In 2017, Maine set another record — 418 people died of drug overdoses. For all the talk in recent years about confronting the opioid crisis, this number shows that Maine leaders have completely failed.
There are many steps that could be taken, if lawmakers support them and are willing to override a veto from the governor, and stand up to his obstruction when necessary.
Gov. Paul LePage has still not signed off on rules allowing the overdose reversing drug naloxone, also known as Narcan, to be sold without a prescription. LePage let the rules languish for five months before demanding that the Board of Pharmacy change them to raise the Narcan purchase age from 18 to 21. The pharmacy board made the last-minute change in early February to appease the governor. But LePage still has not signed off on the rules.
The Maine Department of Health and Human Services could raise its reimbursement rates for medication-assisted treatment for recipients of the state’s Medicaid program, known as MaineCare. Maine has one of the lowest reimbursement rates in the nation for addiction treatment providers who treat patients who use Medicaid for health insurance. Maine’s $60-per-week reimbursement for methadone clinics has affected the quality of care at some clinics by limiting the amount of behavioral counseling available. In 2016, legislation to raise the reimbursement rate passed both chambers of the Legislature, only to die for lack of funding.
DHHS should also eliminate caps on methadone treatment. While MaineCare covers all three Food and Drug Administration-approved medications to treat opioid addictions, it limits access to the two most common medications — methadone and Suboxone — by initially limiting Medicaid patients to two years on the medication. It is one of only 10 states with a time limits on Suboxone treatment. Such time limits apply to no other medications, and there’s no scientific evidence showing that addiction patients should be time-limited. LePage signed this hurdle into law, and his administration has opposed eliminating it.
Together, the misguided two-year limit on medication-assisted treatment and Maine’s low reimbursement rates for this low rate puts the ability of many clinics to provide effective care for their patients in doubt.
The voter-approved expansion of Medicaid could also help increase access to treatment. The expansion will extend health insurance to about 70,000 Mainers, most of whom are working but don’t currently qualify for Medicaid or subsidies to purchase health insurance through the individual market. Many of these people are currently dealing with substance-use disorder but are unable to afford treatment. LePage continues to throw up roadblocks to compliance with the voter-approved law.
Instead of supporting any of these measures, LePage, in a belated press release about the record number of drug deaths in 2017, again emphasized the need for more law enforcement, treatment beds in correctional facilities, education of middle school students in hopes of keeping them away from drugs and faith-based treatment.
The LePage administration and the Legislature have already increased funding for law enforcement and more treatment in correctional facilities, but the number of overdose deaths continues to increase. Warning middle school students about the danger of drugs is fine, but does nothing to help the Mainers, many of them middle aged, who are dying daily of drug overdoses.
It is past time for state leaders to focus on what works. They have spent hours debating a bill to outlaw female circumcision, which is already illegal and may not be happening in Maine. LePage convened a special task force on animal abuse.
If they are truly concerned about Maine’s addiction epidemic, the state’s leaders will remove barriers to increase the availability of Narcan and medication-assisted treatment.
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