In the wake of news that more and more patients are seeking treatment for heroin use in Maine, one bill this session was particularly troubling. LD 802, sponsored by Rep. Lawrence Lockman, R-Amherst, would have prohibited coverage under MaineCare for certain treatments for people suffering from drug addictions. Fortunately, the legislative Committee on Health and Human Services voted that the bill should not pass and the full Legislature recently agreed.
But some arguments presented in favor of the bill showed there continues to be a divide in understanding about addiction, especially among leaders responsible for helping to address the state’s massive opiate addiction problem. Maine has the highest addiction rate per capita, according to the Maine Office of Substance Abuse, and more people died from prescription drug overdoses than car crashes in 2008, 2009 and 2010.
Yet, even though the American Society for Addictive Medicine no longer defines addiction as a behavioral problem but a “ primary, chronic disease of brain reward, motivation, memory and related circuitry,” some Maine lawmakers are still arguing over whether to call addiction a “disease.” Apparently, if it’s not termed a disease, it means the state has less responsibility to help treat it — because patients simply can decide to no longer be addicted.
Of course, in reality, drugs change the brain. And no single approach to detoxification will work for all addicts. There is certainly no research to back up the effectiveness of ending health insurance coverage for low-income patients’ methadone treatments for their addiction. And while it’s a good idea to change the physical form of some prescription drugs to be more difficult to misuse through snorting or injecting, it doesn’t necessarily get rid of the problem. People will find other means to get high. What works? Finding the treatment that’s right for the patient.
“Opiate addiction doesn’t remit by itself. Decreasing access to one opiate does not resolve the problem of opiate addiction. Opiate addiction worsens. Opiate addiction spreads. Opiate addiction can only be affected by increased access to opiate treatment,” said Dr. Mark Publicker, president of the Northern New England Society of Addiction Medicine.
Defeating LD 802 was the right move, but it can’t be called a step forward, especially when other policies and mindsets continue to hold the state back. Maine has limited the duration of methadone treatment for which MaineCare recipients will be reimbursed. Treatment is not readily accessible throughout this rural state. And MaineCare recipients being treated for opiate addiction also cannot gain coverage to participate in an intensive outpatient treatment program that addresses their other disorders. To get and stay sober, some patients need more than just medical treatment.
Residents and therefore lawmakers will continue to argue that the state can’t afford to pay for treatments. They will say that addicts’ choices led to their drug misuse, so they should deal with the addiction on their own. But that approach neglects the fact that society pays for other people’s addictions all the time. Moralizing a serious public health problem only makes it more difficult to fix. There were 56 pharmacy robberies in 2012 — a state record. In 2012, there were 779 drug-affected babies born in Maine, up from 165 in 2005.
It will take far more than state policy changes to address Maine’s drug problem. For example, a greater emphasis on prevention efforts, especially for the young, could help reduce the risk of future drug abuse and addiction. But a wider cultural shift is needed, too. The duration and type of treatment for opiate addiction should be determined by the patient’s history and the severity of the drug addiction, not by arbitrary limits set in law. We’ve had enough of uninformed debates about whether it’s right to treat addicts. Treat them with respect, treat their disease and address a statewide problem that otherwise will only get worse.