If we’ve learned anything from the state’s struggles to care for the mentally ill, it is that community-based services must be ready when a transition away from institutional care takes place. Decades ago, the state’s mental institutions were dramatically downsized with the promise that these institutions’ former residents would get care at less restrictive facilities in the community. Many people with mental illness were released from institutions, but community services weren’t — and largely still aren’t — in place. As a result, those with mental illness make up a large percentage of our jail and homeless shelter populations.
Now, Gov. Paul LePage’s administration proposes to make a similar mistake with the treatment of opiate addicts. Through its proposed budget, the administration aims to stop state payment for methadone treatment with the promise that addicts will instead be seen by primary care physicians who will prescribe a different drug, Suboxone.
Encouraging more primary care visits is a good thing, but the system is not ready to absorb the 3,800 addicts on MaineCare who currently get methadone at one of the state’s 11 clinics. In addition, Suboxone is a different medication than methadone and does not work for all addicts.
Rather than a mandate to stop methadone treatment for MaineCare recipients, the administration should first devise and test an alternative that is readily available and flexible to meet the varying needs of recovering addicts who need different types of treatment.
Certainly, there are problems with methadone treatment for drug addiction. It requires many recovering addicts to travel to a clinic each day for a dose of the drug. This has the effect of concentrating recovering addicts in service center communities like Bangor and it makes it difficult for many, especially those who travel a long way to a clinic, to keep jobs. Treatment can take years.
Other treatments, especially Suboxone, can alleviate many of these problems for some people and offer promising alternatives. But Suboxone, too, has problems. It is more easily diverted to people without a prescription. It can have deadly side effects when combined with alcohol and other medications. It must be prescribed by a doctor, but few are trained and available to treat addicts. Doctors who are registered to prescribe Suboxone can only treat 100 patients at a time.
Suboxone, which costs much more than methadone, is a good alternative for people with less severe addiction. For those with more serious, or long-standing, addictions, methadone is the only choice. In fact, some with severe addiction are treated with methadone for years before stepping down to Suboxone when they need a less potent drug.
“According to the Substance Abuse and Mental Health Services Association, providing primary care to individuals with addictions enhances their recovery from substance abuse,” Department of Health and Human Services Commissioner Mary Mayhew said at a legislative hearing on the proposal last week. “Primary care treatment results in better health outcomes, in contrast to back-and-forth referrals between behavioral health and primary care offices that leave up to 80 percent of individuals without care.”
Of course, getting people to consistently see a primary care provider to manage their health will improve their health, whether they are dealing with substance abuse or a chronic heart ailment, whether their course of treatment is methadone or Suboxone. It is a leap to say some addicts aren’t effectively treated with methadone.
The governor’s budget proposal include $300,000 for a pilot project to use Vivitrol, an anti-addiction drug given through shots, with addicts recently released from jail. Trials like this are a better approach than simply cutting off methadone use.
A pilot program to get addicts into the primary care system to manage their withdrawal would also make sense. If it works well and there is capacity, many recovering addicts could move to this approach. But some will continue to need methadone and should continue to receive their treatments.
