March 18, 2018
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It’s time to start treating addiction for the medical problem it is

BDN file | BDN
BDN file | BDN
Nurse Deanna Boisvert cleans up after dispensing methadone March 17, 2015, at CAP Quality Care in Westbrook.
By The BDN Editorial Board

The medical consensus on addiction has long been definitive: Addiction is a brain disorder that needs to be treated as such.

But even as Maine contends with a record number of deaths caused by heroin overdoses and a steadily increasing number of people seeking treatment for a heroin addiction, it’s still the exception — instead of the norm — for someone suffering from an opiate addiction to receive the treatment medical researchers have long agreed is most effective.

That treatment is generally methadone maintenance therapy coupled with counseling and support services designed to help someone with an addiction get back on his or her feet.

But as BDN editor Erin Rhoda shows in her recent chronicle of 21-year-old Garrett Brown’s life, it’s possible for someone suffering from the chronic disease of addiction never to receive evidence-based treatment — even if that person ends up in the emergency room after an overdose or in jail after an arrest.

Put together, it amounts to a widespread failure in Maine and elsewhere to treat addiction for what it is — a medical problem.

In 1995, when Maine’s first methadone clinic opened, the reimbursement rate from MaineCare — the source of health coverage for most seeking treatment — was $80 per week per patient. It was all-inclusive, covering daily medication at the clinic; monthly counseling; random urine screening; occasional blood work; regular reviews by a doctor to determine the right medication dose; case management to connect the patient with education and job opportunities, housing and other services; and all the associated administrative work.

Virtually any other service provider would have the ability to bill for those services separately.

Eighty dollars in 1995 is worth $124.37 in today’s dollars, and research performed for the National Institute on Drug Abuse has concluded methadone maintenance therapy, delivered effectively, should cost $143 per week. But MaineCare’s weekly reimbursement rate today — expected to cover the same range of services — is even lower than it was more than 20 years ago: $60, one of the lowest rates in the nation.

In response, clinics have cut back on the numbers of counselors they employ, and the state has allowed it so clinics can remain open.

A major element of the methadone treatment model is counseling, and “that big leg has been undermined dramatically,” according to Brent Miller, director of Discovery House, a Bangor methadone clinic.

One consequence has been higher burnout and greater turnover, Miller said. A common complaint among Discovery House patients is that they have limited access to their counselors and that their counselors change frequently. Discovery House employs five counselors; properly funded, Miller said, the clinic would employ 12.

Another consequence of below-cost reimbursement rates is limited capacity and waitlists. At Discovery House, which serves 550 methadone patients, the waitlist last week numbered 61 people.

“You ought to celebrate that a person is reaching out to get well,” Miller said. “We impugn them at every turn and make it difficult for them to actually do it. That’s why it’s a miracle that people are able to fight through the prejudice and actually get into recovery.”

If a spot opens up and Discovery House calls the first person on the waitlist, the clinic might no longer be able to reach that person. Maybe he or she has started using again, been arrested or overdosed.

If Discovery House does manage to reach someone on the waitlist, if that person has MaineCare and if that person successfully starts treatment, a three-year-old state policy could limit the length of methadone treatment to two years. (The same limit applies to buprenorphine, known commercially as Suboxone.) For what other chronic disease is treatment limited to two years?

It’s no wonder so many view methadone treatment as ineffective — because state policies haven’t allowed it to work to its full potential.

Still, the research shows methadone treatment, compared with other treatment options, offers those with an addiction the greatest hope. And when one considers the benefits of methadone clinic patients being able to work and avoiding arrests and hospitalization after starting treatment, the societal and financial benefits become clear.

That’s why Maine policymakers’ decisions over the years to let the state’s investment in methadone treatment languish could well end up costing more long-term than they saved. Now that the seriousness of Maine’s addiction epidemic is clear, it’s critical the state pay more for methadone — a legislative committee Wednesday endorsed a measure to boost the reimbursement rate to $72 — eliminate the arbitrary two-year methadone treatment limit and start treating addiction as the medical problem it is.

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