Gov. Paul LePage’s veto of a bill to make the overdose-reversing drug naloxone more readily available betrays a fundamental misunderstanding of addiction.
In his veto letter, LePage said naloxone hydrochloride, does not prevent deaths; it just delays them because people with addictions will overdose again. “Creating a situation where a heroin addict has a needle in one hand and a shot of naloxone in the other produces a sense of normalcy and security around heroin use that serves only to perpetuate the cycle of addiction,” the governor wrote.
Researchers affiliated with The Miriam Hospital at Brown University addressed this thinking in a 2010 study, which cited a growing body of research that found that drug use did not increase with naloxone availability. “It is unethical to allow a narrow focus on the harms of drug use to overshadow an opportunity to save human lives,” they wrote. At worst, opposition to expanded use of naloxone “represents a denial of drug users’ basic human dignity by devaluing their lives.”
Naloxone, which often goes by the brand name Narcan, does save lives. If someone has overdosed on heroin or prescription opioid medication and is quickly given naloxone, he or she can be revived. This gives someone a second — and yes, sometimes, a third or fourth — chance. Some will use that chance to end their drug use.
Administering naloxone shouldn’t happen in isolation. Treatment, preferably medication-assisted treatment, is needed next. But in Maine, as in many other states, access to treatment is hampered by a lack of funding and by residents’ lack of health insurance.
In his veto letter, LePage emphasizes the need for law enforcement to keep heroin out of Maine, the need to boost prevention and education to warn young people of the dangers of addiction and the need to improve opioid prescribing protocols. These are important and lawmakers this session approved increased funding for Maine Drug Enforcement Agency personnel, prevention efforts and adopted strict opioid prescribing protocols.
But LePage stops there and leaves out treatment. Research is clear: Those who receive treatment, especially medication-assisted treatment coupled with counseling, are much more likely to overcome substance abuse disorder than those who do not.
“The research is unassailable,” the Pew Charitable Trusts said in a recent report. “Staying in recovery and avoiding relapse for at least a year is more than twice as likely with medications as without them. Medications also lower the risk of a fatal overdose.”
Yet, only one in five Americans dealing with opioid addiction is receiving methadone or buprenorphine, two common anti-addiction medications, according to a November study by researchers at Johns Hopkins’ Bloomberg School of Public Health. Barriers include a shortage of medical providers licensed and trained to provide the medications, a lack of insurance among those who need them and limited or no coverage from some insurance plans. The result is long waitlists of people with addictions who want to stop using drugs.
If LePage were truly interested in saving lives, he would loudly advocate for medication-assisted treatment and reimbursement rates that cover the full cost of such treatment. Two decades ago, when Maine’s first methadone clinic opened, MaineCare, the health care coverage for most clients, paid $80 per patient per week. Since then, the rate has fallen twice and today is $60, one of the lowest in the country. The National Institute on Drug abuse calculated that effective weekly methadone treatment should cost $143 per week.
A bill to raise the methadone reimbursement rate temporarily to $72 sits on the appropriations table and is likely to languish there because of a refusal to fund it.
Naloxone by itself is not the solution to substance use disorder, which is a disease not a personal failing. But the anti-overdose drug, backed up by a robust system of treatment and support, can be part of it.
If the governor’s veto stands, some Mainers who overdose on drugs will die unnecessarily. It is up to lawmakers to ensure this doesn’t happen by overriding the veto.