AUGUSTA, Maine — Gavin Gabrion has been addicted to heroin “on and off for years and years.”
At 32, he’s tried three times to kick it, he said Thursday at his home in downtown Augusta.
“I’ve done the cold turkey way, which is difficult and hard to maintain,” he said. The second time, “I went to a methadone clinic for a brief period of time, which I didn’t like at all for a variety of reasons.”
But about four months ago, a physician at Protea Integrated Health and Wellness, who was helping him manage symptoms of bipolar disorder and schizoaffective disorder, convinced him to try again. The physician prescribed Suboxone, a type of medication-assisted treatment that, with weekly group and individual therapy, has helped Gabrion stay clean.
Several times each week, Gabrion, like many of the organization’s 350 other clients, would visit the Protea office on Water Street in Hallowell, provide a urine sample to show he hadn’t used heroin, and pick up several days’ worth of Suboxone. Gabrion also attended therapy sessions at Protea and received prescriptions for the mood stabilizer lithium and an antidepressant.
“Having someone look over your shoulder isn’t an experience I usually dig, but for this sort of thing, it’s helpful,” he said. “I don’t need anyone to follow me around or hold my hand, but at the same time, knowing someone is going to be checking on you — that level of structure [is helpful]. I feel like I‘m doing really good on my own with medications. I’ve been really good about not missing a dose.”
A ‘house on fire’
Two weeks ago, the physician told Gabrion that Protea would close that Friday, Sept. 30. To make matters worse, he said most of the Protea staff stopped showing up for work in the next few days. The Bangor Daily News was unable to locate former Protea employees, and state officials also did not offer an explanation for the abrupt closing.
That Friday, when Gabrion returned to the clinic to pick up the month’s worth of medication and prescriptions his provider had promised him to get him through until he found a new doctor, the office “was like a house on fire,” he said.
Only two employees were present, and they were “utterly overwhelmed” by the number of clients seeking prescriptions. They didn’t know where to find clients’ files, he said.
“It was awfully nice [of them to work], but at the same time, it was still not enough people to keep up with the overwhelming number of clients coming in and on the phone,” Gabrion said. “I ended up giving the one girl I knew my prescription bottle and having her count the strips inside. … She promised she would do it, but I guess I got lost in the mix. Friday after 5 [p.m.], after they closed, it was just over. I was pretty stressed out about that.”
He went home without Suboxone — but also without prescriptions for the lithium and the antidepressant that have kept his mood stable for nearly a year.
The following day, Gabrion’s mother contacted the former Protea prescriber at his private practice, and the physician called Gabrion within 20 minutes, he said, to “convey his deepest apologies” and make arrangements to get Gabrion the medication he’d need for the next month.
He’s spent the days since then searching for another practitioner to provide his Suboxone and his psychiatric medication. He had one in mind, but the doctor hadn’t called back as of Tuesday afternoon.
With several weeks of medication available to him, Gabrion said he’s worried about the other clients who don’t have his resources — clients who don’t receive MaineCare through disability and the many he knew who also relied on the services of interpreters — and who as of Friday had run out of Suboxone.
“If you need case management services and a translator, how on Earth would those people have found anything,” he said. “And if you’ve got to go without for a matter of days … you’re going to get very, very sick.”
Unlike addiction to alcohol, which some people can kick simply by stopping drinking, opioid addiction almost always requires treatment with medication, addiction treatment experts say. Medication-assisted treatment of opioid addiction is most effective when coupled with regular counseling, so the abrupt loss of a clinic that provides both counseling and medication oversight heightens the urgency to find a new provider.
Gabrion said he received a letter mid-week from Protea explaining the closure, but it did not include instructions on how to find a new provider. He said neither he nor any other former Protea clients that he knows heard directly from any state officials or caseworkers.
Samantha Edwards, spokeswoman for the Maine Department of Health and Human Services, said in an Oct. 5 email to the BDN that “all Protea clients receiving Suboxone have access to a provider.”
