It’s a tired debate: “Don’t come here with your troubles. Go back where you came from.” We hear it today with refugees fleeing persecution and torture. Now, some in this city are using it as an excuse to not treat people with a medical condition who otherwise may die.
In the middle of an opioid epidemic, Bangor seems poised to deny expanding access to a type of treatment that could help heal the brain of people devastated by addiction and usher them into recovery — and life. Why? Because there’s a perception that the city is shouldering all the burden and does not have the capacity to handle those who are struggling.
The Penobscot County Metro Treatment Center — a methadone clinic in the Maine Square Mall — has asked the City Council to allow it to treat 500 patients, up from its current 300. It recently had a waiting list of 173 patients and is contacted daily by three to five people seeking help. Many have been waiting for more than 120 days to be admitted.
There are so many things wrong with the treatment delivery system. Yes, it should be easier for people to get care in their own communities. No, they shouldn’t have to drive so far to get help. No, it’s not ideal for Bangor to carry any socioeconomic impact that might result from offering health care services to patients who may display challenging behavior.
But would Bangor prefer to continue to see people high on the streets, in our homeless shelters and jails, stealing merchandise to sell for heroin, or dead, rather than trying to get well? The long-term costs of doing nothing far outweigh those of expanding treatment. Stopping people from accessing treatment ensures the continuation of the very behavior the public wants to prevent.
No one likes being on methadone, just as no one likes chemotherapy. But 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.
Who else will step up but the city? Gov. Paul LePage has made the situation worse with his dangerous rhetoric about the overdose-reversing drug naloxone merely extending lives “until the next overdose.” The Legislature has proved it’s capable only of passing piecemeal bills that barely scrape the surface of the problem and that the LePage administration resists carrying out. Maine’s congressional representatives may be well-intentioned, but they have little power to force Congress to fund treatment programs or reform the criminal justice system.
It’s unfortunate that city councilors seem hesitant to expand access to methadone and counseling because doing so is the fastest way to save lives in an epidemic. That’s because the infrastructure is already in place. Increasing the number of providers who can dispense another medication, Suboxone, takes more time because the providers need training and guidance, and patients don’t always have ready access to the right behavioral and psychological support.
Methadone clinics are far from perfect. They operate on shoestring budgets, since state law directs them to receive one of the lowest Medicaid reimbursement rates in the country. That means they don’t provide the level of counseling and support they could otherwise. What’s more, the state has a two-year limit on medication-assisted treatment for people with Medicaid, even though many patients need more time to stabilize. And not all patients have insurance.
Combine three facts — that the state made it difficult for clinics to provide optimal service, that relapse is common for people with substance use disorders, and that drug use changes the very parts of the brain responsible for judgment and self-control — and it’s no wonder why some patients drop out.
The city should be hammering the Legislature to improve the care people receive. It should be pushing for increased reimbursement rates for clinics and for federal funding for federally qualified health centers to meet the requirements set out in law to dispense methadone and safely store it.
But it can’t ignore the need at its doorstep.