May 22, 2018
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Methadone program becomes major expense for taxpayers

By Richard Malaby, Special to the BDN

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.

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