AUGUSTA, Maine — Doctors and mental health professionals said a proposal by Gov. Paul LePage to stop state payments for methadone treatment for opiate addicts receiving Medicaid benefits would result in dramatic and likely tragic consequences.
The proposal, part of LePage’s $6.57 billion, two-year state budget, instead would require addicts to be treated with Suboxone prescriptions administered by primary care physicians.
The shift, according to Maine Health and Human Services Commissioner Mary Mayhew, would save the state about $1.6 million over the budget cycle.
About 3,800 MaineCare patients are being treated at 11 methadone clinics statewide, Mayhew told a joint meeting of the Legislature’s budget-writing Appropriations and Health and Human Services committees Thursday.
Mayhew said Maine spends $8 million in combined state and federal funds each year to cover methadone treatments and another $10 million on transportation costs for those patients.
She said 19 other states do not cover methadone treatment as part of their Medicaid programs and Maine should follow suit. She also told the committees that several studies show addiction treatment is more effective when handled by primary care physicians.
“According to the Substance Abuse and Mental Health Services Association, providing primary care to individuals with addictions enhances their recovery from substance abuse,” Mayhew said. “Primary care treatment results in better health outcomes, in contrast to back-and-forth referrals between behavioral health and primary care offices that leave up to 80 percent of individuals without care.”
But addiction and mental health experts from around Maine and beyond disputed much of Mayhew’s testimony.
Dr. David Moltz, a psychiatrist and chief of Outpatient Behavioral Health Services at Mid Coast Hospital in Brunswick, said while methadone and Suboxone are effective as opioid replacements, the drugs are not necessarily interchangeable.
“Suboxone is effective only up to a point,” Moltz said. “It has a ceiling effect, meaning that after a certain point there is no benefit to increasing doses. For someone with a history of heavy addiction, it may not be enough to stop the craving or withdrawal. Methadone has no ceiling and can be effective for higher levels of addiction.”
Bangor Mayor Nelson Durgin testified against eliminating methadone reimbursements but said his city did support a reimbursement model of more counseling and an increase in the use of Suboxone for treatment.
Bangor, Durgin said, has worked long and hard to reduce and combat opioid drug addiction, but LePage’s proposal to move to a primary care solution model did not have an infrastructure in place that could support it.
And while there are hundreds of primary care doctors licensed by the federal government to prescribe Suboxone, few do, Durgin said.
“Cultural changes need to occur within the primary care practices and rural communities to help absorb the 1,500-plus methadone patients currently seeking treatment in Bangor,” Durgin said.
Doctors who testified Thursday said most primary care practices, even those licensed to prescribe Suboxone, were not set up to handle addiction treatment in the comprehensive way methadone clinics do.
“There is simply not the resources to make this transition,” Moltz said. “Many of those doctors accept cash only, many others are at capacity and many of them just don’t prescribe.”
Timothy Cheney of Walpole spoke as an addict in long-term recovery and said swapping methadone for Suboxone would not work for many patients.
Cheney said he became a heroin addict at the age of 15 and spent 13 years on high-dose methadone maintenance in Boston.
Cheney said during that time he earned his GED, graduated from Boston University with honors and went on to work for the city of Boston as the director of research for its drug treatment program. His work in substance abuse treatment and recovery over his career eventually saw him awarded the President’s Lifetime Achievement Award for his addiction and child welfare advocacy, he said.
Cheney said he was a father and a grandfather. “I have been in abstinence-based recovery for over 33 years,” he said. “Had I not been on methadone, I would have not reached my 25th birthday.”
He urged the committee to see addiction as the chronic disease that it is.
“It is not a criminal or moral issue,” he said. “It is a health care issue, plain and simple.” The proposal to eliminate methadone from Maine’s Medicare program is “analogous to introducing a proposal that eliminates reimbursement for insulin or hypertension medication,” Cheney said, arguing the LePage administration’s proposal would result in tragic outcomes if passed into law.
“If it passes, lives will be lost or destroyed by overdose and incarceration, families will be ripped apart, the incidence of HIV, hepatitis B and C will increase, emergency room and criminal justice costs will increase and the economic and health care burden will rise dramatically,” Cheney said. “Passing this proposal will be a death sentence for many.”