First Methadone Clinic in Franklin County Opens in Saranac Lake

People in New York's Tri-Lakes who take methadone for opioid use disorder no longer have to drive to Plattsburgh or Canton for a daily dose. St. Joseph's Addiction Treatment & Recovery Centers opened an outpatient opioid treatment program in August at the Robert R. Reiss Community Services Center on John Munn Road in Saranac Lake — the first and only place in Franklin County to dispense the medication — and it is now dosing close to 20 people a day.

Until the clinic opened, both of the nearest dispensing sites were more than an hour away, a round trip that had to be repeated six days a week.

The barrier was distance, not willingness

"Too often the barrier to recovery isn't willingness to get help, it's whether help is close enough to reach," Jennifer DiTullio, network chief operations officer for St. Joe's, said at the center. "The bottom line is methadone saves lives."

Kati Jock, the network's senior vice president, said patients had been making the drive for years, and that the schedule punished exactly the people the medication was meant to stabilize: it was hard to hold a job, support children, attend school or stay in treatment while spending hours on the road. She added two words about winter in the Adirondacks — "especially in snow."

Emily Gokey, St. Joe's behavioral health director, put the same point more plainly. "Being able to access treatment shouldn't be the barrier," she said.

Inside a dosing clinic

The program occupies a renovated space with the fixtures federal rules require for a controlled substance dispensed on site: badge- and code-secured doors, alarms, a safe bolted to the floor, dispensing machines, mirrors, windows and security cameras. Patients check in with an identification card and wait in a room where tables and shelves hold overdose reversal kits, fentanyl test strips, first-aid supplies, hand sanitizer, condoms and resource pamphlets. Staff restock the bathrooms with harm reduction supplies constantly, Gokey said.

When a patient is called, the dose is handed across a window that looks like a bank teller's, next to a water cooler and a bowl of flavored LifeSavers meant to cut the medication's bitter taste. The clinic is open Monday through Friday from 6 a.m. to 4:30 p.m. and Saturday from 7 to 9 a.m.; Gokey said nurses will stay a little late if someone calls to say they are running behind.

Why methadone rather than buprenorphine

The center also prescribes Suboxone, the take-home formulation of buprenorphine, and some patients choose it. Gokey said others worry they will take too much and run out, or have a history of not following a schedule, and prefer that a professional monitor each dose.

For people using fentanyl or xylazine, DiTullio said methadone is often the more effective option because buprenorphine has a ceiling: past a certain point, a higher dose does not add benefit. Full-agonist methadone does not work that way.

Jock cited research finding a 59 percent reduction in opioid overdose deaths among patients receiving methadone and a 38 percent reduction for patients receiving buprenorphine. She said the spread of synthetic opioids has made cases arriving at the clinic more complex, at a moment when more than 4,500 New Yorkers died of overdoses in 2024.

The settlement money behind the door

The renovation and the equipment needed to store and dispense a controlled substance securely were paid for with $600,000 in grants from the New York State Opioid Settlement Fund, according to the center. The fund was created from the state's litigation against opioid manufacturers and distributors, which settled for several billion dollars.

The grant paid for construction and equipment, not for the medication itself: settlement money made the space secure enough to hold a controlled substance, and the program bills for treatment separately.

What a daily dose still asks of a patient

Franklin County now has a dispensing site, but not a shorter week. Methadone for a new patient means attendance nearly every day, and the Saturday window here runs only two hours. The clinic's current volume of about 20 patients a day suggests a program still building its caseload, and a dosing site does not by itself create detoxification beds or residential capacity for people who need a higher level of care before daily dosing makes sense.

How quickly the caseload grows will depend on referrals from the county's other providers and on word of mouth in a region where the trip itself had become the argument against starting treatment. The opioid treatment program model and the medication itself are described in more detail elsewhere on this site.