Saranac Lake Opens Franklin County's First Methadone Clinic
St. Joseph's opened Franklin County's first methadone clinic in Saranac Lake in August, ending a daily drive of more than an hour for Tri-Lakes patients.
SARANAC LAKE — The clinic opens at six in the morning, which is the point. A person who needs methadone has to take it every day, and until August the nearest place to get it was in Plattsburgh or Canton, each more than an hour away from this village of about 5,000 in the Adirondacks.
St. Joseph's Addiction Treatment and Recovery Centers quietly opened an Outpatient Opioid Treatment Program at the Robert R. Reiss Community Services Center on John Munn Road over the summer. It is the first and only location in Franklin County that dispenses methadone, a fact that has less to do with construction than with the federal and state apparatus required to hand someone a cup of medication under supervision.
"The bottom line is methadone saves lives," said Jennifer DiTullio, the network's chief operations officer, in an interview with the Adirondack Daily Enterprise. "Too often the barrier to recovery isn't willingness to get help, it's whether help is close enough to reach."
A Daily Drive That Ran Past an Hour
Methadone for opioid use disorder is not a prescription a pharmacy fills. It is dispensed by federally certified opioid treatment programs, and for decades the model has been built around showing up in person, early, most days, at a licensed clinic with a locked safe and a dosing window.
That works in a city. In the Tri-Lakes, it meant a round trip of two to three hours before work, in weather that in January can close mountain roads. Kati Jock, a senior vice president at St. Joe's, has watched patients make that drive for years and described what it costs them: jobs they cannot hold, children they cannot get to school, classes they miss. "Especially in snow," she said.
The arithmetic is unforgiving for a medication that only works if it is taken daily. Miss a dose and withdrawal begins within a day or two. Miss several and the body's tolerance drops, which is when a return to the same amount of fentanyl becomes lethal. Clinics call the resulting scramble "guest dosing" — arranging for another program to dose a visiting patient — and it exists precisely because daily attendance is the rule.
What Opened on John Munn Road
The Saranac Lake program sits inside a building that already houses counseling rooms, a telehealth laptop, adolescent and family services and medication management for alcohol use disorder, including acamprosate, disulfiram and naltrexone. That co-location was deliberate. Walking into a building with a methadone window on the ground floor is a different act, socially, than walking into a clinic whose only business is methadone.
"It removes the stigma of someone going to a methadone clinic," DiTullio said.
The building has an exam room with an EKG machine, because methadone can affect heart rhythm and physical health has to be tracked during treatment. There are blood draws and physicals and primary care on site.
Inside the Dosing Room
The waiting room holds overdose reversal kits, fentanyl and xylazine test strips, first-aid supplies, hand sanitizer, condoms and resource pamphlets. Staff restock them constantly. "This stuff goes quickly," said Emily Gokey, the network's behavioral health director, adding that patients taking the supplies is the intended outcome, not a loss.
Dosing happens at a window that looks like a bank teller's. Beside it sits a water cooler and a bowl of flavored LifeSavers, because cherry-flavored methadone is still bitter enough that patients reach for something afterward.
The clinic dispenses for close to 20 people a day on average. It is open Monday through Friday from 6 a.m. to 4:30 p.m., Saturday from 7 to 9 a.m., and closed Sunday — patients leave Saturday with a take-home dose. Nurses have stayed late for someone who called to say they were running behind.
Security is not decorative. Federal rules for opioid treatment programs require controlled storage and accountability for a drug that is itself an opioid, so the building has badge- and code-secured doors, alarms, a safe bolted to the floor, dispensing machines, mirrors and cameras. Renovation and equipment came to $600,000, paid with grants from the New York State Opioid Settlement Fund.
Why Methadone Does Something Buprenorphine Cannot
St. Joe's also prescribes Suboxone, and Gokey is careful not to sell one medication over the other. Plenty of patients do better with buprenorphine: it is a take-home prescription, easier to fit around a job, and some people prefer not to be watched while they take it. Others have a history of running out early or taking more than prescribed and want the structure of a supervised dose.
But there is a pharmacological difference that matters more now than it did a decade ago. Buprenorphine is a partial agonist, which means its effect plateaus. Past a certain dose, more does not buy more relief. Methadone is a full agonist with no such ceiling, and clinicians increasingly reach for it when the drug supply is dominated by fentanyl and xylazine, where patients arrive with tolerance that buprenorphine struggles to cover.
Jock said synthetic opioids have made cases more complex, and that methadone is often the most effective option for them. The mortality figures St. Joe's cites are stark: a 59 percent reduction in opioid overdose deaths among patients receiving methadone, and 38 percent among those receiving buprenorphine.
| Methadone at this clinic | Buprenorphine (Suboxone) | |
|---|---|---|
| How it is dispensed | Supervised daily dose at the clinic window | Prescription, taken at home |
| Dose ceiling | None; titrated to craving and withdrawal | Partial agonist; effect plateaus |
| Take-home supply | Limited by federal schedule, clinician discretion | Not restricted the same way |
| Best fit | High tolerance, fentanyl or xylazine exposure, patients who want monitoring | Patients with stable housing and routines, or a preference for privacy |
More than 4,500 New Yorkers died of overdoses in 2024, a figure St. Joe's officials cite when explaining why they built the program. Federal provisional counts now show overdose deaths falling nationally, but a declining curve still leaves a county of about 50,000 people with a rate that public health officials describe as unacceptable.
