BANGOR, Maine — On the first day of 2014, hundreds of Mainers were removed from their methadone and Suboxone treatment regimens after losing MaineCare coverage, prompting concern among addiction treatment experts and addicts that many former methadone patients will end up back on street drugs, in prison or dead.
MaineCare recipients known as “noncategoricals” — typically childless adults who don’t qualify for disability or other categories that would make them eligible — lost their coverage on Jan. 1. In that group are hundreds of addicts in recovery who use the program to pay for their chemical-assisted treatment.
Gov. Paul LePage began looking at ways to reduce the number of Mainers on MaineCare in recent years. He has said he wants more “able-bodied” Mainers to fend for themselves, work and pay for their own health care, and that the state’s welfare system isn’t financially sustainable.
Officials who deal with addiction worry the human costs will far outweigh the costs the state faces in paying for their treatments through MaineCare.
On the edge
Jacob Vanadestine, 33, of Palmyra had been on methadone for about six years. He began receiving treatment in Bangor five years ago at Discovery House, a national outpatient addiction treatment provider that also has offices in South Portland, Waterville and Calais.
“With all the drugs I did in my past, and how addicted I became, my brain has been altered by it for the rest of my life,” Vanadestine said during a recent interview. During that interview, he shook, struggled to sit still and was tense.
When Maine lawmakers passed a two-year lifetime limit on methadone treatment that took effect on the first day of 2013, Vanadestine figured he had two years to taper his doses and, hopefully, get clean. Then, in October, he received a letter notifying him that he would be losing MaineCare at the end of the year.
Instead of another year to taper off methadone, he had two months. As he weaned down his doses toward the end of the year, his withdrawal symptoms became so severe that he asked Discovery House to stop reducing his doses, he said. He had to come off methadone suddenly on Jan. 1.
On methadone, “I was able to at least keep myself out of trouble each day,” Vanadestine said. “Everybody that I know that’s using the program right, their lives have always gotten better.”
Vanadestine recently spent three nights in severe pain at the emergency department of a Pittsfield hospital waiting for a crisis bed to open up, according to his mother, Sheryl Vanadestine. He was eventually discharged and sent home without an answer, she said. Doctors think the pain is related to his withdrawal, but he isn’t so sure. He still has no health insurance, will have to swallow the costs and likely sit on the debt for a long time, his mother said. He recently sent out an application for disability, but isn’t sure if the severe knee and leg pains that put him in the hospital will be enough for him to qualify.
“It’s like all the old feelings, the old thoughts, the old cravings, all of it is starting to come back,” Jacob Vanadestine said during an interview a week before losing MaineCare benefits. He was worried he might relapse, get back onto street drugs and start shoplifting again to feed his addiction.
His concerns turned out to be right. According to his mother, he went to the streets in late January to acquire illicit drugs to stave off withdrawal pains.
“This is hard. This is scary. I mean, I don’t know, I might die,” he said in the weeks leading up to the end of his MaineCare.
Brandi Harriman, 28, of Glenburn and Lindey Saunders, 35, of Ellsworth also received letters in October saying they were losing MaineCare. Both also were receiving methadone treatments at Discovery House.
Saunders says she has back problems and can’t work. She is hoping to get disability but has already been denied three times. She is appealing but believes it will take awhile to find out the results.
She’s on 12 different medications for issues ranging from pain to depression and says doctors have told her she can’t just stop taking them. Her parents have been paying for her medication and paying the $95 per week fee to continue purchasing methadone while Discovery House continues to try to wean her off.
Harriman also is continuing her methadone program by paying for it out of pocket, but the money is drying up, and she isn’t sure she’ll be able to pay her next series of bills.
“There are a lot of people in this program that would probably be dead if they hadn’t come here, and I’m one of them,” Harriman said.
She said she would like to get back into the workforce, but she doesn’t have a car and lost MaineCare, which paid for transportation to appointments. She doesn’t live close enough to town to use public transportation.
“This isn’t a substitute for a high, this isn’t a substitute for doing the same thing you were doing before,” Harriman said. “This is a program that will give you just as much as you need to feel better, and then you wean yourself down.”
Brent Miller, director of Bangor’s Discovery House, said the loss of treatment would be “life-destroying” for many of his clients, some of whom have told friends and workers at Discovery House that they were considering having children in order to retain their MaineCare, he said.
