There are problems with methadone treatment for drug addiction. It requires many recovering addicts to travel to a clinic each day for a dose of the drug. This has the effect of congregating recovering addicts in service center communities like Bangor. Treatment can take years.
Other treatments, especially Suboxone, can alleviate many of these problems for some people and offer promising alternatives. But Suboxone, too, has problems. It is more easily diverted to people without a prescription. It can have deadly side effects when combined with alcohol and other medications. It must be prescribed by a doctor, but few are trained and available to treat addicts.
Given this complexity, a state budget is not the place to dictate — as a matter of state policy — the optimal treatment for opiate or heroin addiction. Yet, Gov. Paul LePage has proposed in his two-year budget that the state stop paying for methadone treatment for those on MaineCare to move them to Suboxone treatment. The rationale behind the move — to get more people to be seen by primary care physicians — is a good one. But it is not that simple.
Methadone and Suboxone are not the same drug. Substituting one for the other is not like replacing a name-brand drug with a cheaper, generic version.
Suboxone, which costs much more than methadone, is a good alternative for people with less severe addiction. For those with more serious, or long-standing, addictions, methadone is the only choice. In fact, some with severe addiction are treated with methadone for years before stepping down to Suboxone when they need a less potent drug.
“Legislators should not determine the proper treatment for addiction any more than the government should determine the proper treatment for hypertension or heart disease,” said Dan Coffey, president and CEO of Acadia Hospital.
It is easy to demonize drug addicts as unmotivated residents living off taxpayer-funded programs. But addicts and recovering addicts are our co-workers and our neighbors. For a large number, their first exposure to opiates came through medication they were prescribed for pain. In 2008, the state had the highest rate in the country of residents admitted for treatment for oxycodone addiction.
Methadone treatment is not easy; it requires a commitment to recovery. Those undergoing methadone treatment must go to a clinic every day to get a liquid dose of the drug, which is hard to divert. For recovering addicts in rural areas, this means a daily commute to service-center communities such as Bangor. Treatment, which should also include counseling and other supports, can take years. More than half those receiving methadone treatment are on MaineCare.
While Suboxone is prescribed by physicians, few, especially in rural parts of the state, have gone through the training and licensing required by the Drug Enforcement Agency. Those who have can only treat 100 patients at a time. So, without a system to ensure more doctors are willing and able to treat patients with Suboxone or other alternatives, simply ending state funding for methadone treatment (which will also cause a loss of federal funding) will leave many recovering addicts with no options.
The governor’s budget proposal does include $300,000 for a pilot project to use Vivitrol, an anti-addiction drug given through shots, with addicts who have been recently released from jail. Trials like this are a better approach than simply cutting off methadone use.
“We don’t have the infrastructure in place for this transition,” said Bangor City Manager Cathy Conlow. To ensure that recovering addicts have needed treatment, she worries that Bangor would have to pick up the cost of methadone treatment if it is not covered by MaineCare.
Two years ago, the state limited MaineCare recipients to two years of methadone treatment. Taking that treatment away completely, without equivalent alternatives readily available, will do more harm than good.
Resources should be invested into developing those alternatives, instead.