Somerset — Floyd County native Terry Scott knows the culture of Eastern Kentucky.

That’s why when the uproar began about Somerset Addiction Solutions, LLC — an opiate addiction treatment clinic slated to locate to the community in the near future — he wasn’t truly surprised.

“You always have to prove yourself with each community,” Scott said.

But Scott’s work is cut out for him in this instance. The community has been in a fervor about the proposed clinic, which will treat those people addicted to opiates with the dispensing of drugs such as Suboxone and methadone. Many local officials, including Somerset City Council, have cried foul against Scott, claiming things would’ve been much more different had Scott approached local officials with his plans long before the applications were filed and the inspections were carried out at 3450 S. U.S. 27 — the future location of the clinic, as confirmed by property owner Kenneth Ford.

“Do people who open pain management clinics have to notify the local officials?” Scott asked. “No.”

The idea of a Suboxone and methadone clinic no doubt brings to mind images of drug-addled patients looking for a quick, cheaper fix than those they’ve become addicted to over the years.

But those images, Scott said, are largely incorrect.

“All we’re trying to do is help people,” Scott said.

Scott operates three small opiate addiction clinics in Pikeville, Elizabethtown and Paintsville. And he expects the clinic in Somerset to operate much in the same way as those clinics. Scott said he will cap patients treated by methadone at 150 and Suboxone patients at around 80.

Methadone is a narcotic pain reliever, similar to morphine. It also reduces withdrawal symptoms in people addicted to heroin or other narcotic drugs without causing the "high" associated with the drug addiction.

According to information gleaned from the Office of National Drug Control Policy, methadone treatment, when performed under the watchful eye of a doctor, is approved by the Office of National Drug Control Policy — but many worry about the effects should the treatment not be carried out according to state guidelines.

Methadone can react dangerously with other drugs and alcohol, and there are worries about the drugs demand on the streets.

Information from the Office of National Drug Control policy also reveals that Suboxone — a relatively new drug used to treat opiate dependence — contains a combination of buprenorphine and naloxone. Buprenorphine is an opioid medication. Buprenorphine is similar to other opioids such as morphine, codeine, and heroin however, it produces fewer euphoric effects and therefore may be easier to stop taking.

Naloxone blocks the effects of opioids such as morphine, codeine, and heroin. If Suboxone is injected, naloxone will block the effects of buprenorphine and lead to withdrawal symptoms in a person with an opioid addiction. When administered under the tongue as directed, naloxone will not affect the actions of buprenorphine.

Scott said his clinics operate under a strict set of guidelines set out by the state and federal governments — and he said he ensures that each of his clinics go beyond those requirements to ensure the safety of patients and the community.

“Everybody has to prove themselves to the clinic that they can be in treatment,” Scott said.

Every new patient who enters the clinic must be tested for drugs and alcohol through urine or swab tests — and that is after the patient passes the initial phone screening to determine whether he or she would be a good candidate for opiate addiction treatment.

Methamphetamine addicts and cocaine addicts are ineligible for the treatment, because methadone and Suboxone do not react with receptors in the brain affected by those drugs, Scott said.

And yes, heroin addicts are eligible for the programs, but Scott said after several years operating clinics in Pikeville and Paintsville, he’s seen fewer than 30 heroin addicts in all.

“It’s not going to be no heroin hub,” Scott said about the Somerset clinic.

The majority of patients, he said, are those people addicted to painkillers prescribed by physicians.

Morphine, heroin and certain prescription painkillers — Vicodin, Oxycontin and Fentanyl — act on specific (opiate) receptors in the brain, which also interact with naturally produced substances known as endorphins or enkephalins, which are important in regulating pain and emotion.

And while prescription painkillers are highly beneficial medications when used as prescribed, opiates as a general class of drugs have significant abuse liability, according to information provided by the National Institute of Health.

Should an eligible patient be found to be under the influence of a drug besides that of an opiate, they’re given the opportunity to get sober within 60 days before treatment begins.