Edwards said “the department dispatched its Rapid Response Team” after a staff member heard secondhand about the closure, in order to obtain a list of active clients and work with area providers “to figure out capacity and a timeline for how soon the transition can take place. Since most departures are abrupt and unexpected — it is quick. The department’s top priority is making sure the transition is as soon as possible for clients.”
Edwards declined to provide specific information about how the department attempted to contact former Protea clients, and declined to share a list of providers who have accepted former Protea clients except to say in an email Thursday that they are “spread out around Augusta/Waterville.”
Edwards said recent media reports that the closure left hundreds of clients without services were inaccurate, and said, “It is important to note, like other providers, Protea had contractual and regulatory obligations in closing the agency — this included allowing the Department to work with them to develop a plan to help ensure the transition of active consumers to appropriate levels of care in other agencies.”
‘A disaster for patients who have been doing well’
Other providers in the state said it’s extremely unlikely that many of the 350 Protea clients were able to find providers that fast. A report by providers who participated in Gov. Paul LePage’s Maine Opiate Collaborative in May that said people who sought medication-assisted treatment for opioid addiction in central Maine during the first quarter of 2016 waited an average of 70 days.
Citing statistics from the Office of Substance Abuse and Mental Health Services, which operates as part of the U.S. Department of Health and Human Services, the same group reported that only 13 substance abuse treatment providers in Maine provided medication-assisted treatment in 2015 — with a total capacity of 4,300 patients — and determined that 25,000 to 30,000 people in Maine sought medication-assisted treatment in 2015 but were unable to find services.
“It’s a disaster for patients who have been doing well on Suboxone maintenance,” Dr. Mark Publicker, a Portland addictionologist and past president of the Northern New England Society of Addiction Medicine, said recently. “The availability of treatment in the state is extremely poor. It’s difficult enough for people to find prescribing doctors, but now there are upwards of 300 patients who are going to be seeking alternatives at the same time other people are seeking alternatives. I fear there are going to be many people who are in danger of relapse [if they can’t] find new physicians before their prescriptions run out.”
Because so few providers are available, Publicker said he sees clients from as far away as Houlton.
Publicker recommended former Protea clients contact programs such as the Addiction Resource Center in Brunswick; Grace Street Recovery in Lewiston, Portland and Sanford; Key 3 West in Lewiston and Biddeford; and Groups, a private medication assisted treatment program with offices in Auburn, Biddeford, Portland and Rockland.
Jeremy Hiltz, clinical director of Grace Street Recovery, said his organization hasn’t heard from the state or from any former Protea clients. Nor has Don Kent, clinical director of Groups.
Kent said Thursday he heard Protea was closing “before it hit the papers” and tried to call the organization, “but by the time I called, they weren’t answering their phone and their voice mailbox was full.”
During a routine phone call with DHHS, I “mentioned that I had tried but wasn’t able to reach them, and if there was someone at the state who would like to be in touch, we’d certainly like to reach out and offer some help to those folks if we could do it. From my standpoint, it’s the decent and humane thing to do,” Kent said. “We haven’t really heard anything.”
Subsequently, he said, three or four former clients had contacted his Rockland office, but he’s still heard nothing from the state.
“These people are going to get sick, and they’re going to get really sick, really fast,” Kent said. “Co-occurring issues will take a bad situation and multiply it by 10. Frankly, the whole thing is a tragedy for all of those people having their services cut so abruptly … you have to wonder how on Earth did it get that bad that fast? Who was responsible? It’s ridiculous. But the first order of business is to take care of these people.”
Gabrion said Thursday he’s been “calling doctors and providers and seeing who’s taking new patients, and finding out what I can. I’ve got to get an appointment to start — that takes a little bit of time, and sometimes it takes a little bit of time for them to see you. I hope to stay near Augusta, but if it turns out I’ve got to go a little further afield, that’s OK.”
He’s optimistic and said he’s coping with the frustration and anxiety the uncertainty has caused.
“I’m going to get in somewhere,” he said.
“A lot of guys I know, just the world I come from, go out and turn to crime to support their habit,” he said. “That’s why the state of Maine claims that they’re doing everything they can to fight the opioid epidemic, and I happen to know for a couple of reasons that that’s just not so.”