Bangor is home to three methadone clinics that provide treatment services and support to recovering addicts from the city and rural surrounding areas. It also is home to a dedicated group of volunteers searching for ways to reduce drug addiction and its consequences. So it makes sense for the city to be at the forefront of tackling drug addiction that is killing more and more Mainers each year.
In 2014, 208 people died from drug overdoses, according to data from the state attorney general’s office. Among the deaths in 2014, 57 were caused by heroin or morphine, spiking from 34 in 2013, when there were 176 deaths attributable to drug use.
Through a legislative resolve sponsored by Sen. Geoff Gratwick, a Bangor physician, the Bangor area would be the setting for a much needed pilot project aimed at determining why too few doctors provide alternatives to methadone treatment, such as buprenorphine, also known as Suboxone. As Gratwick asks: Is it financial? Is it because of the stigma of treating addicts? Or are logistical difficulties to blame?
These types of questions must be answered before dramatic changes, such as Gov. Paul LePage’s proposal in his two-year budget to stop state support for methadone treatment for MaineCare recipients, should be considered.
“Our goal is to allow these members to access a more comprehensive health care delivery package,” Dr. Kevin Flanigan, medical director for MaineCare, said of the plan to move recipients of the government health insurance program for low-income people away from methadone. This is a laudable goal, as is the Department of Health and Human Service’s emphasis on primary care as part of addiction treatment, but members can’t be transitioned to a treatment package that doesn’t exist.
Earlier this year, three University of Maine graduate students conducted a telephone survey to find out how many of the 112 doctors included on a federal list of buprenorphine prescribers actually prescribe the medication. Less than half of those listed, 43, confirmed that they prescribed it, while another 42 said they had stopped prescribing the addiction treatment drug. Another 27 didn’t respond.
The students found only two prescribers in Aroostook County.
The students’ research didn’t answer why, which is where LD 524 fits in. As amended, the resolve directs DHHS to set up a stakeholder group to get answers to several questions, such as whether reimbursements from government programs and private insurers are a barrier to physicians treating opioid addicts and whether state regulations are a hindrance.
Once these questions are answered, the group is to design a pilot program to better use treatments other than methadone in rural areas where many addicts live. The group is directed to look at mobile clinics, telemedicine, federally qualified health centers as well as physicians offices.
Although this review will take time, it is far preferable to taking away methadone treatment without a viable alternative in place.
Suboxone has many benefits. Most important, it does not require a daily, often time-consuming trip to a clinic like methadone does. This means recovering addicts can better maintain employment and family connections where they live. But not all addicts can be treated with Suboxone. Those with the most severe addiction are generally best treated with methadone, which also is less likely to be diverted or sold. To ensure proper treatment, MaineCare recipients should not entirely lose access to methadone.
LD 524 will start the process of gathering much-needed data so policymakers can make informed decisions about the best approaches to community-based addiction treatment in the future. This resolve deserves their full support.