A southern Maine doctor who specializes in addiction recently made a bold announcement on Facebook: In an attempt to combat the state’s heroin epidemic, she would treat anyone who needed help, regardless of whether the patient had insurance to pay for it.
Merideth Norris — who works at addiction treatment centers at multiple southern Maine locations, and can provide medication-assisted treatment, such as methadone — says she hopes her offer will encourage prospective patients, and the public at large, to have a more well-rounded discussion about addiction and the available treatment options.
“People are not really being exposed to that conversation,” Norris said. “There are a lot of opinions out there, but [as a doctor], I’m supposed to be giving data and data-based decisions.”
But more broadly, the offer underscores how Maine’s medical professionals are responding to a health crisis that last year killed a record number of people.
Because of MaineCare regulations, Norris can’t provide free appointments, she said. Instead, she’d charge only a nominal amount that fits into each uninsured patient’s budget. Patients need to pay for any medications. But such costs are usually the least expensive part of medication-assisted recovery.
Her offer is rare.
“The number of people available who are actually prescribing [medications] and are charging whatever people can pay?” said Mark Publicker, one of the state’s foremost experts on addiction treatment and past president of Northern New England Society of Addiction Medicine. “I’d be shocked if you’d be able to find many.”
A patient seeking treatment for a substance use disorder could face a $500 bill for his or her first visit with a doctor, and between $250 and $350 for monthly appointments thereafter, Publicker said. For those with no health insurance and limited resources, it’s a significant deterrent.
“I would say on any given day there are thousands of people in Maine who would be getting treatment if they had health insurance,” said Martin O’Brien, co-founder of Grace Street Recovery Centers in Lewiston and Portland, who works closely with Norris at those facilities. “There are folks who clearly understand that without health insurance, they have no options. Insurance can be prohibitively expensive, or they could be working part-time jobs that don’t offer health insurance.”
Publicker said most facilities that even accept MaineCare for addiction have waiting lists for those services.
According to a 2015 analysis by the Washington Post, the wait for admission into state-funded rehab programs in Maine is 18 months or more.
Norris’ offer comes against the backdrop of a high-profile opioid addiction crisis in Maine where, last year, a record 272 people died from overdoses. Of those, 157 deaths were caused by heroin and/or nonpharmaceutical fentanyl, and 111 were caused by pharmaceutical opioids.
The crisis spurred bickering about the best solution among lawmakers. Editorial boards and bloggers weighed in. After some initial disagreement with Gov. Paul LePage, the state Legislature approved $3.7 million in additional funding for drug agents, as well as treatment, recovery and education services for those battling a substance use disorder. For his part, the governor has argued for new limits on prescription opioids.
“There’s been all kinds of press that we need to ‘do something,’ with a capital D and a capital S. It’s good for people to want to do something,” Norris said. “But it’s not supposed to be the volunteer army that’s making those decisions or telling patients how to manage it.”
Much of the public dialogue surrounding Maine’s opioid crisis has focused on increasing the availability of detox beds, but that type of treatment wouldn’t necessarily be the best option for many patients battling an opiate-use disorder, Norris said.
But in many cases, a medication-assisted treatment — involving suboxone or methadone — can be more effective, experts say.
“I certainly wouldn’t say that there is no one with opiate addiction who has ever gotten clean using a non-medication model of treatment,” said Publicker. “But all of the science literature and empirical research tells us that medication is the most effective. Should we go with the faith-based system, or should we go with the science-based system?”
In many circles, that kind of treatment has a stigma that can prevent patients from considering it, even if it’s the most appropriate treatment for their condition, she said.
“We’re doing this very resource-intensive process. Someone is arrested or presents himself, and we scoure the state looking for detox beds,” Norris said.
According to one study published by the National Institutes of Health, for instance, about half of the physicians who were surveyed and who were willing to prescribe methadone said their patients wouldn’t accept it as a treatment because of the social stigma surrounding it.
Norris said anyone seeking to take her up on her offer to see uninsured patients needs to visit her at her Kennebunk office, and come with a support person — a parent, sibling, friend or anyone else — who will stick with them through the recovery process.
“Look, this is a real life-threatening condition, and we need to have more medical people involved in the conversation,” she said.