Manna Ministries in Bangor says financial problems stemming from mismanagement of a now-defunct addiction clinic could force it to close two residential, faith-based programs for people with addictions.
The closure of Elijah’s House and Derek House in Bangor — Manna’s two residential programs — would represent the loss of programs on which some with addictions depend. Faith-based treatment without medication, however, isn’t what Maine needs more of to address its addiction epidemic in a serious way.
Policymakers in Maine need to rely on science, decades of medical research and a view of opiate addiction as a medical problem as they address Maine’s opiate addiction crisis. That mindset should invariably lead conversations about treatment in the direction of medication-assisted treatment. The public policy debate should be about how to make it easier for patients to access it — not about whether that approach is the right one for Maine.
Too few people with addictions to alcohol and drugs ever receive any form of treatment. A five-year study by the National Center on Addiction and Substance Abuse published in 2012 found that just one in 10 people suffering from an addiction ever received treatment. “Of those who do receive treatment, few receive anything that approximates evidence-based care,” the study’s authors wrote.
There’s little debate in the scientific community about what kind of care people with addictions should be getting — care backed up by decades of scientific evidence: treatment that couples medication such as methadone or Suboxone with behavioral therapy.
Yet, as Huffington Post writer Jason Cherkis put it last year, “addiction treatment is mired in a kind of scientific dark age.” Even though research has repeatedly shown that patients’ chances of survival, of avoiding future drug use, of staying away from criminal activity and of future employment increase significantly when the treatment they receive involves medication, medication-assisted treatment too often is the exception rather than the norm.
State and federal policies surrounding medication-assisted treatment remain outdated and erect obstacles for people who want to stop using substances. Even though the Food and Drug Administration has approved three medications to treat opiate addictions, a 2013 report published by the American Society of Addiction Medicine found that only 28 states’ Medicaid programs covered all three.
Even when a state Medicaid program covers all three medications, a number of them — such as Maine — limit patients’ access to the medications. Maine is one of 10 states that impose a limit on the amount of time a Medicaid patient can access buprenorphine (known commercially as Suboxone), according to a 2014 Substance Abuse and Mental Health Services Administration report. MaineCare generally limits Medicaid patients to two years on the medication, and the Pine Tree State is the only one whose Medicaid program imposes a two-year lifetime limit on access to methadone. Such lifetime limits apply to no other medications, and there’s no scientific evidence showing that addiction patients should be time-limited.
Federal law also contains a restriction on buprenorphine that applies to no other kind of medication and that contributes to limited availability of a much-needed medication. When a doctor is first authorized to prescribe buprenorphine, he or she can prescribe it to only 30 patients. After a year, the doctor can request permission to prescribe it to a maximum of 100 patients.
The Obama administration recently proposed a rule to raise those caps — to 100 patients in the first year and 200 thereafter. That’s helpful, but the caps need to be eliminated. Federal law also needs to change to bar federal support for treatment programs that prevent patient access to medications.
And in Maine, state law needs to change to raise the rate at which MaineCare reimburses methadone clinics. Maine’s $60-a-week reimbursement for methadone clinics — coupled with the misguided two-year limit — puts the ability of many clinics to provide effective care for their patients in doubt.
While some might worry about the loss of a faith-based addiction treatment option in the Bangor region, policymakers, medical establishments and the community at large can’t afford to lose focus on the true need: support for effective, medication-assisted treatment for those who are ready to put their substance use behind them.