On April 21, the Bangor Daily News ran two front page articles dealing with methadone reimbursements and the waiting list at the Department of Health and Human Services for people with intellectual and developmental disabilities. For me, the two issues are very much related, at least financially. The exploding cost of our methadone program has clearly crowded out our ability to adequately fund housing for those with disabilities.
In March, I voted to cut the reimbursement to methadone clinics by 14 percent — from $70 a week to $60. The Health and Human Services Committee, on which I serve, was later asked to vote for limiting methadone maintenance treatment for MaineCare patients to two years.
I grappled with the issue, because I support the effort to get opiate-addicted people clean and in recovery. I wondered if this arbitrary limit was not intervening in medical practice and protocols, something I am reluctant to do. I would not deny a diabetic his insulin after only two years, but is limiting state-paid methadone use to two years the same issue?
I had heard and read the testimony of the efficacy of methadone, how it had “saved” so many lives. It is one of the most studied drugs on the market. I received 120 letters from current methadone users who opposed the cuts the Committee was contemplating.
As I also serve on the Substance Abuse Services Commission, I am keenly aware of Maine’s opiate addiction problem, and I am painfully cognizant of the social costs, cycle of abuse, impaired driving, poverty and crime that can accompany addiction.
There is no question that methadone is a tool that can be used on the road to recovery, when used appropriately. But clearly, an open-ended, state-funded addiction to a drug such as methadone with its high affinity for brain receptors can’t be healthful, nor is it recovery. Methadone maintenance does remove crime from the addiction, but are we not simply replacing one addiction with another?
During the public hearing and the work session, I was assured that exceptions would be made for those people who are medically unable to completely taper off methadone due to a lifetime of often-intravenous drug use. I was also reminded that going “cold turkey” from opiates, while torturously painful, is not the life-threatening killer that going “cold turkey” from alcohol dependence can be.
I decided to support the bill, because I support recovery and see methadone as a treatment that is perhaps overused and often over-dosed. However, it is a tool in reducing our opiate problem. Of the 3,971 registered patients, Maine has about 500 individuals who pay for their own methadone. How many more might join that group, or quit opiates completely, when we enact limits?
States are not compelled to offer methadone maintenance treatment and, in fact, 10 states do not. Unfortunately, once you start you can’t legally stop.
In 1996, under Gov. Angus King, Maine launched a methadone program. That year we had 148 people seeking treatment at an annual total cost of $300,000 — paid for by MaineCare. The methadone itself costs the same today as it did then, less than 5 cents per average dose.
By 2010, we had 3,971 people seeking treatment at our nine clinics. Slightly fewer than 500 of them either paid for their treatment or had their insurance pay for it. The rest, numbering 3,498, were being treated and paid for by MaineCare at a cost of $9.75 million. Transportation costs added another $7 million. Methadone recipients receive free rides to the clinic; in some cases, they take taxis and bill the fare to taxpayers.
Perhaps even more alarming is the number of opiate-addicted infants that are born in Maine every year. In the medical community, these children are known to have neonatal abstinence syndrome, or NAS. On average, two-thirds of all the opiate-addicted infants are addicted to methadone. In 2005, we had 165 NAS children born in Maine with a neonatal intensive care unit cost of $4.5 million. In 2010, we had 570 of those children born in Maine, and last year we had 667 NAS births.
Of the 11 sudden infant death syndrome deaths we had statewide in 2010, eight were NAS babies.
Somehow I wish we could take the dollars we spend on methadone and use them to address the long waiting list for adequate housing for our developmentally and physically disabled populations, some of whom have been on a waiting list for years.
State Rep. Richard Malaby, R-Hancock, serves on the Health and Human Services Committee.
There’s no reason to not have a taper program. Two years is more than generous…
No, two years is not enough for many people. What does need to change is putting in place a cap on the maximum amount of methadone prescribed (300-800 mg a day is just wrong). And there should be no take-homes, ever. That may encourage people to work toward getting themselves off methadone.
A failure rate for a few shouldn’t dictate the policy for all. How often would addicts fail on a two year taper program? 5%?15%? 50%? Are there studies that clearly demonstrate that tapering never works?
