The Maine leaders who convened two summits this week designed to address the state’s deadly — and growing — problem with drug addiction said they wanted to come out of their meetings with action items.
The first one should be mustering the commitment, will and ambition needed to solve the problem.
Some 105 people died from drug overdoses in Maine in the first six months of this year, including 63 who overdosed on heroin or fentanyl. That sobering reality follows the worst year on record for overdose deaths. Earlier this summer, emergency crews in Portland responded to 14 overdoses, two of them fatal, in a 24-hour period.
Last year, more than 2,500 people in Maine checked in for treatment primarily due to heroin or morphine addiction, a 167 percent jump since 2010, according to the Maine Department of Health and Human Services. Meanwhile, most people who need treatment for drug dependence aren’t receiving it: According to drug use survey data, nearly 10 percent of 18- to 25-year-olds needed treatment for illegal drug dependence in 2012 and 2013 but didn’t receive it. For alcohol, the figure is 14 percent.
Maine’s problem with addiction constitutes a public health crisis, and it needs to be treated as such.
That means an acknowledgment that Maine isn’t doing nearly enough to connect those struggling with addiction with the help they need to start recovery. It means an acknowledgment that Maine won’t find its way out of the problem with its current mix and level of resources for those who need treatment. It means an acknowledgment that the state has to marshal financial resources (read: spend money) it hasn’t been willing to marshal in order to have an impact. It means we can’t neglect prevention efforts — from education at young ages to efforts in the medical community to prescribing fewer pain medications.
At Tuesday’s opioid abuse roundtable in Brewer, hosted by Sen. Angus King, those in attendance shared tales of drug users intentionally overdosing or committing crimes to get arrested in order to receive treatment.
Many spoke of the lack of capacity to treat people with addictions who are seeking help — whether they show up at a hospital emergency room, ask a police officer for assistance or step into a treatment facility.
Building up that treatment capacity will require a significant short-term investment. Maine needs detox facilities so those who are ready for help can find it within a reasonable distance of home. County jails should not be the state’s de facto detox centers. Those in desperate need of help should not have to resort to jail. And they shouldn’t have to fear criminal charges when they are seeking help.
While policymakers have to come to grips with the reality that they will have to spend more in the short term, an investment in treatment is likely to pay off in the long run in the form of crime prevented and criminal justice and incarceration costs avoided. According to the National Institute on Drug Abuse, the return on investment in treatment can be four to sevenfold. With reduced health care costs factored in, the return can grow to $12 for every $1 invested in treatment.
As more in Maine come to better understand the state’s drug addiction crisis, one policy blunder from the past few years should become immediately clear: Gov. Paul LePage’s rejection of an expansion of Medicaid under the Affordable Care Act has hurt people. Extending coverage to 70,000 low-income adults would have allowed hundreds in recovery to continue methadone and Suboxone treatment; instead, their coverage ended last year. It would have provided others with the means to enroll in treatment. The federal government would have assumed the vast majority of the cost, and the money spent on substance abuse treatment would have yielded a return.
Another short-sighted policy move was to twice cut reimbursement rates for methadone-assisted treatment — in 2010 and again in 2012 — as a way to balance the state budget. Maine’s Medicaid program now pays methadone clinics $60 per week per Medicaid recipient, down from the $80 rate that took effect in 1995. The $60 rate is the lowest in the nation and is barely 40 percent of the $143 per week it can cost to provide effective methadone maintenance treatment.
Clinics have responded by providing less counseling, which ultimately puts their accreditation at risk and could make for less effective treatment. One methadone clinic in Sanford this week announced its plans to close.
So far, Maine’s response hasn’t matched the magnitude of the state’s drug addiction problem. Serious summits can be a good start, but it’s time to get to work.