A new opioid treatment program (OTP) is about to open in Georgia, and it’s notable for the fact that one of the two owners is a methadone patient and a nationally known patient advocate. Zac Talbott, along with Keith Jones, will open the program within the next few months, after final inspections have taken place.

Talbott had always planned on a career in behavioral health, he told ADAW last week in an interview about his program, and about how the program where he was a patient kicked him out when they found out about it.

Talbott told the owner of the OTP where he had been a monthly patient for a number of years about the plans to open a clinic. “Two weeks later he called me in and discharged me,” said Talbott. “His initial reaction was that patients shouldn’t own clinics, that I wasn’t really in recovery, and that I would have access to all that methadone.” (In fact, Talbott won’t have access: DEA registrants can’t be dependent on opioids.) He was told he had two weeks to find another clinic — Talbott had two weeks of take-homes left — but gave him no referral. “It was no big deal, because I had connections, and I was able to find another clinic,” Talbott said. “But this shows how far we have to go — too many providers still have that foundation of anti-patient stigma.” Since then, the two have talked, and the owner seemed apologetic, but what he did was “highly unethical and potentially illegal,” said Talbott. “I was completely compliant as a patient, and my recovery and my life were potentially put at risk because of I was going to open a clinic?”

Studying social work

Talbott was in a master’s program for clinical social work at the University of Tennessee in Knoxville before he became addicted to opioids and ended up in treatment with methadone. “Once I was stable and in recovery, all the dreams of the pre-addiction Zac started coming back,” he said. He then became a certified medication-assisted treatment (MAT) advocate, and met many people in the OTP field. “I had done consulting work with OTPs, visited numerous OTPs, done patient advocacy and training for staff,” he said. “With my passion for this treatment, not only because it saved my life but because of my travels across the country, seeing that this was an amazing treatment when done properly, it was natural for me ultimately to want to open a clinic.”

Access is particularly difficult in Tennessee — in fact, although Talbott is a lifelong resident of Maryville, his OTP is south of the state line, in Georgia, which is much more hospitable to OTPs. “My dream would be to open an OTP in my town, but it’s really not possible to open an OTP now in Tennessee for many reasons,” he said.

Talbott’s clinic will be a for-profit, self-pay model, like all the OTPs in Tennessee and all but two in Georgia. However, by the end of the year, he hopes to be able to take Medicaid. As for commercial insurance, he will not be taking that at first. “I would love to have a billing person that can do all that as parity starts to really kick in, but we’re just trying to open to bring services to a no-service area first,” he said.

The beginnings of the plan took place at the OTP-G meeting two years ago — the annual meeting of the Georgia chapter of the American Association for the Treatment of Opioid Dependence (AATOD). He met Jones, who is the owner of a company that develops software for OTPs, at that meeting. “He was a supporter of patient advocacy, and we got to talking,” said Talbott. Then at last year’s Georgia meeting, they met up again and discussed the idea of opening up a clinic. “So in casual conversation, we said let’s follow up, and we are now business partners,” said Talbott.

Siting

There are several OTPs in the metropolitan Chattanooga area, which is about an hour from Chatsworth, where Talbott’s OTP is located. So Chattanooga, which itself sits on the state line, didn’t need new OTPs. Chatsworth, however, is in the middle of an area in which there are no OTPs. Georgia already has 62 OTPs, but more are needed, said Talbott. “It made sense for us to go into this underserved area.” he said.

The OTP, called Counseling Solutions, will be able to accommodate up to 300 patients starting out. Talbott anticipates that eventually there will be about 500 patients, based on what he knows about the area and the population.

The process of opening an OTP varies from state to state, but even in Georgia, it’s “very cumbersome and difficult,” said Talbott. Applications must be filled out with the Substance Abuse and Mental Health Services Administration, with the Drug Enforcement Administration, with the accrediting body (in this case, the Joint Commission), with the state, and, in the case of Georgia, with the Board of Pharmacy. “And the problem is, they all want you to have applied with someone else first,” said Talbott. “The DEA won’t even give you a copy of their application until the state gives you one, and the state won’t give you one until the DEA does.” There are standard local business licenses and liability insurance.

There is no specific zoning for OTPs in Georgia. Talbott was fortunate to find a building that was previously a doctor’s office — a freestanding building that is zoned medical. “The other good thing about Georgia is that you don’t have to go through any public hearings or putting it in the paper, like in Tennessee, and getting the community all stirred up,” he said.

Talbott introduced himself to the citizens of Chatsworth, explaining that “we’re an opioid treatment program, we’re mostly going to be doing counseling, and most patients will need some kind of medication,” he said. “People hear ‘methadone clinic’ and they immediately have connotations that are not accurate, so I give the complete truth but don’t use words that shut down their mind,” he said. The OTP will have methadone liquid and diskets, and buprenorphine, from day one, and in the future might also have Vivitrol on an as-needed basis, he said.

Talbott credited Mark Parrino, president of AATOD, for giving him advice throughout the process. “Despite my experience in the field, I’m far from knowing it all,” he said.

“I think Zac is the ideal patient to own a clinic,” said Walter Ginter, project director of M.A.R.S. (Medication-Assisted Recovery Support) in New York City. “He is bright, well-educated and a great advocate.” Ginter’s only concern for Talbott is that now that he is a provider himself, his long-established relationships with other providers can “suddenly turn cold.” Ginter calls this “an interesting kind of stigma, but Zac can handle it.”

As for the treatment Talbott received at the clinic where he was formerly a patient, Ginter, who had known about Talbott’s plans for a long time, said he had advised against going public until the clinic was actually open, for this exact reason. “It really isn’t uncommon for clinic owners to think that patients shouldn’t run treatment even if the clinic owner inherited the clinic and their prior experience was working in a pizza parlor,” he said.

The Georgia Department of Community Health, then the Board of Pharmacy, and then the DEA must come to inspect before the program can open, but “we’re in the home stretch,” said Talbott.

For the OTP’s website, go to www.counselingsolutions.clinic/resources.html.