An Arizona-based chain of opioid treatment centers hopes to open a regional clinic in Grand Forks.

Community Medical Services plans to open its 49th clinic later this fall in the Turning Point Health and Wellness building on 32nd Avenue. The for-profit company’s clinics aim to help people kick opioid addictions in part by administering relatively low doses of methadone, a synthetic opioid that can satisfy the same physical cravings as heroin or pain pills but, when used properly, doesn’t get the user high.

“We believe there is a sufficient need in that community,” Mark Schaefer, the company’s Minot-based vice president of northern territories, said of Grand Forks.

Company staff estimate they would ultimately treat about 300 Grand Forks-area residents at any given time at the hoped-for clinic, a number that sits about midway between the not-quite 300 they treat at their clinic in Minot and the 400 or so they treat at another clinic they operate in Fargo. About 86% of Minot patients are still visiting the clinic there after 90 days, Schaefer reported, and about 85% of patients at the Fargo clinic do the same.

The clinic that company administrators hope to open in Grand Forks would, in the same vein as the other two, be a “home base” that can offer addiction counselors, intake services, and more. Having an office here would make things logistically simpler for people who are taking methadone to treat their opioid addiction, according to Schaefer.

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“When people first start treatment, they’re coming in on a daily basis,” he told the Herald. “So distance is always an issue and can be a barrier.”

One of the company’s patients lives in Grand Forks but used to commute to Minot every day to get a methadone dose, Schaefer said. The drive lasts at least three hours. When the company opened its Fargo clinic, the patient went there instead.

Grand Forks Public Health staff suggested the 32nd Avenue location because it’s on the southern end of one of the city’s more densely populated areas, because it's next to a city bus stop, and, of course, because it had space available, according to Michael Dulitz, the health department’s opioid response coordinator.

Opioid overdoses in Grand Forks spiked dramatically earlier this month. Grand Forks police responded to four overdoses the weekend of Sept. 12, all of which police believe were caused by heroin and counterfeit pharmaceuticals.

'The best one is the one that works'

Methadone “saturates” the opioid receptors in a person’s brain, which can ward off withdrawal and control cravings, according to Dulitz. Providers try to tailor the dose in a way that generally doesn’t get a patient high.

“You’re just taking enough where you feel normal,” Dulitz said. “The brain isn’t calling for more.”

From there, Schaefer said, patients can work to find a job, secure housing, reconnect with family members, head to treatment, and so on. The general plan is to then gradually taper doses to zero, but some patients stay on the drug for years or the rest of their lives.

Methadone is one of three drugs commonly used to wean a user off of opioids.

The second, Buprenorphine, partially activates those opioid receptors, which can lessen withdrawals and cravings, but often not to the same extent that methadone can. It also has a “ceiling effect,” which means larger doses don’t produce greater relief after a certain point.

And the third, Naltrexone, is similar to narcan, the common “antidote” to opioid overdoses, and it completely blocks those same opioid receptors, which means those drugs have little to no effect. But it also blunts the effect of chemicals naturally produced by the body -- endorphins, for instance -- and that can lead to depressive episodes and other problems.

“The best one is the one that works,” Dulitz said. “And that’s why we’re trying to make those options all available.”

The latter two medications aren’t regulated as tightly, which means they’re more commonly used to treat opioid addictions. Grand Forks currently does not have a clinic that offers methadone.

Data collected by city police and presented Monday to Grand Forks City Council members indicate there have been 38 suspected opioid overdoses in Grand Forks so far in 2021. That’s the highest figure recorded in the past five years.

A federal survey indicates that, between 2017 and 2019, 0.26% of North Dakotans used heroin and 3.3% of them misused prescription pain medication. Applying those figures to Grand Forks itself leads staff at North Dakota Behavioral Health to estimate that as many as 1,988 people here have abused opioids relatively recently, according to James Knopik, the state’s opioid treatment authority who manages its addiction and prevention programming and policy.

Government subsidy

The clinic, or at least efforts to set it up, is in line for as much as $100,000 from the federal government via the state and city.

North Dakota typically receives about $6.5 million each year from the federal government for Substance Abuse Prevention and Treatment Block Grants, which are similar to the Community Development Block Grants administered by Grand Forks City Hall staff every year.

The federal Coronavirus Aid, Relief, and Economic Security Act -- commonly called the “CARES” act -- apportioned to the state a further $6.1 million over the next two years, effectively ramping up the budget for its substance abuse grant program by 50% through 2023.

Of that supplement, state administrators have set aside $250,000 to expand medication-assisted opioid treatment, and $100,000 is set to head to Grand Forks and Community Medical Services this year in some form or fashion.

That means, Knopik said, that it could go toward a community relations plan for the clinic, a “diversion control” plan that would spell out how clinic staff would try to keep patients from handing out their meds to others, or a certificate that would establish for federal regulators the need for the clinic in the first place, among other options.

The remaining $150,000 of the money for treatment expansion could go toward similar efforts in the western part of North Dakota.

“The areas that we know with the highest need are Dickinson, Williston, Grand Forks,” Knopik said. State administrators have had meetings with representatives from those westerly cities, but “Grand Forks is the only one where there’s any action.”