This is good news, but it’s just a start. A new detox facility, likely in Bangor, faces a long planning process before it opens its doors. Additional funding for treatment, while welcome, won’t make much of a dent in the heroin and opioid epidemic gripping Maine and the nation when facilities have long waitlists for their services. It will take months to get 10 new drug agents — included in the bill as an olive branch to LePage — on the streets.
The challenge going forward is to build on the goodwill and hard work that went into LD 1537’s passage to take additional, larger and likely more controversial steps to address drug addiction.
Increasing access to medication-assisted treatment should be a priority — because it works. Maine, like other states, is woefully behind when it comes to medication-assisted treatment,
“The research is unassailable,” the Pew Charitable Trusts said in a recent report. “Staying in recovery and avoiding relapse for at least a year is more than twice as likely with medications as without them. Medications also lower the risk of a fatal overdose.”
Yet, because of lingering perceptions that addicts are weak and that addiction can be overcome with willpower, medication-based treatment is available to too few. (It wasn’t part of the comprehensive bill that just became law.) Only one in five Americans dealing with opioid addiction is receiving methadone or buprenorphine, two common anti-addiction medications, according to a November study by researchers at Johns Hopkins’ Bloomberg School of Public Health. Barriers include a shortage of medical providers licensed and trained to provide the medications, a lack of insurance among those who need them and limited or no coverage from some insurance plans. The result is long wait lists of people with addictions who want to stop abusing drugs. Wellspring in Bangor, for example, has 40 people on the waiting list for its 28 beds.
Although MaineCare covers methadone treatment, lawmakers have placed a two-year cap on the duration of treatment and decreased payments to providers, making the treatment unsustainable for some medical facilities. Maine, like most states, has too few doctors prescribing buprenorphine, a methadone alternative that can be prescribed by a doctor who has met federal requirements. Each doctor, however, is limited to working with only 30 patients the first year and 100 in following years. Sens. Susan Collins and Angus King and Rep. Chellie Pingree are co-sponsors of federal legislation to ease these restrictions so more medical providers can prescribe buprenorphine.
The state soon will begin a pilot project involving Vivitrol, another treatment drug that is available in long-lasting shots, but only for those who have not used opioids in at least seven days. The state is working on a contract for the project and hopes to begin the pilot in March.
Bills to be considered by lawmakers in coming weeks seek to make treatment and overdose medications more available. One bill, sponsored by Sen. David Woodsome, R-Waterboro, would return the reimbursement rate for methadone treatment to $80 per week from its current $60 — among the lowest rates in the nation.
Another bill would create a program to buy the anti-overdose drug Naloxone in bulk for use by municipal first responders.
Other bills focus on enforcement. LD 1534 would create an interdiction unit to conduct patrols on state roads as a means of reducing the amount of illegal drugs coming to Maine. LD 1541 would increase the penalties for some drug trafficking crimes.
Expanding Medicaid coverage under the Affordable Care Act, which LePage has vetoed five times, is another important piece of the addiction puzzle. Many on wait lists for treatment have no health insurance. With insurance, they are much more likely to get the treatment they need. Plus, they would be able to afford other needed health care.
The quick passage of a modest bill to ease Maine’s addiction problem is an important step forward. Much more remains to be done.