Tapering works when when the brain has adequately recovered from drug abuse. People who have been shooting up 30-40 bags of heroin a day for 20 years or abusing large amounts of oxycontin for a number of years (which selectively targets opioid receptors in the brain) are not going to magically reverse that kind of brain damage in a short amount of time.
My question is how many people does this situation cover? Are there medical publications to support your assertion? If only 10% fall into the “likely to fail” category, why have a policy of limitless methadone for all?
There is plenty of research establishing the benefits of methadone treatment; it is the most well documented form of treatment for opiate abuse. Contact the methadone program at Acadia Hospital for the names of numerous studies, if you are so desperate to have facts and figures. Please note that you are one throwing around percentages, not me.
I understand: it’s the best we have. But that’s terrible, because we can do better. I would support greater funding for opiate addiction treatment research. Substituting one dependency for another is a sad excuse for treatment (the patients deserve better).
Honey isn’t going to answer your question because the rate of people that graduate to abstinence is extremely low.
As I recall, approximately 2 to 4% are successful at kicking the habit.
That figure raises to a bit above 10% for those that detox in a controlled(locked down) environment.
The methadone industry will cite various success rates in the 80 to 90 percentile.
That’s because success to the industry means that the client is still in their program.
(Hooked.)
Methadone is a synthetic opiate that, by it’s very nature of having a long half life, is extremely difficult to detox from. (Something the “counselors” fail to mention to the rocket scientists that are looking to be enrolled).
The long half life means that it does a very good job at controlling the longing for opiates, but detoxing from it can take as long as two weeks of excruciating pain and suffering, whereas withdrawal from heroin can be done in as little as three days.
The brain can recover from opiate addiction, but not easily. It takes a stronger will than the one that agreed to get involved with drugs in the first place along with help and support from family and true friends.
The methadone industry is just along for the easy money.
“How often would addicts fail on a two year taper program? 5%?15%? 50%?
Are there studies that clearly demonstrate that tapering never works?”
Actually, there are several studies that show that. 3-6 months methadone tapers used to be quite common in the 80’s and 90’s but the failure rate was so high, about
90%, that it’s rarely done anymore. There is another study that shows similar
results for people who leave treatment after a year. The results get better the
longer someone stays in treatment. 2 years is considered the minimum, not the
maximum.
Believe it or not but things aren’t done the way they are just for the heck of it. It’s
done that way because numerous studies and 40+ years of experience has taught
us that longer treatment works best. Pushing people to get off methadone is not
in anyone’s best interest and can have devastating results. Fortunately most
clinics don’t push or force their patients to taper anymore but it used to be
very common and the outcome was just not good at all.
So, to answer your question: The failure rate for a 2 year taper program is high. The
longer someone stays on methadone the better.
“The
longer someone stays on methadone the better.”
For what outcome? A lifetime addicted to methadone with free rides to the “dealer” at the taxpayers expense? If Methadone treatment is still the best we have after 40 years, we haven’t come very far…
What a crock – this is a money making scam for the clinic and we the taxpayers foot the bill.
Put them in prison for a lot of bucks a year, or spend $$$ on methadone programs? What’s the difference? Which is cheaper?
Or should society DECRIMINALIZE drugs, as was done with alcohol, and only imprison those who break the laws due to intoxication?
As it is now, you can go out to IRVINGS and buy your 30 pack of Budweiser, go home, and get blitzed, and until you beat up your spouse, or drive your car, it is NOT SOCIETIES’ PROBLEM.
But making drugs illegal means you either have to allow methadone to be sold over the counter to registered addicts, set up a methadone treatment program, or pay a lot of money to put all of these addicts in prison.
I guess another alternative would be to RECREATE COOL HAND LUKE, and have a series of county work farms where you contract prisoners out as labor, and make a profit for the government?
I’m not offering or suggesting solutions, but merely pointing out that you can decriminalize methadone, and sell it like you do alcohol, or dispense it like psychiatric medication, or DAY AFTER BIRTH CONTROL PILLS, and other items that used to be illegal (pornography is another example), or JUST BUILD MORE PRISONS?
The problem is like WATER FLOWING DOWNHILL. Dam it one place, and you’ll have to provide another location for the water to get downstream, because IT’S ALWAYS GOING TO BE RAINING (even if you live in the dessert).
