BANGOR – The possibility of a small, for-profit methadone clinic setting up shop at a strip mall in Bangor may not stir local passions quite as much as the proposal to provide methadone treatment at Acadia Hospital did three years ago.

The dire predictions conjured up by opponents to the area’s first methadone program have failed to materialize – there’s no indication that Bangor has become a mecca for opiate addicts, drug-related crimes have gone down instead of up, and, to the untrained eye, methadone-related activity at Acadia’s Stillwater Avenue campus is virtually indistinguishable from the hospital’s other comings and goings.

Importantly, it has been determined that the methadone implicated in most drug-related deaths and overdoses in Maine has been in tablet form and not the liquid supplied by addiction clinics. That means that most of the methadone on the street is coming from someplace else – through fake prescriptions, stolen pain medication, or other illicit means – rather than being diverted from addiction treatment programs.

Kim Johnson, director of Maine’s Office of Substance Abuse, said Friday that methadone treatment is always controversial and indicated that the Florida-based Colonial Management Group, which has signed a 10-year lease on a storefront near the Bangor Mall, should expect community resistance.

“Methadone generates a lot of fear,” Johnson acknowledged. “Most of it is unjustified.”

That fear includes the possibility that, however well-intentioned, any clinic that dispenses hundreds of doses a day of a potent narcotic to vulnerable – and sometimes manipulative – recovering addicts will contribute more to a community’s substance abuse problem than it resolves. It means coming to terms with the reality that substituting a daily dose of methadone in place of some other, more dangerous drug may be a lifetime treatment and not a step toward abstinence. And it requires an acceptance that methadone’s predictable side effects, which can include a drowsiness that borders on stupor, are preferable to the unpredictable and acutely dangerous effects of heroin, OxyContin, Percocet, Xanax and other narcotic pain relievers and anti-anxiety drugs.

Despite these drawbacks, demand in Maine for methadone treatment continues to grow, Johnson said. “Every methadone clinic in Maine has a waiting list,” she said. There are now four such clinics, in South Portland, Westbrook, Waterville and Bangor, with a fifth licensed and expected to open soon in Calais. Another is on tap in Rockland. The new Bangor facility makes seven altogether. The clinic at Acadia Hospital is the only not-for-profit in the bunch.

Scott Farnum, director of substance abuse services at Acadia, said Friday that while not all clients who are eligible for methadone can be accepted right away, the hospital’s comprehensive substance abuse and mental health environment means “no one is turned away.” More than 500 people are treated for substance abuse and addiction at Acadia every day, Farnum said, and 80 percent of them receive methadone.

Farnum cautioned that a stand-alone program like the one being proposed at Maine Square Mall is paid differently from Acadia’s hospital-based clinic. Using Medicaid as an example because the majority of his clients are enrolled in the low-income public health care program, Farnum said Acadia is paid separately for each service it provides. A dose of methadone, a doctor’s examination and a counseling session, for instance, generate three distinct Medicaid payments. “We charge for what we provide,” he said.

But in a storefront clinic such as Colonial Management’s, a client’s visit generates one “bundled” Medicaid payment. That payment is the same, regardless of how much care the client receives. The system is designed for efficiency, but can result in clients being underserved, Farnum pointed out.

While he acknowledged the continuing demand for more methadone and other treatment services in northern and eastern Maine, Farmun questioned whether Bangor is a good geographic choice. With the opiate addiction problem spread throughout the vast region, “it doesn’t make much sense to have two clinics a mile apart,” he said. Ellsworth or Bar Harbor, he suggested, would be a more logical choice.

But Bangor has “the numbers,” according to Colonial development director Lynn Costigan. Well-established communities with solid zoning and public transportation systems make it easier to start up a new methadone clinic without having to start from scratch, she said.

Staffing at methadone clinics is regulated by state and federal guidelines. Colonial’s medical director, Dr. J. Thomas Payte, said Friday that the new Bangor clinic will observe all official guidelines as well as exercise professional caution in treating drug addicts in Bangor.

Most clients will be required to visit the clinic daily for their methadone dose. All will undergo routine monthly urine tests as well as random checks to determine whether they’re still using street drugs. Clients who demonstrate commitment and responsibility may be allowed “take-home” doses, he said, but also may be called upon at any time to bring their unused portions back to the clinic to show they haven’t been selling their medication or using it recreationally.

Payte, who said he has used methadone to treat his clients’ addictions for 40 years, said most of the 13,000 people being treated by Colonial at its other sites receive about 100 milligrams of methadone a day. “There are a handful who take 300 milligrams,” he said, “and one or two at 500 milligrams.” While the goal is to use as low a dose as is effective, Payte said it’s important to keep blood levels high enough that clients do not experience cravings or withdrawal.

Though many clients and their families resist the notion that methadone treatment may last a lifetime, Payte said he has come to accept that “opioid addiction is a chronic, progressive disease that is probably not curable.” While Colonial providers sometimes support a client’s desire to get off methadone and abstain from all drugs, the chance of a devastating relapse is high.

Johnson of Maine’s substance abuse prevention agency, said that while methadone remains a powerful and effective treatment for many addicts, others are responding as well or better to Suboxone, a relative newcomer to the treatment world.

Suboxone, which provides little by way of a “high” and will make the user acutely ill if it’s mixed with recreational narcotics, can be prescribed by any trained physician.

Payte said his company is licensed to prescribe Suboxone and that he hopes to be using it with Maine clients within a year of opening the Maine Square Mall site.