The state doesn’t have an accurate count of how many addicts lost their MaineCare coverage on Jan. 1, but in 2012 there were 869 Mainers considered “noncategoricals” who filed MaineCare claims for their methadone treatments for the year. That included 311 from Bangor, 55 in Portland, 130 in South Portland, 103 in Westbrook, 116 in Waterville and 74 in Calais, according to data provided by the Maine Department of Health and Human Services. Any of those “noncategoricals” who were on MaineCare in 2012 and were still on it at the beginning of 2014 lost their method of paying for treatment, as did any “noncategoricals” who joined treatment under MaineCare in 2013.
Add to that several hundred more “noncategorical” patients expected to lose coverage that pays for Suboxone, another replacement drug, and there likely are well over 1,000 people who will lose access to treatment. Maine DHHS says there were 1,081 physicians in the state with about 11,500 patients to whom they prescribed Suboxone, but DHHS doesn’t have information on how many of those patients used MaineCare to pay for their treatments and lost that coverage.
Both Suboxone and methadone are used to treat opioid dependency, serving as a replacement drug that patients are weaned off slowly, sometimes over the course of several years. While administering the medication, officials at treatment centers work to find a dosage that helps a patient feel “normal” — without getting “high” but still staving off symptoms of withdrawal.
Options for “noncategoricals” losing their MaineCare are few — hope to qualify for disability coverage; get a job with benefits or pay for new coverage on the health care marketplace; or rely on family and friends to help cover medical costs.
Bangor City Council Chairman Ben Sprague said that since Jan. 1, the city has seen an influx of requests for general assistance in a program that is already stretched to the limit by budget constraints. Twenty requests have come in since the first of the year, he said, and in one day, there were four requests from people who needed a total of 17 different medications, the costs of which would add up quickly.
“I’ve said it before, and I’ll say it again,” Sprague said. “Bangor is stretched past its limits. Bangor’s taxpayers cannot fund the care for an entire region.”
Responsible or ‘life-destroying’
LePage has been critical of methadone as a treatment method.
“One of the primary reasons the governor introduced methadone legislation last session was because this addiction has no recovery plan,” LePage spokeswoman Adrienne Bennett said in a recent email. “The current programs are continuous without a plan for recovery, which is not healthy for the individual and unaffordable for Maine taxpayers paying the bills.”
Childless adults became eligible for MaineCare coverage about a decade ago under a Medicaid expansion.
Bennett stressed the fact that Maine has the third-highest Medicaid spending total in the nation and the state’s welfare system isn’t financially solvent as it stands.
Miller challenged LePage’s views of methadone treatment. Federal and state laws require every individual in methadone service have a treatment plan that is updated every 90 days.
“The science, the data, the evidence are unequivocally clear,” Miller added. “This is a medical disease no different from heart disease, cancer, any medically diagnosable illness.”
Miller likened cutting off access to substances like methadone and Suboxone to cutting people off from medication used to treat chronic illnesses like heart disease or diabetes.
“The only way to improve this chronic, lifelong, relapsing disease it is to treat it,” and, when the client is ready, help them get off the medication-assisted treatment and into a recovery support system — such as a support group, counselor, family or church — that the addict can use to help maintain their sobriety, Miller argued.
He also questioned whether the human costs of cutting hundreds of people from addiction treatment would outweigh the roughly $22 million in savings the state expects to see from not paying for their health care.
Many who are losing their treatment could end up back on drugs, committing crimes to feed their addiction and eventually find themselves in jail, Miller said. He added that providing a year’s worth of methadone costs about $3,000, whereas it costs the state $56,000 to incarcerate one person in prison for that same year, according to the VERA Institute of Justice. Frequent emergency room visits from addicts who relapse would also be costly, he said.
Shawn Yardley, director of community services for Penobscot Community Healthcare and Bangor’s former director of health and community services, and Miller cite studies that have found that when addicts are involuntarily removed from their chemical-assisted treatment programs, there’s an 80-90 percent chance they will relapse and turn back to street drugs.
Yardley also questioned the LePage administration and GOP’s strong stance against the Medicaid expansion and their using it as justification to eliminate childless adults from the MaineCare rolls.
“The issues of mental illness and substance abuse and treatment is unfortunately caught in an outdated and very emotional and ideological place denying the current science and best thinking of our medical science field,” Yardley said. “We certainly need to stay focused on these issues impacting health outcomes and health costs, but denying health care to thousands of poor people in Maine should be a separate conversation and not used as some sort of punishment to an entire group of people.”