PS By the way, I do not use illegal drugs, but do use prescribed psychiatric medications, and for many years, was lucky to have a Section 8 Rental Assistance apartment in New Jersey. Not having a place to live is something most former homeless people will tell you is A TERRIBLE WAY TO SURVIVE AS A HUMAN BEING.
As I see it there are two issues here; does methadone
treatment help addicts recover, and should the state pay for it? As a
politician it’s reasonable for Mr. Malaby to comment and have an opinion on the
financing of methadone treatment. But he is way out of line to publicly make a
determination on the legitimacy of MMT (methadone maintenance treatment) as a
treatment and the efficacy of the method since he clearly has a very poor
understanding of what MMT is and how it works. The comment “…an
open-ended, state-funded addiction to a drug such as methadone with its high
affinity for brain receptors can’t be healthful” is evidence alone that
Mr. Malaby doesn’t understand the issue. What does the affinity have to do with
how “healthful” it is? And how is taking a medication as prescribed
and living a normal life addiction? Clearly Mr. Malaby doesn’t even understand
what addiction is and therefore he cannot fully understand what recovery is.
And yet he feels qualified to determine that MMT is not recovery and is just
trading one addiction for another.
FYI, Mr. Malaby and anyone else who may be interested in learning, taking a
medication daily is not addiction. Using despite negative consequences, being
preoccupied with the drug, lying and stealing to obtain the drug, the drug
causing trouble in one’s social life and employment, etc. – that is addiction.
Those are not things that apply to methadone patients. Those are things that MMT
is meant to stop, which is, by definition, recovery. Methadone, when used to
treat addiction, stops the symptoms of addiction which is what treatment is. A
lot of people take medication for long periods of time to stop symptoms of
various disorders. A person with bi-polar disorder, for example, may need
lithium to treat the symptoms of mania and depression and he may need it for a
long time. Would you call that addiction to lithium? I bet not. Then why call
taking methadone addiction? And why is providing help to manage the symptoms of
addiction for a long period of time such a bad thing? If that’s what someone
needs to live a normal, productive life without having his life revolve around
drugs I think that’s a good thing. Now if the public should pay for that
forever for everyone is definitely worth discussing but the argument that Mr.
Malaby made that it’s addiction and not recovery is simply ignorant.
Why can’t they taper down over time?
Also, are they not physically addicted to methadone? Can they stop abruptly without withdrawing?
@hophead2,
I’ll address your last question first since it’s an issue a lot of people misunderstand.
No, people are not physically addicted to methadone. They are physically
dependent which is not the same as addicted. Addiction is a brain disorder that
has behavioral symptoms. Having withdrawal symptoms when you stop taking a
substance is dependence. You can be dependent without being addicted and you
can be addicted without being dependent.
People who are on methadone maintenance are not addicted to the methadone but they are dependent. If they stop taking the methadone abruptly they do suffer withdrawal symptoms. This is true for everyone who takes any opiate, and a number of other substances (like Prozac, for example), daily for more than a few weeks. For example, a cancer patient who takes morphine for pain will become dependent pretty quickly but that person is not an addict.
Physical dependence in itself is not harmful and it can be fairly easily fixed by
tapering slowly. People on methadone can definitely taper over time and that
would be a great solution if dependence was their problem but it’s not.
There is a huge misconception that the reason addicts keep using is to avoid withdrawal symptoms. That’s not really true. In fact most addictive drugs don’t cause a physical dependency at all yet the addicts remain addicted. Most addicts, including those addicted to drugs that cause a physical dependency, successfully get off drugs several times. The problem is that they remain addicted even after the dependence is gone and end up relapsing. 85-90% of addicts relapse even after completing inpatient rehab. The brain still craves drugs and sends sense out the window causing the addict to relapse, even though he knows better and is no longer struggling with physical symptoms. Methadone stops those cravings and enables the addict to regain their sense so that they
can choose not to pick up again. It’s not mainly, as so many think, a tool to deal with withdrawal symptoms.
The problem is that like most medications it only works as long as you take it. Once you get off methadone all those symptoms of addiction comes back and many relapse. Some have learned ways to deal with those symptoms and do well but some don’t and
will continue to have to take medication to stay away from drugs. THAT is why some
people stay on methadone for a long time, NOT because they are dependent. Yes,
they could taper over time but since the risk of relapse is so high doing so is
often a bad idea. Having a time limit on treatment would be devastating for a
lot of people and truly counterproductive for both society and the individual
addict.
