We’re mildly encouraged by Gov. Paul LePage’s admission of the obvious at a Bangor church Tuesday night.
More than a year after he declared in a veto letter that naloxone “does not truly save lives; it merely extends them until the next overdose,” LePage admitted to the overdose antidote’s life-saving potential during a summit on addiction at Crosspoint Church.
“I believe that Narcan will save lives. However, if you allow it to go to 12, 13, 14, 15 times with the shots, the odds are against you,” he said at the forum, calling for aggressive intervention after someone is revived — either charging that person for the dose of naloxone or forcing the drug user to “go to rehab.”
For a governor who has been intent on standing in the way of meaningful progress in fighting the state’s opioid addiction epidemic, the change in thinking about naloxone represents progress. But it would be more encouraging if the governor’s change in thinking actually signaled a willingness to undertake a more aggressive state effort to combat opioid addiction based on the scientific evidence about what works in treatment.
That doesn’t appear to be the case, however. At the same forum Tuesday night, LePage stated that faith-based treatment is an effective way to curb addiction.
If Maine stands a chance of reducing the toll of an epidemic that claimed 376 lives last year, it can’t rely on faith-based treatment that preaches abstinence and no medication. The state needs to focus on making available treatment that’s proven to have the best chance of being effective. Based on decades of medical research, the most effective form of opioid addiction treatment available is treatment that involves medication and counseling and that recognizes addiction as the disease that it is, not as a personal failing.
There’s little debate in the scientific community about what kind of care people with addictions should be getting — care backed up by decades of scientific evidence: treatment that couples medication such as methadone or Suboxone with behavioral therapy.
Yet, as Huffington Post writer Jason Cherkis put it in 2015, “addiction treatment is mired in a kind of scientific dark age.” Even though research has repeatedly shown that patients’ chances of survival, of avoiding future drug use, of staying away from criminal activity and of future employment increase significantly when the treatment they receive involves medication, medication-assisted treatment too often is the exception rather than the norm.
While addiction is a chronic disease, there’s widespread resistance — even shared by U.S. Health and Human Services Secretary Tom Price — to treating it as such. No medical specialist would prescribe a cancer treatment regimen that didn’t involve the best available medicine. But many, including some in power, view treating addiction with medication as, in Price’s words, “substituting one opioid for another.”
If LePage were interested in launching a concerted, evidence-based effort to combat the state’s addiction epidemic, there are several places where he could start.
While Maine’s Medicaid program covers all three Food and Drug Administration-approved medications to treat opioid addictions, it limits access to the two most common medications — methadone and Suboxone — by initially limiting Medicaid patients to two years on the medication. Such time limits apply to no other medications, and there’s no scientific evidence showing that addiction patients should be time-limited.
LePage signed this hurdle into law, and his administration has opposed eliminating it.
In addition, Maine’s $60-per-week reimbursement for methadone clinics — among the lowest rates in the nation — has affected the quality of care at some clinics by limiting the amount of behavioral counseling available. Coupled with the misguided two-year limit, this low rate puts the ability of many clinics to provide effective care for their patients in doubt. Last year, legislation to raise the reimbursement rate passed both chambers of the Legislature, only to die for lack of funding.
The direction in which Maine’s anti-addiction policies should move is clear. Maine people with addictions deserve a shot at the most effective treatment available.