Jessica Payne got hooked on drugs at just 16 years old. A prescription for Percocet to treat her chronic pain and a birth defect in her hands opened the door to what would stretch into more than a decade of addiction.
“I would do whatever was put in front of me, whether it was uppers, downers, it didn’t matter,” Payne said. “But OxyContin was my drug of choice.”
Years of intravenous drug use, including heroin, led to a stint in state prison for drug dealing. Payne lost custody of her son. But it wasn’t until her father, who was largely absent during her childhood, died from an overdose of crystal methamphetamine that Payne decided to try methadone treatment.
“It was one of those moments where I realized that if I didn’t change my life I was going to die like him, and it was going to be my son feeling this guilt and wondering why,” she said.
Payne, 34, finally sought help three years ago from the Discovery House methadone clinic in Bangor. She now has been clean for two years and leads a peer support group for methadone patients and others.
Payne, who lives in Bangor, has no doubt she would be dead today were it not for the methadone, a synthetic opiate, and support from her peers and counselors.
“I’ve just been building my life back up,” she said. “I talk to my son now and I have friends who don’t use drugs and I go see blues music and I have a life.”
The Discovery House clinic in Bangor is one of nine methadone clinics in Maine reeling from a state budget cut that some say puts their survival at risk. The cut, which slashes Medicaid reimbursements, has led the state to consider temporarily easing regulations on methadone treatment so clinics can stay in compliance.
As of April 1, Maine’s methadone clinics are receiving $60 per week for each Medicaid patient they treat. That’s down from $70 over the previous year and a half and a steep drop from the $80 reimbursement of the prior decade.
With costs averaging $115 per person each week, clinics have long offered more services than Medicaid has paid them for, according to Dr. Joseph Py, corporate medical director for Discovery House, which has clinics in Bangor, South Portland, Calais and Waterville.
The reduction to $60 per patient per week makes Maine’s Medicaid reimbursement the lowest in the country, he said. Meanwhile, paperwork and counseling requirements have increased, Py said.
“This makes it extremely difficult for us to try and figure out if we can survive,” he said. “We’re not sure at this point how we’re going to do that.”
The reimbursement covers methadone dosing, medical checks, drug screening and counseling.
Roughly 85 percent of all methadone patients in Maine are covered by or eligible for Medicaid, known in the state as MaineCare. That leaves clinics little room to cover their losses by shifting costs to patients with private insurance.
The cut comes as the state Legislature struggles to balance the budget for health and social services. Maine spent $3.6 million in fiscal year 2010 on methadone treatment for 3,500 MaineCare patients, with the federal government kicking in another $6.2 million.
An additional $7 million in state dollars paid for recipients’ transportation to methadone clinics and service sites.
In response to clinics’ financial concerns about the reimbursement rollback, the state is moving toward temporarily relaxing regulations over staffing ratios for methadone clinics. The Department of Health and Human Services’ Office of Substance Abuse has suggested that through June 30, clinics could assign one counselor for every 150 patients.
Licensing regulations call for a ratio of one staffer to every 50 patients.
“It’s an effort to maintain that service at a level that we’re comfortable with,” said Guy Cousins, director of the Office of Substance Abuse. Methadone treatment practices are based on research and clinical expertise, which the state must balance against budget realities, he said.
The 2010 reimbursement cut, to $70 per patient per week plus a $2 co-pay, also resulted in an exemption for some clinics, he said.
It’s not uncommon for the state Office of Substance Abuse to issue waivers, but the staffing ratio proposed in the most recent exemption is unprecedented, Py said.
As a result of the reimbursement cut, clinics have been forced to cut back on counseling services, an integral part of successful methadone treatment, according to Jennifer Minthorn, assistant vice president of development and community relations for Merrimack River Medical Services, which operates the Portland and Lewiston methadone clinics.
“If we do not provide the level of counseling that’s required by our accreditation company, we could lose our accreditation and go out of business,” she said.
Decades of research show that methadone treatment works and is cost-effective, Minthorn said.
“These folks really want to make improvements in their lives, and the research has really shown that it does [work] and we’ve seen firsthand the improvements people make,” she said. “They hit bottom and they’re able to reconnect with their families, they’re able to go back to school, they’re able to get jobs.”
If patients in Maine can’t get treatment, the costs will shift to jails, as addicts steal to get drugs, as well as to emergency rooms, where drug users attempt to score painkillers or wind up after an overdose, she said.
The reimbursement cut is projected to save about $87,000 in this fiscal year, plus $475,000 next year. Those savings are minuscule in light of the public health crisis the cuts would cause in the long term, Py said.
According to a 2011 federal report, Maine tops the nation in the number of residents seeking treatment for prescription drug abuse.
Py said the Office of Substance Abuse is working with clinics to cope with the reimbursement cut.
Clinics also are facing another piece of legislation that would require special authorization for MaineCare patients to continue methadone treatment beyond two years. LD 1840, which lawmakers passed pending final approval of the Legislature’s budget-writing committee, requires providers to get state preapproval for a longer treatment period.
Rep. David Burns, R-Whiting, the bill’s sponsor, said two years of methadone treatment is long enough to determine whether a patient has a medical need to continue.
“Under the current system, addicts can receive methadone for years — it’s open-ended,” he said in a March press release. “This is expensive treatment, and since the taxpayers are paying the bill it’s only fair that we put some oversight in place.”
Burns’ bill is projected to save about $1.5 million in state money in the next fiscal year, and nearly $3 million over each of the following two years.
Minthorn argued that methadone treatment is too individualized to set time limits on patients.
“People come into treatment at different stages of their dependency,” she said. “Some people might have been addicted to opiates for 20 years, versus someone that might have been addicted for only a couple of years.”
Jessica Payne said she’s tapering down her dose of the medication. But she’s not ready to cut off treatment just yet, she said.
“I’ve been on it three solid years and I’m just now at a point where I feel I can live a life without methadone,” Payne said.