I hope that answered your question.
I wonder if better treatments can be developed. I understand your explanation, and I see the truth in it, but I can’t help be ask if Methadone therapy is the best option. It doesn’t treat addiction but substitutes a less dangerous dependency. Lifetime prozac dependency, or methadone dependency: neither is great. 40 years and this is still the best option? I think more research investment is required.
There’s other things (treatments) that can be done alternatively, but these programs can’t trust users who might take their meds and sell them to buy crack or anything else they might have been accustomed to getting high on. From what I’m reading on another site, suboxine programs don’t need as close monitoring, no daily visits which would save the state tons on transportation expenses alone, but that leaves the program open for abuse. Half the problem is making sure the users are taking these meds under supervision, and are not selling them to buy something they’d rather get high on.
I’m always surprised that there’s not more in the news about adderol abuse, since I’ve heard of so many abuse horror stories. It seems a.d.d. meds are given out like candy in NH/Maine, and not usually ritalin, but adderol. I’ve heard so many tragic stories about lives ruined by adderol. Benzodiazapines too. Horror stories.
Actually, many many people think that these methadone programs are addiction. And interestingly, the whole thing is very much like an addiction for the State, since “Unfortunately, once you start you can’t legally stop.” And it is also like an addiction for the clinics, for instance Acadia hospital, once they get it going, they can’t stop. Or for all of them, they certainly can’t stop as long as someone else is paying for it.
No idea when people will finally wake up on this issue. People abuse methadone. This has nothing to do with wanting to get off of drugs, and all to do with wanting to get on them with no effort at all, while claiming to be an addict to get that high they need. There’s no help for these addicts as long as they know they can walk through a door anonymously, toss their self respect, and get their fix. It’s just too easy. If it’s not methadone, then it’s suboxine (sp). You tell people they can legally get high for free and they’ll do anything it takes to get in that program, even if they’ve never really been addicted to anything.
I always thought that those programs were for people who were addicted to heroin. These days it seems that people could walk into these places with no proof of addiction of any kind of any real addiction, and are given drugs that get them high. I just don’t understand why it seems to be so easy, from what I’ve read and heard, to get such heavy drugs with just one’s claim that they have been addicted to something and can’t stop using? From all I’ve read and heard, these programs are what’s creating addictions, and anything these addicts go in there claiming to addicted to is labeled as ‘the problem’, when it’s really the free high causing the addiction problems.
Sure there’s those who truly need these programs, but my guess is that a good 75% of those using the programs and these drugs, are there for the high and do not intend to get off anything.
How do you control this problem? From what I’ve gathered, it’s an anonymous type of system. Does anyone really think that even if MaineCare didn’t fund it, these people wouldn’t still be there for their high daily?
I know some don’t like to hear this, but this is a real problem and it’s not just happening here. Anyone who thinks it’s worse here than it is anywhere else, is living in a dellusional state. This is going on everywhere it seems, but we notice the impact more due to our economical problems. What’s worse is the stigma it’s creating for those who truly need help with pain issues and disablities, but can’t get proper care because of the statistics these clinics create with their clientel claiming that they’re addicted to something, when they’re simply seeking out a free high, paid for with tax monies. You take their MaineCare away and they’ll still be at the clinics daily. They will find a way to get the money for their ‘legitimized’ high. Sad but true.
Free ride to and from the free high for the user.
Big $ for the clinic owners
Another straw on the taxpayers back.
What’s not to like for the liberal democrat crybabies in this state?
Oh…….And thank you Angus King.
I am an extreme liberal and even I find this system to be abusive and an outright failure.
Just another group of people that they have control over.
I’m glad your ideas were voted down. You should keep reading to better educate yourself before you take strong positions and advocate for legislation.
“I would not deny a diabetic his insulin after only two years, but is limiting state-paid methadone use to two years the same issue?”I can’t believe anyone would even attempt to compare a Drug addict with someone who has a serious medical condition. A State Rep even!
That is so screwed up there aren’t even words to describe it.
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