After the initial drug test, application process and interview, a doctor determines whether a possible patient can undergo the treatment program. If a person requires more than 140 milligrams of methadone per day, Scott said they’re not eligible for the clinic’s program.

“We refer them out,” he said. “They’re no longer in our program.”

According to the National Institute of Health, methadone works the best if it’s taken daily.

Just how much medication a patient receives depends on the severity of their addiction and the nature of the drug he or she is addicted to.

And those programs — Suboxone and methadone both — are carried out under the supervision of either a certified psychiatrist or an addictionologist. And patients are frequently drug tested to ensure they’re continuing the program sober.

“Every time you come through that door, I’m going to drug test you,” Scott said.

Along with urine and mouth swab tests, Scott said his clinics utilize breathalyzer tests as well, and he emphasized his employees undergo training with local police departments to ensure those tests are carried out correctly. If those tests aren’t carried out, Scott said the safety of those program patients are compromised.

Scott said a patient only qualifies for methadone treatment if they’ve been addicted to a substance for more than a year, and if they’ve developed a strong tolerance to that drug. Patients qualify for Suboxone treatment if they’ve been addicted to a drug for less than a year.

“Methadone is usually the last hope for the addict,” Scott said.

Critics of the clinics have said many of those addicted to opiates — which include morphine, Oxycontin, Vicodin and Fentanyl — will never see themselves off methadone should they begin the program.

Scott said that may be true, but he said methadone treatment, when carried out correctly, can help an addict achieve a life they may not have before.

“Wouldn’t you rather somebody function in society, pay their taxes, have a family ... or would you rather they be off methadone and in jail?” Scott asked.

Scott likened some patients’ life-long need for a maintenance drug to that of people with chronic diseases.

“Do we frown on them (for needing long-term medication)?” Scott asked. “No.”

Of course, many people don’t compare addicts to those with chronic diseases such as diabetes, heart disease and cancer, but addiction is classified as a disease by some government entities, including the National Institute on Drug Abuse. Others, such as the Centers for Disease Control, do not classify addiction as such.

But the success stories aren’t as common as Scott would like them to be. Still, he said many drug addicts aren’t searching for a cheaper way to get a fix — especially since methadone and Suboxone alleviate symptoms of withdrawal without the feeling of getting high — but they’re searching for a way to prevent the severe physical and mental withdrawal symptoms that come with quitting many opiates.

“It ain’t about getting high,” Scott said. “It’s about keeping from getting sick.”

Critics also point out that methadone will surely make its way into the streets of the community through “carry-outs” — take home doses for patients. That’s a true assessment, but only when it comes to other states’ guidelines.

Kentucky is considered to be one of the most strict states for regulating opiate treatment clinics. While clinics located in other states may not be so restricted to treatment guidelines, those clinics in Kentucky are subject to some of the most strict requirements in the U.S.

Scott said his clinics’ patients are only given carry-out doses if they’ve proven to have been sober for at least 60 days. Once that hurdle is passed, the patient is given the medication in liquid form — and only in small doses, making it nearly impossible to sell the drug illicitly on the street.

Among the regulations Kentucky has imposed:

• Clients may take home methadone doses but only after a long phase-in system where the client proves himself or herself trustworthy and dedicated to remaining clean.

• At no time can a client take home more than three doses. That amount can be increased if the client gets written permission from the state.

• Clients must work with counselors to develop life goals, such as getting a job, passing all drug tests and improving quality of life at home to stay in the methadone program.

Still, no matter the nature of the clinic, and it’s possible success rates, community members are concerned. That’s why a forum has been scheduled for Oct. 27 at 7 p.m. at the Pulaski County Courthouse. Scott doesn’t plan on attending, but he said his business partner and psychiatrist Lore Nation may attend.

Scott noted he believes in what he’s doing, and he said one can’t truly know about the affects of addiction unless they’ve lived it, or unless they’re watched a family member struggle with it.

“It’s not just your poor people,” Scott said. “It’s your rich people, it’s your middle (class) people, it’s black, it’s white, it’s green.”