BANGOR, Maine — Maine methadone clinic operators are defending their addiction recovery treatment facilities after Gov. Paul LePage said he was working to shut them down.
“Be careful what you wish for,” Dan Coffey, CEO of Acadia Hospital, which is licensed to treat up to 500 patients out of its Bangor campus, said Thursday.
LePage said during a weekly WVOM radio appearance on July 12 that he has “been trying to close down methadone clinics” since taking office.
Maine is home to nine facilities that administer methadone to people trying to recover from drug addiction or, in some cases, suffering from chronic pain. Three of those facilities are located in Bangor. In total, Maine’s clinics are licensed to treat 4,300 patients with methadone.
“There are many people in recovery, many people are being helped,” Coffey said. “There are many folks who have been able to get their lives back together, to go back to work, to start families, that are taxpaying citizens. It would be pretty draconian to suggest that we’re just going to shut these [treatment centers] down.”
If any of these clinics close, hundreds of Mainers would have to compete to find already sparse alternative treatment options. Many would likely turn back to illegal drugs and lose what stability methadone brought them.
The governor’s administration has favored Suboxone over methadone, but addiction experts believe patients should have access to both and that Suboxone isn’t always the best option for many people suffering from severe addiction.
Funding for methadone clinics has been cut significantly while LePage has been in office.
Until six years ago, the state reimbursed methadone clinics $80 per week for each MaineCare patient they treated. That reimbursement has been reduced twice, and clinics now receive a $60 reimbursement — a 25 percent cut. A bill to increase the rate failed in the last legislative session. MaineCare-eligible patients represent about 75 percent on average of the patient load for these centers, magnifying the effect of the reimbursement cuts.
LePage blasted the treatment, arguing there was “no clinical aspect to it,” and he argued the clinics don’t provide adequate counseling.
However, every clinic is required to follow the same regulations, set by state and federal entities, in order to maintain their licenses. Among those regulations are requirements that they maintain adequate clinical staffing and provide counseling opportunities to every patient who comes through the door.
Clinic operators say they have fewer resources to work with since their funding was cut. If it were increased, they could provide more counseling services, Coffey said.
Before the reimbursement reduction, the required patient-to-counselor ratio was 50:1, according to Brent Miller, director of Discovery House, another clinic in Bangor. When the state cut the reimbursement, it recognized that clinics wouldn’t be able to maintain the same level of staffing with the cut to their revenue with the reduced funding, so it changed the minimum ratio to 150 patients per counselor.
Discovery House, for example, cut its counseling staff from 10 to four in order to keep its doors open, Miller said. Maine treatment centers are required to provide one hour of counseling per month for each patient, but the clinics exceed that, with most, if not all, offering group and individual sessions every week for patients in recovery who want to participate.
With more funding would come more opportunities for counseling and increased services for patients, according to clinic operators.
Miller said his remaining counselors have a huge workload and get burned out easily. Turnover is high.
Asked what he thought of Penobscot County Metro Treatment Center’s recent application to expand its number of methadone licenses in order to serve a 200-person wait list for services, LePage said he’d only favor an expansion of one clinic — Acadia’s. He said it was because he believed they had adequate “clinicians.” Acadia’s methadone treatment, however, operates in much the same way as other clinics in the state.
The Community Health Leadership Board was formed two years ago in Bangor to examine issues related to substance abuse in the region. As part of that effort, representatives of all three medication-assisted treatment centers in the city sit down and try to examine and compare their practices.
“It showed that we’re all doing the same thing, because it’s all laid out in national and state requirements,” Miller said.
Coffey echoed that assessment.
Repeated studies have shown that methadone and medication-assisted treatment, combined with therapy and counseling, is more effective and less expensive than residential detoxification programs.
According to the National Institute on Drug Abuse, patients who stay in methadone-assisted treatment with therapy longer have a better chance at long-term recovery and have a better chance at maintaining employment, among other benefits.
Critics of methadone treatment argue that it’s just a replacement drug and that too many people rely on it for too long.
Methadone is meant to cull opiate cravings and control withdrawal symptoms, allowing the person to function without the drug they’re trying to quit. In order to accomplish that, the brain has to be “rewired” to rid the person of their dependency on the drug and repair damage caused to their brain, Coffey said, and that can take a long time.
“In reality, this disease has traumatized the mind, and it’s a long road back from that,” Miller said.
Follow Nick McCrea on Twitter at @nmccrea213.