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We want your ideas for how to address Maine’s opiate epidemic.

The Bangor Daily News is hosting the One Life Project at 5:30 p.m., Wednesday, May 4, at the Cross Insurance Center in Bangor. There, people will answer questions to come up with specific steps to ease the opiate epidemic.

Sen. Angus King will speak. The Bangor area Community Health Leadership Board will review and potentially pursue some of the ideas that come out of the evening.

We want as much input as possible, so we’re starting to gather ideas now. Below is one of several questions. (Find the rest here.) Send us your answers, big and small.

We expect to run out of room, so please register soon:

Recommendations for methadone treatment

There are three federally approved medications to treat substance use disorders: methadone, buprenorphine (with the brand name Suboxone) and naltrexone. Methadone clinics, where people must go for methadone, are required to provide counseling, monitor patient behavior and keep track of patient outcomes. About 90 percent of patients are using drugs at the time of their admission to medication-assisted treatment, while fewer than 6 percent use a year later, according to the state’s Substance Abuse and Mental Health Services office.

Based on decades of research, medication paired with comprehensive counseling and behavioral therapy is considered the standard of care for treating an opiate use disorder. It’s been shown to significantly decrease drug use, criminal activity, psychiatric admissions, emergency room admissions, jail time, the loss of children to foster care, unemployment, homelessness and death. People who receive treatment are more likely to stabilize in long-term recovery and go on to lead productive lives; without it, the disease normally worsens.

Prejudice and stigma are major barriers to people with opiate use disorders who seek medication-assisted treatment, especially methadone. A number of other factors make it more difficult as well:

— Because methadone is a highly regulated Schedule II drug, federal law requires it to be dispensed daily at specially licensed clinics that must follow regulations other outpatient agencies do not. There are 10 clinics in Maine, requiring some patients to travel significant distances.

— Methadone clinics opened in Maine in 1995 and were paid a set rate of $80 a week per Medicaid patient for their services. The state cut the Medicaid reimbursement rate in 2010 and again in 2012 for a total reduction of 25 percent. Today, methadone clinics are paid $60 per week per Medicaid patient.

— As a whole, methadone clinics provide more services to patients at a lower cost than other outpatient medical practices. The methadone clinic model includes medication, individual and group counseling, drug screening, behavior monitoring that requires daily contact with the patient in the early phase of treatment, peer support and case management, plus connecting people who need it with shelter and food. The National Institute on Drug Abuse has determined that, if billed like other medical providers who operate on a fee-for-service model, the actual reimbursement to methadone clinics would be $143 per week.

— The Medicaid reimbursement cuts put clinics at risk of closure. To stay open, the state allowed clinics to reduce services. They shifted from individual counseling to more group counseling, and increased each counselor’s caseload to a maximum of 150 patients, up from 50 patients.

— For people with Medicaid, Maine has a two-year limit on medication treatment, even though some patients need more time to stabilize. Patients who want to continue to receive the medication beyond two years must get approval from the state.

So, what should we do about all this?

Erin Rhoda

Erin Rhoda

Erin Rhoda is editor of Maine Focus, a journalism and community engagement initiative by the Bangor Daily News.