Last week there was another grim reminder of the magnitude of Maine’s opioid epidemic. Trailing only Massachusetts, Maine had the second highest rate of opioid-related emergency room visits in the country.
This latest figure confirms an uncomfortable truth that the epidemic is particularly out of control in Maine, and it’s not letting up.
Given the magnitude of the problem, a more consistent and effective approach is needed.
This starts with doing more of what we know works. There is overwhelming evidence that using medicine to treat addiction — called medication-assisted treatment — is effective at reducing drug use and, therefore, savings lives. It also improves lives and saves money by reducing infectious complications and decreasing criminality. It also has the potential to save public money by reducing emergency room visits, hospital stays and the burgeoning prison population.
Yet in Maine and across the country, medication-assisted treatment is vastly underutilized. Of the 4,795 Maine physicians, physician assistants and nurse practitioners who could prescribe buprenorphine — one of the two main drugs that help people with opioid addictions, and the only one that’s available in regular doctor’s offices — just 566, or fewer than 12 percent, have the required waiver to prescribe it, according to federal data released to the BDN this week.
Physicians, who have been able to prescribe buprenorphine since it came on the market in 2002, should be leading the other health care professions in providing medication-assisted treatment. Yet they are failing to do so in significant numbers. Of the 2,587 licensed physicians in Maine who practice in primary care or mental health and are in a position to use medication-assisted treatment, a mere 509 have the waiver to prescribe buprenorphine, according to the Substance Abuse and Mental Health Services Administration, the federal agency that oversees the waiver program.
In February, nurse practitioners and physician assistants were also given the right to apply for the waiver to prescribe buprenorphine, when a federal law aimed at combatting the opioid addiction crisis came into effect.
But in the five months since, only 10 physician assistants in Maine — out of 787 total in the state — have sought and received the waiver, according to federal data. And just 47 Maine nurse practitioners have obtained the waiver — out of 1,421 who could.
There’s no good reason for Maine’s health care providers to not provide medication-assisted treatment. The science says it works, and the training to receive the waiver is free and online. While some believe maintenance medications such as buprenorphine only continue the cycle of harmful substance dependence, when these medications are administered appropriately they replace addiction and cravings, allowing people to restore broken relationships, find productive employment and become happy, contributing members of society.
There are plenty of reasons why Maine’s providers continue to resist prescribing buprenorphine. The most common are cultural stigmas, financial disincentives — many drug users either don’t have insurance or have MaineCare, which reimburses doctors at low rates and puts time limits on treatment — and fears of having their practices overrun with challenging clients.
But these reasons can and should be overcome. The medical community is partially responsible for creating this crisis in the first place, by over-prescribing opioids for chronic pain. It’s time the profession also became a vigorous part of the solution.
Of course, increasing the number of healthcare practitioners in Maine who provide medication-assisted treatment will not solve the crisis by itself. But it can help.
With more than one Mainer — usually in the prime of life — dying of an overdose every day, Maine is a patient in the critical care unit whose situation is serious and deteriorating. In such instances, medical professionals intervene — aggressively, decisively, and as a team. Maine’s opioid addiction crisis demands such an approach.