A Merger in the Hudson Valley, and the 150 People Still Driving to Albany for Methadone
Two Hudson Valley addiction providers completed a five-year merger on Sept. 8. The methadone clinic Columbia County still lacks is the part that matters.
Keith Stack had been running treatment in two places at once for most of five years before anyone wrote it down as a single organization. He split his weeks between Albany, Hudson and Catskill, and at some point the arrangement stopped feeling like a partnership to him. "It just became very natural," he said this week. "It just started meshing together."
The paperwork caught up on Sept. 8, when Twin County Recovery Services formally merged into the Addictions Care Center of Albany. The public announcement came Monday at ACCA's headquarters on McCarty Avenue, with state and local officials in the room and a phrase the two boards have adopted as a slogan: stronger together.
Mergers of nonprofit treatment providers are usually administrative events, and this one is being described that way. Patients keep their clinicians. No program closes. The name on the door in Hudson and Catskill changes to one that has existed since 1967.
What the merger does not do is put methadone in Columbia County. The people who run it say that is the next item on the list, and the number attached to it is about 150.
What Was Actually Signed
Twin County Recovery Services lost its chief executive in 2021, at a moment when every provider in the region was short-staffed and demand for addiction care was climbing through the pandemic. The boards of both organizations met that November. By January, a management services agreement was in place that put ACCA's leadership in charge of operations in Columbia and Greene counties while Twin County kept its own board and its own name.
That structure held for two years before anyone proposed making it permanent. ACCA's board chair, Paul Ehman, and Twin County's, Maggie Graham, signed off on a merger that took effect in September. Graham now sits on the merged board and has been careful to describe continuity rather than change. "Our mission continues," she said. "Our commitment to the people we serve is strong as ever and the programs and services our communities depend on will continue uninterrupted."
The merged entity keeps the Addictions Care Center name and plans a broader rebrand in 2027, timed to its 60th year. It is regulated and licensed program by program through the state Office of Addiction Services and Supports, the same oversight that applied to both organizations separately.
A Network That Now Runs Six Counties
By ACCA's own count, more than 1,100 people received treatment last year across 16 locations in Albany, Rensselaer, Warren, Washington, Columbia and Greene counties. The Family Support Navigator program reached about 350 families in 2025 and addiction education reached roughly 5,500 children. Stack wants the navigator piece extended into the river counties, which it never formally covered.
The geography matters more than the headcount suggests. A county like Greene has no hospital of its own and no inpatient addiction beds. Columbia has a hospital but, as Stack describes it, nothing residential for people who need to stay somewhere while they stabilize. Both counties have depended on Albany, thirty-odd miles north, for anything beyond outpatient counseling.
The Beds in Greenport
Construction on a residential facility for men in the town of Greenport is nearly finished and expected to open in February. That would give Columbia County inpatient capacity for the first time, though not a large amount of it. Conversations about a parallel program for women and children are underway, which is harder and more expensive: it requires space for kids, childcare arrangements and a different staffing model than a men's house.
ACCA's outpatient mix in the two counties is also not purely opioid work. Stack said many of his patients are dealing with opioid use disorder, but cocaine and methamphetamine use are rising in the region and alcohol "is still a real challenge."
The Clinic Columbia County Does Not Have
Methadone is dispensed only through federally certified opioid treatment programs, and Columbia County does not have one. Residents who need it travel to Albany, or south into Dutchess and Ulster counties. Stack puts the number at around 150 people making that trip, and talks are underway with Lexington Recovery Center to open a dosing site at ACCA's Hudson location on Power Avenue.
Methadone is not interchangeable with buprenorphine, which any waivered prescriber can order and which most of the region's outpatient clinics already offer. It is the medication that holds some patients with heavy fentanyl tolerance when others do not, and the federal rules around it are stricter precisely because it is a full agonist with a narrow margin.
Both of those facts push toward a facility rather than a prescription pad. That is what makes the county-level gap durable: adding a service line is a licensing question, not a staffing decision, and it can take years.
What a Round Trip Actually Costs
The case for putting a dosing site in Hudson rests on travel arithmetic, and there is recent research on what that arithmetic looks like for patients. A mixed-methods study published in JAMA Network Open this fall surveyed 98 patients at a large multisite opioid treatment program in Washington state and interviewed 16 of them.
