON process, could be used to direct clinics to areas of greatest need. It could result in much more data than currently is available – for instance, the Office of Substance Abuse Services doesn’t actually know how many people who need but cannot get treatment services are in the Bangor area. And it would make the process more public, thereby keeping all those interested aware of the progress on an application.

Bangor has handily addressed that last issue, the public process, through its Community Advisory Committee, which has met regularly since the Acadia clinic opened. Its members -three city councilors, the chief of police, three Acadia board members and three members of the public – have been kept apprised of events, providing Bangor with a forum absent crisis to discuss these difficult medical issues. But a statewide process still is needed.

Bangor has learned a lot about methadone in the last couple of years – both its benefits and its drawbacks, especially as it watches Portland combat drug overdoses associated with methadone. While encouraging a proven clinic, it can also recognize that the demand for methadone is a sign of problems deeper than what the drug alone can address.