Amid an angry speech criticizing and demeaning “liberals,” Gov. Paul LePage muted his tone Tuesday night and turned almost conciliatory as he talked about Maine’s worsening drug crisis. Last year, 378 Mainers — more than one per day, on average — died of a drug overdose. The number of deaths was 39 percent higher than in the previous year. Some 313 of the deaths were attributed to opiates; 243 were attributed to heroin or fentanyl.
“Too many people are dying,” LePage said during his State of the State address, before urging lawmakers to work with him to find solutions.
Those solutions, the governor said, include rehab.
“But it’s got to be sound, it’s got to have an opportunity for success,” he added.
That sounds like medication-assisted treatment.
Research is clear: Those who receive medication-assisted treatment coupled with counseling are much more likely to overcome substance use disorder than those who do not.
“The research is unassailable,” the Pew Charitable Trusts said in a report last year. “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, only one in five Americans dealing with opioid addiction is receiving methadone or buprenorphine, the two most common anti-addiction medications, according to a November 2015 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 coverage or none at all from some insurance plans. The result is long waitlists of people with addictions who want to stop using drugs.
The LePage administration finally has begun to address such waitlists in Maine. In December 2016, it announced the Department of Health and Human Services was putting $2.4 million toward medication-assisted treatment to serve at least 359 new patients.
Now, the governor appears poised to go further. In Tuesday’s speech, he spoke of working with Sen. Troy Jackson, a Democrat with whom the governor has long feuded. On Wednesday, the details of those conversations became clear. The LePage administration proposes to devote an additional $8 million to expand opiate addiction treatment to another 700 Mainers.
Many details remain to be fleshed out, especially how this one-time spending can be replicated in future years so that new patients aren’t brought into the treatment system only to be kicked out in two years. But this is undoubtedly a step in the right direction.
In the past, the governor has tied his (minimal) support for addiction treatment to additional funding for law enforcement. Last year, lawmakers began their work by passing a bill that included funding for 10 additional investigators for the Maine Drug Enforcement Agency and funding for substance abuse services. LePage credited those additional officers for the largest heroin bust in the Northeast — the seizure last month of 8 pounds of fentanyl-laced heroin, with a street value of $1.8 million. The drugs seized were enough for 35,000 individual doses of heroin.
Lawmakers also worked with the governor on a new law that restricts opioid prescriptions and requires more monitoring of these prescriptions.
With these pieces in place, it is encouraging that the administration is now turning its attention to medication-assisted treatment. To make this treatment effective for as many people as possible, lawmakers must revisit Maine’s time limit — the only one in the nation — on treatment with methadone, the most common medication-assisted treatment. Maine’s low reimbursement rate for methadone treatment is also a hurdle to getting more people into treatment. Expanding Medicaid coverage, which the governor has repeatedly rejected, would also help more Mainers afford and access the addiction treatment they need.
There has been frustratingly little action over the past few years to stem a growing epidemic of opiate addiction. The governor’s pledge to work with lawmakers to better tackle Maine’s opiate crisis is a welcome step forward. It’s our hope that it doesn’t turn into more stubborn grandstanding.