There has been a lot of debate in recent months about replacing methadone treatment for opioid addiction with alternatives, such as Suboxone. In his proposed two-year budget, Gov. Paul LePage would end methadone treatment for MaineCare recipients to move them to Suboxone. Many treatment and health care providers warn that addiction treatment isn’t as simple as swapping one drug for another.
Sen. Geoff Gratwick of Bangor has offered a way through the debate. Building on the work of a Bangor group that took a hard look at drug abuse and addiction in the city, he proposes a pilot project to test the effectiveness of using drug treatments other than methadone to deal with opioid addiction. The test sites would be outside Bangor, involve primary care providers and offer peer support.
This is a smart way to cut through the competing claims to verify what will and won’t work. It can also identify what system and supports must be in place for the best chance of success. This is far superior to cutting off a portion of Maine’s population from a treatment they rely on to overcome addiction without a viable alternative in place.
Much credit goes to a committee of residents, medical providers, treatment specialists, law enforcement officials and others who met for six months to come up with a plan to address drug abuse and addiction in Bangor. They emphasize three key focus areas. First is to encourage better pain medication prescribing practices to reduce the supply of opiates. Second is to re-evaluate how addiction is treated in emergency rooms and whether intermediary steps are needed rather than simply sending those who have overdosed back home. The third focus, and impetus for the bill, is to look for alternatives to methadone.
Bangor City Councilor Pauline Civiello was a member of the Bangor committee and is a strong supporter of Gratwick’s bill because it “looks at the whole person.” In addition, it would allow treatment closer to home, offers a support system and holds participants accountable.
Bangor has three methadone clinics, which have long been a cause for concern. Methadone must be dispensed at licensed clinics, requiring that recovering addicts make daily trips to communities such as Bangor and Westbrook. Patients must take their doses — dispensed either as a liquid or a wafer — in front of clinic staff to ensure they don’t smuggle it out of the building. Patients can earn the right to take a bottle home if they avoid illicit drug use and remain committed to treatment.
Suboxone, which costs much more than methadone, is a good alternative for people with less severe addiction. It is prescribed by a physician, and doctors who are registered to prescribe Suboxone can only treat 100 patients at a time. There are not enough doctors licensed and trained to absorb the 3,800 addicts on MaineCare who currently get methadone at the state’s 11 clinics.
As he has amended it, Gratwick’s bill, LD 524, begins to address the concerns with both treatments. It would set up one or two test sites at least 30 miles from existing methadone clinics. This will allow clients to remain close to their families and jobs so they can reintegrate into their communities, one of DHHS’s laudable goals with its Suboxone plan. It will also save state dollars on transportation for methadone patients, which can instead go toward paying for the pilot projects.
It will include primary care providers, perhaps through the state’s system of Federally Qualified Health Centers. Increasing the number of doctors willing and able to prescribe Suboxone must be a cornerstone of any program that seeks to reduce methadone use in favor of alternatives. Telemedicine will be examined as a means of patient counseling. Those who are selected to participate in the initial program must sign a contract with a peer recovery supporter, who will be available to help and support the client’s recovery.
This comprehensive approach is certainly worthy of support.