There have been few wins this year in Maine’s fight against opiate addiction.
The number of overdose deaths hasn’t let up. In the first nine months of this year, about one person per day died of a drug overdose in Maine — 286 total through the end of September, compared with 272 in all of 2015 and 208 the year before that.
Even as more people suffer from addiction and die, the state has yet to make a substantial investment to boost treatment capacity, and specifically to expand access to medication-assisted treatment. In fact, Maine spends less on substance abuse treatment today than it did at the start of the decade.
And Maine continues to stand out as one of a handful of states that limit how long patients can receive medication-assisted treatment — considered the standard of care for treating an addiction — once they’re fortunate enough to have gained access to it. Maine is the only state in the nation with a limit on the length of time its Medicaid program will fund methadone treatment — it also reimburses methadone providers at one of the lowest rates in the nation. It’s one of 10 states with a similar limit for buprenorphine, commonly sold as Suboxone.
In the Augusta area, patients who depended on Protea Integrated Health and Wellness for treatment services were forced to seek limited alternatives when that clinic closed at the end of September.
In Greater Bangor, one promising development is in the works: A 10-bed detox center is on track to open, serving as the first stop for people with addictions who are ready to start treatment. But the Bangor City Council also undermined progress in the region this summer by rejecting an application from Penobscot County Metro Treatment Center to expand capacity at its methadone clinic by 200 patient slots. The council said no at a time when the need for additional treatment was clear and when all councilors had to do to help hundreds of people suffering from addiction was vote yes. (A federal judge Tuesday found the ordinance on which Bangor councilors based their decision discriminatory.)
Given the spate of bad news on the addiction front in Maine, it’s worth acknowledging a positive development announced this week by the federal government: Nurse practitioners and physician assistants, starting now, can take the necessary training to join the ranks of medical professionals prescribing buprenorphine to patients in need.
Buprenorphine reduces opioid cravings for someone with an addiction by attaching to the brain’s opioid receptors. It produces enough of an effect to stop withdrawal symptoms but not enough to cause a high.
Currently, only doctors who have received a federal waiver are allowed to prescribe the anti-addiction medication, and federal rules limit the number of patients to whom they can prescribe the medication.
While the Obama administration recently raised the cap on the number of buprenorphine prescriptions certified doctors can write, the existence of the cap has limited access to the life-saving medication. Today, doctors can prescribe the drug to 30 patients in their first year after receiving the waiver, and 275 patients annually in subsequent years.
Nurse practitioners and physician assistants will be allowed to prescribe buprenorphine to 30 patients annually. The change was part of comprehensive anti-addiction legislation passed earlier this year by Congress — but still not funded in any significant way.
According to the Kaiser Family Foundation, there are more than 1,100 nurse practitioners and nearly 600 physician assistants practicing in Maine. If just a fraction of them took the training and started prescribing buprenorphine, they could quickly add to Maine’s buprenorphine-prescribing capacity.
The most recent data from the federal Substance Abuse and Mental Health Services Administration shows that, earlier this year, 88 Maine doctors were certified to prescribe buprenorphine to up to 30 patients each while 18 could prescribe to 100.
It would be beneficial for policymakers to rethink the federal government’s limits on buprenorphine. But short of that substantive review, the recent move to allow nurse practitioners and physician assistants to prescribe a life-saving medication to those suffering from addiction is a welcome policy change that will make a difference.
