A lot has changed since the last time a methadone clinic was proposed in Rutland.

When Rutland Regional Medical Center and Rutland Mental Health Services sought approval for a clinic to treat addictions to opiate drugs such as heroin and prescription painkillers like Oxycodone in 2001, there were widespread concerns from law enforcement officials, doctors and the public.

Seventy-one doctors at the hospital signed a petition opposed to the plan and a grass-roots group called "Rutland First" held a forum at the Howe Center where more than 100 people heard from a panel of doctors and out-of-state law enforcement officials who were opposed to methadone.

Less than a year after that meeting, plans for a methadone clinic were abandoned.

Ten years and seven months after the Rutland First gathering, another forum concerning a proposed treatment center that would include methadone was held in the same room.

But the opinions of the panelists and the roughly 100 people in attendance were in favor of methadone as a treatment option.

What changed?

In the view of those involved in both clinic proposals, it's what has been learned locally and statewide during the last decade about opiate addiction that has shifted views.

While the sale and use of heroin was a growing concern to health and law enforcement officials in the spring of 2001, the numbers were comparatively small.

State Department of Health numbers show that 49 patients sought help with heroin addiction in the Rutland area in 2000. In 2001, that number nearly doubled to 96.

In the years ahead, the number of addicts seeking help would continue to grow - peaking in 2008 at 315. Last year, 253 people sought treatment.

"I think we've achieved a point here where it's clear there needs to be a (methadone) treatment option," said Wendy Wilton, who 10 years ago co-founded Rutland First.

Wilton and other members of her group voiced a number of concerns in 2001, including the risks of overdosing and diversion of the drug, which is designed to stabilize opiate addicts by countering the effects of withdrawal while, in prescribed doses, providing no high.

But one of their main worries - given voice at a forum by a Pennsylvania police captain who said a treatment center brought hardship to his community - was that building a methadone clinic would draw addicts from other areas to Rutland.

That concern was furthered by the lack of methadone treatment anywhere else in the state. The Howard Center in Burlington, the first facility in the state to provide methadone treatment, was still months away from using it when the debate occurred in Rutland in 2001.

Now there are seven such centers, providing access to methadone in every part of the state, except for Rutland and Bennington counties and a small part of southern Addison County, according to Department of Health officials.

What the state and local officials have learned from those operations appears to have gone a long way toward easing fears.

For one thing, the fears of opiate addicts migrating to methadone clinics hasn't come to pass in Vermont communities that have adopted the treatment.

Burlington Police Chief Michael Schirling said in the 10 years since methadone came to his community, he's seen no indication that it brought extra addicts to the city or contributed to an increase in drug-related crimes.

"There has not been a measurable impact," Schirling said. "If we were having a conversation about starting a methadone clinic today, I know I would not hesitate to endorse it."

In Brattleboro, where a methadone clinic opened about four years ago, Police Chief Gene Wrinn had similar sentiments.

"It's had no more of an impact than any other business," he said. "We've seen no increased crime due to methadone."

To be sure, methadone can be abused and of the 2,622 opiate patients treated last year, 53 of them involved people using methadone without a prescription.

But those abuse numbers pale in comparison with buprenorphine drugs used to treat opiate addiction such as Suboxone. While operating on the same principle as methadone, buprenorphine is prescribed for take-home use as opposed to methadone, which under federal laws can only be administered to a patient inside a clinic under strict controls.

With the same potential for recreational abuse as methadone and less strictly controlled, buprenorphine is much more commonly diverted, Department of Health officials said.

"We didn't know a lot of things then that we know now," said Rutland Police Capt. Scott Tucker. "We didn't know as much about what the needs were and what the need would be to reduce demand."

Buprenorphine combined with therapy - which treatment providers stress is the key to successfully treating opiate addiction no matter which drug is used to stabilize patients - has been the sole treatment option in Rutland for years.

And while it has been better than nothing, the lack of a methadone alternative for patients not ready for buprenorphine and the lack of a comprehensive approach to treating opiate use has been brought into sharp focus, Tucker said, by the departure in July of two of the only doctors in the area able to prescribe the drug.

With some opiate patients unable to acquire buprenorphine, Tucker said drug-related crimes have been climbing.

For example, burglaries between July and October have increased from 59 for the same time period last year to 114 this year, he said, and thefts have climbed from 248 in 2010 to 340 this year.

And increased crime isn't the only harm besetting the community due to inadequate treatment options, Tucker said.

In the 10 years since a methadone clinic was first proposed, the captain said the number of Rutlanders addicted to heroin has grown along with the numbers of people addicted to prescription opiate drugs.

In fact, the number of people seeking treatment for addiction to prescription painkillers long ago eclipsed the number of heroin users being treated in the state. Last year, 623 people in the state received treatment for heroin addictions - down from a high of 722 people in 2006.

The treatment of other opiate drugs - predominantly prescription drugs - has meanwhile increased year-to-year throughout the decade with a high of 1,946 people receiving treatment last year.

Those kinds of increases in demand made it clear to former Rutland Regional Medical Center emergency room physician Dr. Harry Chen that a better plan was needed.

"As a physician in Rutland, it was clear to me that we were not meeting the needs of the opiate-using population," Chen said.

Chen said patients showing signs of drug-related conditions ranging from overdoses to hepatitis C were not uncommon in the ER as were patients complaining of unspecified pain issues in the hopes of being prescribed opiate painkillers.

A year into his tenure as Vermont's health commissioner, Chen was in Rutland last week where he advocated at the Howe Center forum for the new clinic and a comprehensive system of care that would surround it.

"Anytime that you introduce something new, it's normal for people to be worried and concerned," Chen said. "But when you can show that something is safe in other places and can make a difference in the health and well-being of a community while acknowledging that the problem isn't going to go away without it, then I think you'll find that people accept it."

The proposed treatment clinic and accompanying "wrap-around" care model has also won endorsements from city officials who have been studying the plan as part of a community advisory board formed by the hospital and RMHS to gather feedback.

Rutland City Mayor Christopher Louras and Board of Aldermen President David Allaire, who both sit on the board, said they support the proposed clinic so long as the various law enforcement officials, medical providers, housing providers and case workers come together as planned to coordinate and oversee every facet of the recovery process.

"I'm very supportive as long as it must have mandated wrap-around mental health and drug treatment counseling. Otherwise, from what I've gathered in my own research, the individual would be doomed to failure," Louras said.

While no other public forums like the one hosted at the Howe Center have been planned, the advisory board will meet again this Friday at 10 a.m. at the Evergreen Center on Granger Street in Rutland.