June 23, 2018
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A year later, ‘opioid health homes’ aren’t breaking down treatment barriers

Ashley L. Conti | BDN
Ashley L. Conti | BDN
A Cornith resident takes a dose of Suboxone after waking up at the place he rents in Corinth, May 1, 2015.

A year ago, then-Health and Human Services Commissioner Mary Mayhew proudly rolled out a $4.8 million opioid addiction-fighting measure: Some 400 Maine people with addictions would benefit from treatment through “opioid health homes.”

The idea was that someone with an addiction, and without health insurance, could access medication-assisted treatment at a primary care provider’s office that offered a full complement of anti-addiction services.

The primary care offices that qualified for the added state funding would be known as “opioid health homes.” They would have to have practitioners on staff who could prescribe buprenorphine (known more commonly as Suboxone) as well as several other personnel qualified to help patients tackle addiction: a peer recovery coach, a certified clinical supervisor, a licensed drug and alcohol counselor, a nurse care manager with “expertise in addiction treatment,” as well as a licensed clinical team lead with the same expertise.

In exchange for having a team of six people with those specific qualifications, primary care offices would qualify for $500 per month for each uninsured, addicted patient. For $1,000, the offices could directly administer buprenorphine on site; buprenorphine is typically prescribed to patients so they can take the sublingual film or tablet daily at home. Another option would be the less common medication Vivitrol, a monthly injection that reduces opioid cravings.

“It is about building up on a primary care role,” Mayhew told lawmakers.

At the time, we were skeptical. “Maine’s ‘opioid health homes’ are so intricate there will probably be only a few,” read the headline of a BDN editorial last April. Mayhew objected. “If we are going to successfully address the opioid crisis — we need to invest in innovative programs that provide a comprehensive and integrated approach to helping Mainers with opioid addictions,” she wrote in a response to the editorial. “…I am confident this model will help Mainers who need and want to get better.”

A year later, we have the first indication of how well the opioid health home model is performing. In a report released to lawmakers earlier this month, DHHS revealed that only one medical provider had enrolled in the program to serve uninsured residents — the initiative’s target population, for which the state had allocated $4.8 million to serve. Five uninsured residents received treatment. The state managed to spend $13,000 of the allocated funds.

The department said it was finalizing nine more contracts for 2018. (It’s worth noting that Mayhew in April 2017 said seven medical providers had already applied to participate, yet the department reported just one contract by year’s end.)

“The model they were promoting is not usable,” Malory Shaughnessy, executive director of the Alliance for Addiction and Mental Health Services, Maine, told the Portland Press Herald. “Money is left sitting in a bank someplace instead of people getting the services they need in the real world.”

The state is facing an opioid addiction epidemic that’s killing about one Mainer a day. Yet, the LePage administration hasn’t been treating it seriously.

While Mayhew claimed the opioid health home was an “innovative program,” it’s proven so cumbersome that it doesn’t pass as a response to a deadly, statewide problem. Instead of an “innovative program” like this one, the LePage administration should start with simpler measures with a greater chance of success.

The administration could stop thwarting the proliferation of the overdose antidote naloxone. It could act on Maine voters’ mandate to implement the expansion of Medicaid, which would reduce the need for special programs to serve those who are addicted and uninsured. The LePage administration could make a full-court press to encourage more doctors, nurse practitioners and physician assistants to gain the necessary training and waivers to prescribe buprenorphine. It could also focus on raising Maine’s Medicaid reimbursement rates for methadone, which are among the lowest in the nation.

The governor, in a legislative push in his final year, could reverse a policy he championed earlier in his administration that limited Medicaid recipients to two years of buprenorphine or methadone when there’s no scientific evidence supporting such a time limit to treat addiction, which is a chronic disease.

Those apparently aren’t “innovative programs” in the LePage administration’s view, but they’re virtually guaranteed to be more successful than what the administration has been doing.

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