Even as families, their communities and health care providers struggle to keep up with the rapidly worsening opiate addiction crisis, our governor and his staff are AWOL. It might only be a juicy news event that our governor chose not to sign the recent National Governors Association “Compact to Fight Opioid Addiction.” In fact, 46 signed on, leaving him among the small minority who declined to recognize the importance of providing treatment in the states.
But Gov. Paul LePage’s posturing on the national stage mirrors his ill-informed and ill-advised policies here at home, where he seems to be doing everything he can to thwart treatment. That’s right, thwart treatment.
As a provider I have to claw my way through the Maine Department of Health and Human Services’ red tape in a struggle to get paid — a struggle I am losing, by the way. But it gets worse. The governor and his staff are proposing new rules to make treatment even harder to deliver and, for those in need, harder to come by.
One simple example. Urine drug screens are a keystone of treatment supervision — as vital, sometimes more so, as pulse and blood pressure. It is through a urine drug screen that we can determine if someone has relapsed, is taking drugs illicitly or if they are perhaps diverting their prescribed medicine. Such a test costs me $9 in supplies. The state has chosen in the past to pay me $6, so I lose money on every test.
But it gets worse. I recently was told by DHHS I cannot bill for that test at all, that even though this test costs me money, it is just part of my cost of doing business. So there is $1,300 I will not see. At that rate, I lose money on every client I see.
It is bitterly ironic to me that at a time of increasing public recognition and concern about our opioid epidemic that I, as a provider, am getting institutional opposition, not support, from DHHS. I get a definite sense of opposition through administrative barriers and hoops in my dealings with DHHS, not the needed response of, “This is vital. How can we help?”
But this has a still more serious statewide context because my experience has been playing out across the state, seriously weakening our opiate treatment abilities. We actually have fewer treatment resources than a year ago.
Recall that Spectrum, which provided medication-assisted treatment with Suboxone to 105 York County clients had to close after its state reimbursement was dropped last year.
Last year, too, Mercy Hospital had to close what was the state’s largest treatment program, serving 250 clients, because reimbursement was below their costs. Nor does it have to be this way. MaineCare expansion would have brought millions in drug treatment funds, by providing care for the uninsured and by bringing addiction treatment money.
In addition, last year Spectrum’s president and CEO said the state was leaving multimillion-dollar grant opportunities on the table that would have gone to drug treatment.
The public is rightfully in great distress over this problem. They see the havoc and misery in their families and communities. They need to know how the government that is supposed to solve their problems is indeed creating ever more difficulties for the delivery of this care.
This is a perfect storm. We have the highest incidence of opiate addiction among young adults in the country. Every week five or six Maine people die of an unintentional drug overdose, and our governor turns a deaf ear to the treatment community and every addiction specialist who might advise him.
If you care about this issue or those afflicted by it, I urge you to write to the governor or call your representative to ask why this is happening. The governor needs to know that you care even if he might not.
Steve Bien is a family physician in Farmington. He provides buprenorphine-based addiction treatment as part of his primary care.