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The Planning Commission on Thursday will discuss newly proposed amendments to Louisville’s regulations on medical clinics, nearly a year after Metro Council directed the staff of Planning and Design Services to draft such rules that may limit where new methadone clinics can be located.

Counter to the suggestions of one council member, the draft regulations do not specifically limit methadone clinics to certain areas, in order to ensure compliance with the Americans with Disabilities Act. However, the draft regulation does single out any clinic treating drug addiction as being subject to its new requirements, which include providing sufficient parking and waiting areas for patients in order to — as the staff summary states — prevent outdoor loitering and “the influx of clients that would (be) disruptive or unsafe to the surrounding community.”

The Metro Council ordinance passed last November was sponsored by Councilman Brent Ackerson, D-26, shortly after he successfully led the effort to block a private methadone clinic from opening in a strip mall in his district, which neighbors strongly opposed. Though methadone has long been recognized by experts in the field as an effective form of medication-assisted treatment (MAT) for heroin addiction — which is now reaching epidemic levels in Louisville — Ackerson said the for-profit company proposing the clinic was simply a “cash cow, money maker.”

Councilman Brent Ackerson, D-26

Councilman Brent Ackerson, D-26

When pushing for the ordinance last year, Ackerson said the city should limit new methadone clinics to areas zoned for industrial use or near hospitals, far from residential or business areas that might be negatively impacted by the clinic. This August — when noting the long delay of these new regulations being drafted and a company filing a permit for a new methadone clinic downtown — Ackerson floated the idea of passing a citywide moratorium on new methadone clinics until those regulations were drafted.

A staff report for the new amendments to be considered by the Planning Commission note that methadone clinics may continue to be permitted with a Conditional Use Permit in any zoning district, just as any other medical clinic. While staff considered regulating methadone clinics specifically — or more broadly along with other types of drug treatment clinics — they concluded that specifically targeting such clinics with zoning regulations may violate the Americans with Disabilities Act, as persons seeking treatment for addiction to controlled substances are protected under the federal law and may not be discriminated against.

While the proposed amendments to regulations on medical clinics do not specifically mention methadone clinics, they do add requirements on parking spaces and waiting areas that appear to address common concerns about methadone clinics, which typically see a large amount of patients in the morning who are there to take receive their daily dosage of the medication. Medical clinics now must provide an indoor waiting area that is large enough to accommodate all clients arriving for services, as well as an adequate number of parking spaces to accommodate the maximum number of clients expected to be there at one time. Perhaps paradoxically to the latter provision, such medical clinics now must also be located “on or near a collector or arterial street with reasonable access to public transportation.”

The summary of the staff report explained that the waiting area amendment was included “to address outdoor loitering,” while the additional parking requirement also suggested “specific appointment schedules to prevent the influx of clients that would (be) disruptive or unsafe to the surrounding community.”

Dr. Kelly Clark — an addiction medicine physician in Kentucky and the newly elected president of the American Society of Addiction Medicine — told IL over email that she has concerns about how “medical clinic” is defined in the draft regulation, which still “looks like an ADA lawsuit waiting to happen.”

Clark noted this definition specifically includes a facility primarily treating substance abuse, though it states such treatment requires “observation and recovery normally lasting 1-5 hours,” which is “not consistent with a methadone clinic performing its normal services.”

“Calling it a ‘medical clinic’ does not negate the fact that this is trying to regulate substance abuse facilities — consistent with the ‘looks like a duck, quacks like a duck’ test,” said Clark.

Clark also questioned whether the new regulations would affect a medical office of a physician who is board certified in addiction medicine and treats substance abuse without methadone, perhaps instead using MAT with medication such as Vivitrol or Suboxone.

“If the point is to regulate (opioid treatment programs), call them that and let the chips fall,” said Clark. “But as a board certified addictionist, would my private practice fall under this? How about an office of addictionists not requiring direct observation for 1-5 hours?”

Councilman Ackerson did not respond to IL’s request for comment on the draft regulation. The Planning Commission will taken up the regulation at its meeting Thursday at 1 p.m. in the Old Jail Auditorium, and if approved it would be sent to Metro Council for final passage into law.