The Federal Rules Changed in 2024
For most of methadone's history in the United States, take-home doses were rationed by a stopwatch. Patients earned them only after months of clean drug tests, and the schedule was written into regulation. That changed when the federal government rewrote 42 CFR Part 8, publishing the rule in February 2024 with an effective date that April.
The rewrite moved decisions about unsupervised doses to the treatment program's medical director, who weighs stability, living situation, and whether a patient can store the medication safely, rather than to a fixed calendar. What remains is a floor and a ceiling. Any patient can get doses for days the clinic is closed, including one weekend day and holidays, regardless of how long they have been in treatment. In the first 14 days, a take-home supply beyond that is capped at seven days. From day 15, it is capped at 14.
For a rural program, those numbers are the difference between a workable life and an impossible one. A patient who stabilizes can eventually pick up two weeks of medication at a time instead of driving an hour each way every morning.
What the Rule Still Requires
The flexibilities did not deregulate methadone, they moved judgment closer to the patient. The regulation still requires that the reasoning behind each take-home decision be documented in the clinical record, and the program still has to be certified by the federal government and accredited. Patients still have to be seen, tested at least eight times a year at random, and assessed for whether they can store the medication safely at home.
Guest Dosing and the Inpatient Gap
St. Joe's runs an inpatient campus across town, and until this summer a patient admitted there who was already on methadone faced a bureaucratic detour. The program would have to arrange guest dosing with an outside clinic, coordinating between the original prescriber and a local one, transferring records, and hoping the timing worked.
"It's difficult to get someone set up for guest dosing," DiTullio said. Sometimes the arrangement fell apart and the patient simply did not enter treatment, because entering would mean missing days of medication. Now the clinic doses its own inpatients in-house, and admissions move faster.
DiTullio put the stakes plainly: a few days is enough time for someone to change their mind about getting sober. Walking through the door of a treatment program already takes courage, Jock said, and the job of the nurses on the other side is to meet that with compassion rather than paperwork.
The program also serves St. Joe's outpatient clinics in Malone, Ticonderoga and Keeseville. The organization is part of the Daxia Integrated Health Network along with Citizen Advocates, which operates across northern New York, a region where behavioral health providers have consolidated partly because recruiting clinicians to small towns is difficult. The Saranac Lake clinic is hiring nurses and looking for another counselor.
Who Pays for the Dose
Methadone treatment is inexpensive compared with residential care and expensive compared with nothing, and the population that needs it is disproportionately likely to be uninsured or underinsured. The program accepts most major insurance plans, offers a sliding fee scale, and provides enrollment assistance for low- or no-cost coverage. A St. Joe's news release states the policy in one line: no one is turned away.
The $600,000 that built out the space came from New York's Opioid Settlement Fund, the pool created from the state's litigation against opioid manufacturers and distributors. The fund is administered by the state Office of Addiction Services and Supports, which awards money to providers for prevention, treatment, recovery and harm reduction. Using settlement dollars for the physical infrastructure of an opioid treatment program is a fairly literal application of the theory behind the settlements: money from the companies that manufactured the crisis paying for the clinical capacity to treat it.
It is also a reminder of how thin that capacity was. One county needed a grant, a renovated building, a bolted-down safe, federal certification and a staff of nurses before a patient in Saranac Lake could stop driving to Plattsburgh.
One Clinic, One County
Twenty patients a day is a start, not a solution. Franklin County has roughly 50,000 residents, and the clinic's capacity will grow as referrals arrive from Malone, Ticonderoga, Keeseville and the surrounding towns. Whether it grows fast enough depends on staffing, and rural behavioral health hiring is its own chronic problem.
What the clinic changes immediately is the shape of the decision. Someone in Saranac Lake who wakes up sick can be dosed before 7 a.m. and be at work by eight. Someone leaving the inpatient campus does not have to wait for a bed in Plattsburgh. Someone who has been managing a habit on the street has a building on John Munn Road where the door is open five and a half days a week and nobody asks how they got there.
Gokey's version of the argument is shorter than any policy paper. "Being able to access treatment shouldn't be the barrier," she said.
For information about the program, St. Joe's asks people to call 518-891-5353 or visit stjoestreatment.org. The clinic is at 50 John Munn Road in Saranac Lake.
Written by
MTNYC Editorial TeamThe MTNYC Editorial Team is a group of healthcare writers, researchers, and addiction specialists dedicated to providing accurate, compassionate, and evidence-based information about addiction treatment and recovery resources in New York State.
