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Matching rhetoric with action
On Jan. 31, Governor Janet Mills’ office released Maine Opioid Response 2021: A Strategic Action Plan. The goal: “Reduce the negative health and economic impacts of opioid and other substance use disorders (SUD/OUD) on individuals, families, and communities in Maine and, in so doing, give hope to all persons with a substance use disorder that recovery is not just possible, but probable.”
On March 9, LD 967 was introduced in the legislature by Rep. Anne Perry of Calais. LD 967 An Act to Make Possession of Scheduled Drugs for Personal Use a Civil Penalty. This bill would reschedule drug possession as a civil infraction, and give that defendant the option of a $100 fine or the person may choose to be referred for an evaluation regarding substance use disorder.
If we are going to meet the goal of the Mills’ plan, it begins with, as the document states “reducing the stigma associated with [SUD] and identifying it as a chronic medical condition,” how are we supposed to do that if we keep arresting those people? That’s a direct question for Mills and Gordon Smith, director of opioid response. The Mills administration has formally opposed this bill, while Smith has been confoundingly absent from public conversations regarding the bill.
For the sake of my family and my community and my state, I ask them to please align their policy with their rhetoric. Roughly 10 Mainers are dying every week, and keeping them in a world where their medical condition makes them a criminal is not working.
The future of medicine
Jacob Appel’s informative column on physician shortages makes a great point that our current medical school admission policies miss exceptional future physicians. Agreed.
However, we are over doctored especially in sub-specialists, compared to most European countries, including those with universal health care. We certainly need sub-specialists, just not so many. We are under doctored in primary care physicians who provide most of our health care. Minorities, inner cities and rural communities don’t have enough physicians.
Medical schools can do better. This includes a culture shift to elevate the stature of primary care. Like other professions, there are high status and low status career paths. Medical schools must be strategic and actively seek out and recruit exceptional candidates who want to be primary care physicians and practice in underserved communities. Medical schools must establish residency programs in underserved communities. Physicians tend to practice where they were trained. Because sub-specialty care is a big revenue source for medical schools — “Doing well by doing good” — these changes will require additional public funding.
Essential changes, but not sufficient until everyone can access health care regardless of ability to pay. Physicians cannot make a living where they are needed most. We’ve bemoaned our primary care physician shortage for decades to no avail. Meanwhile, underserved people get sick, sicker, lose time at work and die young.
Voices like Jacob Appel can help move these interdependent solutions forward.
I moved from Arizona to Maine in 2000. One of the biggest culture shocks I had moving to this beautiful state was the realization that the Wabanaki tribes in Maine are excluded from federal legislation that ensures tribes’ inherent rights to govern themselves. I could not believe it when I heard it! This is not the case in Arizona or many other states across the country. Why should it be any different in Maine?
I know the federal legislation and am confused when it comes to Maine’s laws. The Wabanaki tribes are not asking for any special privileges; they are asking to be treated like the other federally recognized tribes across the country. They are asking to be sovereign nations. They are asking to be able to protect their peoples, lands and waters. I fully support them in doing so.
I understand that the bill that would have addressed this issue this year is being held over to 2022. I hope to see positive movement on this piece of legislation coming into the next session, and I urge all of Maine’s political representatives to support the inherent rights of the Wabanaki tribes in Maine.