I am writing this from the perspective of a family physician in Maine who has for more than 30 years provided services, including obstetrics and addiction treatment, for thousands of patients in the Bangor area. At the Eastern Maine Medical Center Family Medicine Center and Residency Program, we are one of the few local offices that treat opioid addiction with Suboxone and the only office that provides both prenatal care and office-based opioid addiction treatment.

We are overwhelmed with requests for treatment by patients with heroin or oxycodone addiction. Because of this, we usually cannot take on new patients for opioid addiction treatment, with the exception of the openings we hold for pregnant women. In a recent week, we had five, 19- to 29-year-old pregnant women emergently call our health center, pleading to get treatment for their addiction. They worry about their unborn children, as they should.

Every one of these women wanted addiction treatment over a year earlier but could not afford it. All these women are young and, though most had jobs, they were part time with low pay. All of them would have qualified in the past for noncategorical MaineCare status because of their low income. But that was before they got pregnant. And that was taken away last year by our state government.

Since that decision, there have been catastrophic consequences as many patients in treatment were dropped or left treatment because they couldn’t afford it. They’re back on street drugs, which can have significant, even fatal consequences for the fetus when it is subjected to drug impurities and the more dangerous effects of yo-yoing: intoxication, then withdrawal. Conversely, extensive studies of methadone or Suboxone (buprenorphine), available in treatment settings, have not shown that these medications cause long-term harm to the unborn baby.

All these women kept their addiction secret from their families and their doctors because of profound shame and the fear of negative judgments from important people in their lives. And unfortunately — because the large majority of primary care physicians don’t offer office-based, medication-assisted treatment for opioid addiction, such as Suboxone — patients with addiction don’t see these physicians as much help anyway.

Addiction, like a stroke, is a permanent, chronic brain disease. But its distinction is that many times its roots are in permanent brain changes associated with childhood or adult trauma: physical, sexual or emotional abuse, losses, abandonment. People with strokes can relearn how to speak. Addiction can be overcome with counseling to relearn how to cope in a non-addictive way with the consequences of trauma after being stabilized from craving and pain with medication-assisted therapy.

Addiction hijacks the brain’s reward system so people with addiction don’t even see they have other options. There is an incredible, overwhelming drive to use the drug just to feel OK. But OK is not good or normal. It simply is not as much nausea, vomiting, crawling out of your skin, abdominal, muscle and bone pain, depression, anxiety and feeling like a failure because they’ve lost the important people in their lives and would rather be numb.

The wealthy and the poor can be trapped by opioid addiction, but the former usually have good insurance and can afford the expense of treatment. Market economics show that where there is need, entrepreneurs will find a way to deliver supply; here in Maine, there always will be drug dealers. Treating people with addiction and doing it well takes away that need. The Maine Drug Enforcement Agency and police deserve a lot of credit, but they will tell you as long as there are lots of untreated addicts, they are playing whack-a-mole with mostly low-level drug dealers. Any one of our five patients could be one of them, coerced to sell drugs in order to satisfy their need.

Do we as a society really want to care for pregnant, addicted women in jail? Jail does not treat addiction. The cravings continue. When they are released, recidivism is very high. Think about this: The treatment programs in Bangor confirm treating addicted patients with methadone or Suboxone and counseling costs $5,000-$12,000 per year. Jail runs $35,000-$45,000 per year. Just ask your sheriff.

People with addiction are treatable. Most treatment programs are not free. They need insured patients or they will go bankrupt. When that happens, they serve no one. We can catch addicts fairly easily. But taking away the monetary resources to treat poor patients with addiction while increasing jail numbers increases society’s costs with virtually no improvement in the problem.

Death cures addiction. Our state has the dubious honor of having more young people dying of inadvertent overdose than in motor vehicle accidents, and a higher percentage of pregnancies complicated by addiction — which are, by far, more expensive because of preterm births and other costs — than most states.

Not just from a health perspective but from an economic one, greater access to locally available substance abuse treatment — methadone, Suboxone and counseling — and providing our at-risk population with insurance or access to low-cost, subsidized coverage makes much more sense than to arrest and imprison.

Patients with addiction and their babies are not expendable. We should act like we mean it.

Dr. Eric Brown is a family physician who has been treating Maine families since 1981. He is a faculty member at the Eastern Maine Medical Center Family Medicine Center and Residency Program, the University of Vermont and University of New England.