Tri-Cities Holdings, an opioid treatment program (OTP) that has been trying to get a certificate of need in Johnson City, Tennessee, is waiting to hear from the federal Department of Justice (DOJ) about an appeal it filed based on civil rights violations. Represented by attorney James A. Dunlap Jr. from Atlanta, Georgia, the OTP would serve the 500 to 1,000 people who live near Johnson City but have to drive more than 100 miles across the border to North Carolina to obtain their medication.

The complaint is asking the federal Department of Justice to intervene in the case of Tri-Cities Holdings and eight patients, who have the disability of opioid addiction. The OTP says that the certificate of need process instituted by the state and the ordinances imposed by the city violate the Americans with Disabilities Act (ADA).

Lisa Taylor, an attorney with the DOJ Civil Rights Division in Washington, has been investigating the case, which began in June 2013. The violations, according to Dunlap, have gone on for more than a decade, resulting in lost lives.

An OTP in Johnson City would be the only clinic within 50 miles in any direction. However, Johnson City and the state Health Services and Development Agency (HSDA), which issues certificates of need, have made it difficult to site the clinic. Since 2003, Johnson City has used a zoning ordinance to block the OTP, according to Dunlap.

High need

Ironically, Johnson City and the surrounding area have many people with opioid addiction who need treatment. Currently, they drive — often over dangerous mountain roads in the early-morning dark so they can get to work on time — across the border.

“It’s unconscionable that a state would have in place a certificate of need process that would force a pregnant opioid-dependent woman to drive one to two hours each way every day to receive what is known and accepted as the standard of care for her medical condition,” said Zac Talbott, the director of the Tennessee Statewide and Northwestern Georgia chapter of the National Alliance for Medication Assisted Recovery (NAMA Recovery). “The certificate of need process in Tennessee blatantly discriminates against opioid-dependent individuals, as no other substance use disorder treatment other than opioid treatment programs is subjected to the certificate of need process in Tennessee.”

Talbott told ADAW that he hopes the DOJ will rule, as a result of their investigation, that the certificate of need process in Tennessee and the Johnson City ordinances violate the ADA. “The current certificate of need process in the state of Tennessee is, quite literally, killing people,” he said. “This process has resulted in the blocking of numerous opioid treatment programs from opening over the years.”

“NAMA Recovery of Tennessee will continue to advocate for opioid-dependent individuals — both those in treatment and those who are still unable to access the gold standard treatment due to the state’s discrimination — until quality opioid agonist therapy is available on demand for every person who needs it,” Talbott said.

Criticism from NC provider

And Jana Burson, M.D., a North Carolina internist who treats opioid addiction with buprenorphine and also works in an OTP, said medication-assisted treatment of opioid addiction with methadone “is one of the most evidence-based treatments in all of medicine, yet government officials in Tennessee have repeatedly interfered with the delivery of this essential treatment to its citizens.”

Noting that Tennessee has a high rate of overdose deaths, Burson said, “You’d think they would welcome help to treat opioid-addicted citizens instead of thwarting efforts to establish an opioid treatment program.”

Johnson City and other towns of Eastern Tennessee rewrote their zoning laws in an effort to prevent methadone clinics from being established, said Burson. Even though Johnson City’s attorney said there was no intentional discrimination against drug addicts, “history speaks for itself,” said Burson. “Multiple facilities have tried and failed to get permission for a methadone clinic in that town over the last ten years,” she said. Future generations will likely judge state and local officials harshly for preventing the treatment of opioid addiction with methadone, since this treatment has been proven to save lives, she said.

Word was expected from the Justice Department on the results of its investigations shortly.

Bottom Line…

The state of Tennessee and a city are charged with violating the civil rights of patients in opioid treatment with methadone.