EDITORIALS

Limiting Maine addiction treatment is foolish

Kathy Alarie, CAP Quality Care Clinic nursing director and assistant director of programming, stands beside artwork created by a graphic arts student who is a client at the methadone clinic in Westbrook. The inspirational quotes on the poster are from fellow clients who receive their daily methadone maintenance dose in the booth behind Alarie.
Kathy Alarie, CAP Quality Care Clinic nursing director and assistant director of programming, stands beside artwork created by a graphic arts student who is a client at the methadone clinic in Westbrook. The inspirational quotes on the poster are from fellow clients who receive their daily methadone maintenance dose in the booth behind Alarie.
Posted Dec. 29, 2012, at 6:06 p.m.

One day, what if you suffer an accident, are prescribed a painkiller, such as oxycodone, for your extreme pain and become addicted? What if the debate about treatment centered on your life?

Being addicted to prescription drugs causes family- and employment-related distress for so many Maine people. In 2008, the state had the highest rate of residents admitted for treatment for oxycodone addiction in the country and one of the nation’s biggest increases in pharmacy robberies.

Opiate addiction is a chronic disease — it doesn’t go away — but it can be managed over time. So for those who are working to stay clean, a cap on MaineCare reimbursements for methadone and Suboxone treatments, which takes effect Jan. 1, is insulting. Any savings to the state will likely be consumed by long-term health care and criminal justice costs.

It was not for medical-based purposes that the Maine Legislature approved a supplemental budget in the spring that limits coverage for methadone treatments to two years for MaineCare patients unless they get prior authorization. A similar change for Suboxone treatments, which also takes effect Jan. 1, was included in a February supplemental budget.

Placing an arbitrary limit on treatment perpetuates a stigma that people who suffer from addiction exhibit a moral failing. People make unhealthy decisions, but addiction is a medical condition, and patients require comprehensive physical and psychological treatment that is right for them. Not everyone needs to be on methadone or Suboxone treatments for two years, but a fair number do.

The U.S. Centers for Disease Control and Prevention describe methadone treatment as “the most effective treatment for opiate addiction.” Methadone is not a cure. It suppresses withdrawal symptoms, lessens cravings and should be paired with counseling to address underlying issues. With proper doses, it does not get people high. It is a long-term, long-acting treatment, and the length of time people need it varies.

What will change on Jan. 1? The clock will begin ticking for methadone patients on MaineCare. After two years, physicians will have to request an extension for some patients to continue to provide methadone treatment, according to the Maine Department of Health and Human Services. A tapering-off period will begin if the request is denied.

MaineCare patients on Suboxone, another common opiate replacement drug, will be subject to a 24-month retroactive cap starting Jan. 1 if they don’t get prior approval.

Is having another administrative layer necessary? Will it help patients? Will it provide assistance to doctors who are being bombarded with patients needing treatment?

The state estimates that methadone treatment cuts will save an estimated $1.36 million — starting January 2015. But a state plan amendment must still go to the Centers for Medicaid and Medicare Services for approval. Suboxone treatment estimated savings total $600,000.

Coverage cuts are foolish, especially since dollars spent treating those suffering from substance abuse save future health-care costs, according to the Maine Office of Substance Abuse Services.

And treatment services make up a small percentage of the total estimated workforce, criminal justice and health care costs associated with substance abuse in Maine — which in 2005 totaled $898.4 million, equalling $682 for every Maine resident. Of that total, substance abuse treatment costs comprised the smallest proportion, at 2.8 percent. Costs associated with crime comprised the largest proportion, at 23.9 percent.

Across the U.S., the sale of prescription painkillers to pharmacies and health care providers tripled over the last decade, according to the Drug Enforcement Administration. So did the number of fatal prescription drug overdoses. Maine is at the forefront of the prescription drug epidemic, and the state’s reaction is to cut methadone and Suboxone treatment?

We are disappointed. Because, in the end, it’s not just about you. We’re all touched by prescription drug abuse — whether we feel the effects directly or not.

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