November 13, 2018
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LePage should leave medicine to those of us who went to medical school

George Danby | BDN
George Danby | BDN

Gov. Paul LePage apparently thinks he went to medical school. He thinks he knows something about addiction. He wants to shut down methadone clinics — and replace them with what?

I moved to Maine a year ago, to Washington County, and was shocked at the opioid addiction epidemic I encountered. Everyone I met was either addicted to opioids or related to someone who was. In response, I received training in medication-assisted treatment and obtained my buprenorphine waiver to help treat addiction.

There are limits to office-based treatment. Not everyone responds to buprenorphine. Some patients need a more structured environment. Office-based treatment requires very motivated patients who are ready to be responsible for their recovery. That is not always the case for people with addictions. Particularly early in treatment, they may still be engaged in behaviors that require more monitoring than is possible in an office setting.

The governor thinks the 90 minutes he spent monitoring a clinic tells him the story of how methadone treatment works. That is misguided. Federal mandates are in place for the number of groups and counseling sessions patients must attend. The seven-minute average the governor observed likely were dosing days and not counseling days. I would like to have more counseling in place, however. As it is, methadone treatment barely survives financially. Who is going to pay for the increased time?

In addition to my office practice, I previously served as the medical director of Discovery House Bangor and Discovery House Calais. I would encourage the governor to visit, to at least read up on the history of addiction and treatment, and come up with solutions rather than make brash statements out of ignorance. He could start with “ Methadone: Bad Boy of Drug Treatment: What Works & What Doesn’t” by Rebecca James. At least start with facts.

The Maine Department of Health and Human Services also is proposing new requirements for buprenorphine prescribers that are untenable. As a solo family medicine physician, I cannot possibly have a psychotherapist in my office in rural Maine — much as I would love to for so many reasons — nor can most practices. While the intent is laudable, the practicality of such legislation would be to shut down the availability of medication-assisted treatment.

The proposed law also would require practices to be open six days per week. Again, this would shut down many providers of medication-assisted treatment. We are trying to expand access to treatment, and it seems LePage wants to eradicate treatment options.

LePage also famously said he does not think Narcan saves lives. What is his intent, really, just to let all people with addictions go without any treatment at all? Perhaps he is unaware that all medication-assisted treatment, including methadone, is associated with a reduction in criminal behavior. We have tried filling our jails with people with addictions, and that repeatedly has been a failure. I am not sure why the governor insists on continuing this tact. As I recall, the definition of insanity is repeating the same action and expecting a different outcome.

LePage should leave medicine to those of us who spent the time to go to medical school, residency and get advanced training. The damage new legislation placing strict limits on prescription opioid painkillers is going to do and the number of new addicts it is going to create is going to be bad enough. Apparently, we did not learn from the last time we legislated what doctors do — when I started my training — which was to legislate the treatment of pain. As physicians we were told we had to treat pain. We were told that pain was the fifth vital sign. We were told we were not giving enough pain medication. Legislating the treatment of pain is what has contributed to our current opioid crisis. Yet we did not learn from this disaster, and once again those without any medical training are telling physicians what to do.

As the new opioid prescribing requirements go into place at the end of the month, patients whose pain medication doses are drastically reduced will turn to the streets, and we will have a whole new group of addicts to treat. The governor should not take away the options for treatment.

Cathleen London, M.D., is a physician with a private practice, Door To Door Doctors, in Milbridge.

 


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