For almost 30 years, CHAMP Clinic has operated out of a tiny building around the corner from the State Capitol. It also sits across the street from Princess Ruth Keelikolani Middle School.

One of only two methadone clinics on Oahu – and one of only four in Hawaii – it’s served about 3,000 people recovering from opioid addictions, according to its staff.

But CHAMP’s neighbors have gripes about the clinic’s clientele, saying patients have been disruptive both to them and the students commuting to and from school.

“I am not going to say all of the people are bad, but there are constant fights, yelling, cussing, and situations that we have had to call the police,” Joseph Passantino, the school’s principal, wrote in testimony supporting a bill that would have forced the clinic to relocate. He did not respond to an interview request.

The evolution of House Bill 378, which in its original form called for a ban on methadone clinics within 750 feet of a school, reflects similar debates that have played out nationwide amid the opioid crisis.

Other laws and zoning efforts aimed at restricting the location of substance use disorder services have been successfully challenged in courts as people in recovery are protected under the American Disabilities Act.

But community opposition is a powerful obstacle to overcome, and there seems to be no easy solution for that. The CHAMP clinic testified that it conducts regular community surveys and takes measures to limit the interaction between clients and people outside, but it clearly does not enjoy universal approval in its current spot.

‘A Necessary Evil’

Everybody agrees that the school was there first. 

The grounds were originally the site of Princess Ruth Luka Keelikolani’s palace, Keoua Hale, completed in 1883. A school has existed there in some form since 1908, over 80 years before the clinic moved in across the street.

Princess Ruth Keelikolani Middle School, previously named Central Middle School, has more than 300 students enrolled in grades six through eight. Most are Native Hawaiian or Pacific Islander, according to the U.S. Department of Education database.

And while much of the surrounding area contains luxury housing, says the school’s website, “the majority of our students currently reside in government and affordable housing complexes or transitional and homeless shelters, and others live with relatives or in multi-generation homes.”

CHAMP employees contend that the clinic’s presence isn’t being questioned just because of its proximity to a school. 

They blame the neighboring luxury housing at Capitol Place, where residents and workers submitted testimony in support of the relocation effort that expressed both their own personal concerns and worries about the school children.

“Methadone clinics are a necessary evil,” said Sen. Karl Rhoads, who introduced a companion bill in the Senate and whose district includes the clinic and the school.

Rhoads said he’s heard concerns about the clinic ever since he was first elected in 2006. After struggling to reach the manager over the phone, he said, he walked in and talked to the manager in person.

The manager seemed to take it seriously. He tried to keep clients inside the waiting room rather than outside on the street, which lessened the number of complaints, Rhoads said. But that was only temporary.

Ideally, the clinic would be able to return to that setup so it can continue supporting its clients while keeping them from interacting with nearby students – “some sort of arrangement where the guys didn’t congregate outside the clinic,” he said. 

CHAMP’s waiting room does include a map with red-highlighted portions showing where clients are not allowed to gather, with the threat of being dismissed from the clinic if that rule is broken.

Location Is Important

Staff recognize they’re in a sensitive location — but maintaining this location is important, said Leanne Simon, a counselor at CHAMP.

“The location CHAMP is in now was very specifically chosen,” she said during a hearing. It’s conveniently located because many bus routes converge within just one block, making it accessible for clients who live farther away as well as those nearby.

“The issues of illicit drug use, homelessness, sex work, petty crime, and all the other social problems were here long before the clinic,” Simon said in written testimony. “And these issues would not be affected, nor disappear, if the clinic were to go.” 

CHAMP is a methadone clinic. When people with opioid addictions try to wean themselves off of harder drugs like heroin, methadone, a relatively milder option, can act as an effective gateway to sobriety.

Not just anybody can dole out controlled substances like methadone. Outpatient clinics must register with the Department of Public Safety first, and must adhere to restrictions related to how they store substances and keep records.

The first couple iterations of HB 378, which was introduced by House Speaker Scott Saiki, included a requirement that clinics cannot be within 750 feet of a school, something the employees at CHAMP opposed.

“We are the only methadone clinic within 750 ft of a school and as such our Honolulu clinic alone would be targeted by this action,” Mohamed Ayman El-Dakhakhni, president of CHAMP Clinic, said in written testimony.

El-Dakhakhni also owns the property that CHAMP uses, according to testimony from CHAMP’s manager Aisha Esker, and this alleviates pressure from landlords and the community to move. CHAMP declined to comment for this article.

Federal Law A Factor

In subsequent amendments, the requirement to be outside a 750 feet radius was changed to a requirement that when approving clinic registrations, DPS consider “the prevention of activities within the applicant’s areas that are potentially injurious to the health, safety, and welfare of the public and neighborhood.” 

But that also felt restrictive, said supporters of CHAMP. The Downtown-Chinatown area has problems with crime. Would the clinic become a scapegoat for problems it has no control over?

“How far away do I need to be as a neighbor before I feel like I have justification to demand that someplace move or that they’re not allowed to open? It’s just not clear,” said Sen. Jarrett Keohokalole, who chairs the Senate Commerce and Consumer Protection Committee. 

Keohokalole stripped that language from the bill when it passed through his committee.

In its current form, all that’s left is the creation of a working group to discuss how to balance public safety with treating substance use disorders and the requirement to submit a report before next year’s legislative session.

The group would include both a representative of a school located within 750 feet of a methadone clinic and a representative of the clinic, among others.

Keohokalole cited the American Disabilities Act as a key reason for amending the bill’s language to just retain a working group for now, at least until the bill runs the gauntlet of conference committee. 

“That doesn’t diminish the concern of people that live in neighborhoods where treatment centers are located,” said Keohokalole. “But we can’t violate federal law. And places do need to be somewhere.”