I recently met with a man in his late 40s. I’ll call him Greg — his name and minor personal details have been changed, but this story is true. He was well-dressed, well-educated and held a prestigious job. He was also addicted to opioids and seeking admission to Acadia Family Center’s Suboxone program. Suboxone is a combination drug that provides both a long-acting opioid — which does not give a person an actual “high” but helps minimize the intense withdrawal symptoms — and an opioid blocker to prevent misuse. It is an essential element in the path to recovery for many people with opioid addiction.
Greg told me he started using opioids in his late 30s because a girlfriend was using them, and he slowly increased his use until he realized he couldn’t stop. Nearly a decade later, a relationship failed and his ex-girlfriend told his children from his first marriage that their father was a “junkie.” This information carried enough stigma that his children cut off contact with him, and, despite his efforts, he has not heard from them in several years.
Greg talked about his addiction the way someone would talk about cancer or heart disease. It happened. It wasn’t intentional. It wasn’t because he wasn’t a good person. It wasn’t because he “deserved it.” It happened, and once it was there it wouldn’t go away.
He eventually started buying Suboxone on the street in an effort to break the vicious addiction cycle; it got him off other drugs and allowed him to function without being high all the time. But buying it on the street was illegal, failed to provide him with any emotional support or direction and could have harmed him because he wasn’t taking the controlled substance under the care of a physician. Fortunately, Greg found his way to Acadia Family Center, where we could provide him with legal Suboxone under a physician’s medical supervision as well as the essential counseling he needed to develop and maintain his recovery. Greg isn’t alone anymore; we’ve got his back.
If Greg lived in Sanford instead of Bar Harbor, treatment might not be available to him. Sanford’s methadone clinic announced last month it would close because of lack of state funding — methadone, like Suboxone, is a replacement medication used to treat opioid addiction — following the pattern of closures afflicting treatment centers across the state. Several years ago, I personally watched the state of Maine year after year cut reimbursement rates for a large opioid treatment program I was supervising, making it difficult for this and other treatment centers to stay afloat.
In August, there were two “drug summits” in Maine that addressed our growing opioid epidemic. The first focused on a treatment and recovery approach to the problem while the other concentrated on law enforcement.
While law enforcement may be one aspect of our state’s effort to curtail drug use, those of us in the trenches helping people with opioid dependence and addiction know there are treatments that work and that those suffering from opioid use disorders are not “bad” people — they just want to get better. Many providers believe effective and accessible treatment will be the ultimate solution to the opioid epidemic. From a financial perspective, treatment is the clear solution, with a return on investment tenfold greater than arrest and punishment: A year of rigorous outpatient treatment costs about $5,000 while a year of incarceration often costs more than $50,000. Even setting aside the devastating impact on individual lives that incarceration and the lack of a support system creates, treatment is the logical course of action.
As third-party payers continue to decrease reimbursement rates for opioid treatment and state officials continue to devote more resources to law enforcement than they do to treatment, a dangerous imbalance is being created: Fewer treatment centers remain open, leaving fewer openings for patients in need, even as the number of people in need of treatment continues to grow.
When a treatment center closes, those in need of its services do not disappear; instead, they find themselves that much further away from recovery and a better life. Acadia Family Center is lucky to have a network of private support that has thus far allowed us to weather this storm. But just because we are running at full capacity does not mean we are satisfying the tremendous demand for our services. I cringe every time I see the waitlist for the Suboxone program at my own clinic, because I know each name on that list represents a person wanting to escape addiction and asking for help who is becoming more at risk every day that goes by without admission to our program or a similar one.
Substance abuse and mental health disorders cut across all demographics, and helping those in need strengthens our entire community. It is my hope that the increased publicity regarding Maine’s opioid problem will serve as a call to action to create a better system to treat addiction instead of punish it. This is an issue that affects real people throughout our state, and they should not be left to suffer because some in power find it easier to avoid the complexities of a treatment-based approach and simply prefer to condemn those with addictions as criminals.
Dan Johnson is the executive director of the Acadia Family Center in Southwest Harbor. He previously worked for over 20 years in clinical and administrative positions at Acadia Hospital in Bangor.