It is widely acknowledged that Maine has an opioid-addiction problem, with legally-prescribed opioid pain medications being diverted from their intended use, and heroin making a comeback as restrictions on opioid prescriptions are implemented, making pills harder to obtain.
What is not agreed upon, however, is the best approach to tackling this concerning issue. Our elected officials, understandably, are under increasing pressure to “fix” the problem.
For many, treatment for addiction is seen as part of the problem, not part of the solution. For example, the Bangor City Council recently placed a moratorium on expansion of Suboxone treatment facilities, and the Maine Legislature passed a law limiting MaineCare reimbursement for Suboxone and methadone treatment to 24 months. The Legislature is now considering limiting Medicaid-provided Suboxone treatment to six months.
While well-intentioned, these actions run contrary to Acadia Hospital’s standards of practice and contradict 60 years of scientific research, which not only discourages against the use of arbitrary time limits to govern who receives medical care and over what duration, but it overwhelmingly supports opioid replacement therapy (prescribing methadone or Suboxone) as the most reliable and effective treatment for severe opioid addiction.
Policies to limit access to services send the wrong message to those who would benefit from such treatment: “You are a burden to our community, and we are going to decide how long you may access treatment options.”
The sad reality about opioid addiction, which has been consistently reflected in the empirical research, is that premature discharge from replacement therapy dramatically increases the risks for both drug relapse and accidental overdose.
Isn’t this what we as Mainers are trying to prevent?
Here are the facts: methadone replacement therapy reduces mortality rates and criminal activity among those living with opioid addiction, increases employment rates and family stability, and substantially improves birth outcomes for pregnant, opioid-addicted women.
At Acadia Hospital, about 65 percent of our methadone maintenance patients are undergoing a therapeutic taper, with the goal to taper off methadone completely. These tapers must be done under a physician’s care and may take as long as several years to complete to avoid relapse. Acadia Hospital loses money on each methadone client, so there is no financial incentive to increase or prolong treatment.
Legislating arbitrary time limits on reimbursement for treatments for a susceptible population injects government into medical decision making, and it is poor policy. The addicted population that would be affected is encumbered by tremendous stigma and, quite honestly, represents an easy target for the frustration others feel regarding the opioid problem.
The stereotype of individuals receiving opioid replacement therapy is that they aren’t interested in improving their lives but are simply looking for a subsidized way to stay high. Another piece of misinformation is that a majority will tend to stay in methadone treatment for an extended period of time, maybe forever. In our experience of treating thousands of individuals, none of these stereotypes reflect the majority of our patients, who are highly motivated to achieve and maintain recovery, sustain employment, return to school, raise their families and reach their personal goals. The large majority of patients being treated for addiction became addicted on legally prescribed medications, not from recreational use of illicit drugs.
In 2013, the Maine Legislature addressed this root cause in a responsible way through legislation encouraging alternative approaches to the use of opioids for pain management, such as Cognitive Behavioral Therapy, which Acadia Hospital offers. Such a program provides an effective treatment for chronic pain sufferers not wishing to take, or wanting to reduce their use of, opioid medications. However, for those who have become addicted to opioids, we must allow qualified providers to treat their addicted patients unencumbered by misinformed, restrictive laws and moratoriums.
While no treatment is perfect, the long-term cost to society is far less when people are in treatment versus the alternative of actively abusing opioids. Arbitrary time limits on treatment and moratoriums on medical services that are driven by emotion and not based on informed science is dangerous public policy.
What’s next? A limit on Lipitor that lowers cholesterol for those of us who consume too much bacon?
Daniel B. Coffey is president and chief executive officer at Acadia Hospital in Bangor.