Lawmakers returning to Augusta next week have a long-awaited item on their agenda: a legislative response to Maine’s unrelenting drug addiction epidemic.
Republican and Democratic legislative leaders have come together to propose spending nearly $5 million over the next 18 months on a Bangor-area detox center, added treatment capacity, prevention and education efforts and 10 new drug enforcement agents.
After so many months of partisan antagonism at the expense of progress in Maine’s fight against addiction, we welcome the consensus in Augusta on the need to act. We welcome proposed investments in new treatment capacity. And we recognize that, in order to increase the odds of success, legislative leaders are offering Gov. Paul LePage an olive branch in the form of funding for 10 new drug enforcement agents.
The bill, however, is heavy on changes that will take a long time to implement — hiring one new drug enforcement agent can take months, for example — when it also should include changes that could help struggling Mainers sooner.
Take the Bangor-area detox center. It would be a 10-bed facility where those who are ready to stop using opioids can stay for three to five days during their withdrawal. They would have access to medical supervision and medications to manage withdrawal symptoms. They would be expected to start participating in a peer recovery network. The ultimate goal would be to connect those newly in recovery with the course of treatment they need to stop using.
“We feel very confident that that program would not go with empty beds,” Pat Kimball, executive director of Wellspring Substance Abuse and Mental Health Services, said. “It would be affordable and easily run and would be a real godsend to the community to help people enter into recovery.”
The legislation would earmark $200,000 this year in startup funds and $700,000 the next year to cover costs for those without health insurance. A rapid opioid detox, properly connected with follow-up treatment, can be an effective start to recovery, but the Bangor area has a long way to go before it has a detox center. A planning committee has yet to identify a location — members have spoken of using a renovated house, which would have to be brought up to medical standards — and determine operating costs.
Meanwhile, there are detox alternatives that don’t require new facilities. A person with an addiction who shows up at an emergency room can receive a dose of buprenorphine — known commercially as Suboxone — then follow up with a doctor to determine the next course of action.
Buprenorphine “shuts down withdrawal 100 percent,” according to Dr. Mark Publicker, an addiction specialist who worked at the Mercy Recovery Center in Westbrook, the state’s largest substance abuse treatment center, before it closed earlier this year. “You can give someone a dose in an emergency room, then give a prescription and arrange for them to report the next day for outpatient [consultation].
“Without giving people buprenorphine, but only using symptomatic medications, they are generally only modestly effective,” he said.
But the bill going before lawmakers next week doesn’t take direct steps to increase access to medication-assisted treatment such as buprenorphine.
Given the level of need, buprenorphine access in Maine is limited by the number of doctors permitted to prescribe it and their willingness to prescribe it to patients with Medicaid. A financial incentive through Medicaid to encourage doctors to prescribe buprenorphine to Medicaid patients could help make the business sustainable for more doctors.
Maine also needs to change course after twice cutting Medicaid reimbursement rates for methadone-assisted treatment in recent years. Maine’s $60 per week rate for each Medicaid recipient 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.
As long as Maine’s methadone reimbursement rate doesn’t come close to covering providers’ costs, more treatment centers are at risk of closing their doors when the need is most acute. But the legislation headed to lawmakers doesn’t propose raising methadone reimbursements.
Leaders in Augusta are finally coalescing around a policy response to Maine’s addiction epidemic. They should ensure it’s as comprehensive as possible and that it relies on proven solutions.