The mean round trip for a dosing visit was 82.5 minutes, with a range stretching to 330 minutes — five and a half hours. Travel-related costs ran $15.80 per visit on average and as high as $200. Only 55.1 percent drove themselves; the rest depended on a partner, public transit or insurer-arranged medical transport that sometimes did not arrive. Nearly one in five reported a disability that made the trip harder.
Beyond Distance
What the interviews added is that distance alone understates the problem. Patients described dosing visits colliding with work shifts, medical appointments and childcare in ways that forced them to choose, and a waiting room that can run late turns a 40-minute errand into a lost half-day. Missing a visit does not merely inconvenience someone. It risks a return to use.
Prior research cited in the same paper puts the ordinary drive to an opioid treatment program at 37 to 45 minutes, against 15 minutes to the nearest primary care clinic — and estimates that 26 percent of patients cannot reach a methadone clinic within 180 minutes of travel time. Columbia County's 150 are not outliers in the national data. They are the shape of it.
The Cheaper Path Federal Rules Already Allow
The reflex when a county lacks a clinic is to budget for a building. Federal regulation now offers something less expensive, and the language is specific.
Under 42 CFR § 8.11, a certified opioid treatment program may establish medication units authorized to dispense medication for opioid use disorder. Those units can be mobile or brick-and-mortar, and they can deliver any service the parent program provides, as long as the program notifies the federal government on form SMA-162 and complies with state law. A dosing site in Hudson attached to an existing certified program is, structurally, exactly what that rule describes.
The same part of the code has loosened the daily-visit assumption that made rural methadone impractical in the first place. Under § 8.12, take-home doses are limited to seven days during the first 14 days of treatment, extend to 14 days from day 15, and reach 28 days from day 31 — all at the practitioner's discretion, documented in the clinical record. Doses for days the clinic is closed, including one weekend day and holidays, are available regardless of how long a patient has been in treatment.
None of that removes the need for a place in Hudson to dispense. It does mean a patient in Catskill who stabilizes does not have to appear in person every morning for the rest of their life, which is the detail that decides whether a job and a treatment schedule can coexist.
135 Deaths, and a Declining Statewide Curve
The overdose toll in the two river counties between 2021 and 2025 was 135 people, according to OASAS data cited by the Gazette. Over the same years, Albany County recorded 419 deaths and neighboring Rensselaer 237.
| County | Overdose deaths, 2021–2025 |
|---|---|
| Albany | 419 |
| Rensselaer | 237 |
| Columbia and Greene (combined) | 135 |
Those figures sit inside a statewide curve that has been moving in a better direction. OASAS reported on Oct. 19 that provisional data show overdose deaths in New York falling for a third consecutive year. The decline is real, and it is also uneven. A county that loses 135 residents over five years to a condition for which an effective medication exists, and where the medication requires a drive to another county, has a problem that a falling statewide line does not solve.
This is the part of the merger that the ceremony did not emphasize. Consolidating two providers improves the balance sheet and the management depth; it does not by itself create a dosing site, and the counties that gained the most from the agreement are the ones with the least infrastructure to absorb new services.
What to Watch Between Now and February
Three things are concrete enough to track. The Greenport men's residential program is scheduled to open in February, which will be the first test of whether the merged organization can stand up a new site on the timeline its leadership has described. The Power Avenue conversations with Lexington Recovery Center are the only active path to a Columbia County dosing site, and they have not produced a date. And the navigator program's expansion into Columbia and Greene is the piece that requires no license at all, only staff.
For families in the two counties right now, the practical picture has a few fixed points. The state's HOPEline runs at 1-877-846-7369, around the clock, and OASAS publishes licensed program listings by county at oasas.ny.gov. Anyone already receiving care through Twin County should expect the same clinician and the same schedule under a different letterhead.
Stack's summary of what the merger changes for patients was a single sentence, and it was about scale rather than geography. "I think that's what people can expect: new services, stronger services. We want to do more." Whether "more" includes a methadone clinic in Hudson is the question the next twelve months will answer.
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.
