October 20, 2019
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A path forward to addressing the opioid crisis, with a surprising twist

Gabor Degre | BDN
Gabor Degre | BDN
People discuss ideas about dealing with the opioid epidemic during the One Life Project event at the Bangor Arts Exchange, July 18, 2018.

The results of a recent community prioritization event, where three candidates for governor participated, show a clear path forward for addressing the opioid crisis, with a surprising twist.

At the One Life Project: Public Priorities event on July 18 in Bangor, attendees had to vote for the regional and state initiatives they thought were most important to tackle next to help save lives.

Interestingly, the nearly 100 people who attended the BDN-sponsored event chose preventing drug use as the top priority for the Bangor region, out of nine initiatives in total. They said the No. 1 priority in terms of state policy, out of eight initiatives, should be to bolster funding for treatment.

It is not surprising that people cited a need for increased funding from the state. Maine law generally limits Medicaid to covering two years of methadone and Suboxone treatment, and Maine’s Medicaid program pays among the lowest reimbursement rates in the nation for methadone.

It does this even though medication-assisted treatment, which includes Suboxone and methadone often in combination with counseling and behavioral therapies, has decades of research backing its ability to decrease opioid use, opioid-related overdose deaths, criminal activity and the transmission of infectious diseases.

In addition, reimbursement for a range of substance use disorder and mental health treatments has remained at the same level for more than a decade. Recently, even, the state said it would be changing how some providers got paid, effectively decreasing their revenue.

Clearly the providers responsible for treating people with substance use disorders should have their costs covered. But all too often that’s not the case when patients have Medicaid. Health organizations have to make up the difference or cut back on services such as counseling that could help people get well. It is a fundamental flaw in Maine’s system of care that should have been rectified long ago.

But the fact that attendees chose prevention, with a focus on youth, as the No. 1 Bangor-region priority is intriguing. If people want to focus more on long-term restructuring, as opposed to immediate treatment needs, does it mean that the Bangor region has turned a corner in the opioid crisis?

Certainly the providers in this area have made significant strides in increasing access to treatment, and they know what they have left to do. At Penobscot County Health Care alone, there were just a handful of providers licensed to prescribe Suboxone in 2011. That meant fewer than 50 patients were on the medication.

But in 2017 more than 30 providers were licensed to prescribe it, which meant more than 400 patients could obtain the treatment. That is a significant improvement — a 700 percent increase — and one that PCHC should be recognized for.

In addition, the region has reduced prescribing of opioids for a chronic pain, a necessary move given how many dangerous prescriptions were historically handed out to patients despite no evidence backing their long-term use.

There is work to do to improve how patients are connected with treatment after they leave local emergency rooms. But this is something that the right people are talking about fixing.

So it seems to make sense that Bangor would want to turn next to preventing youth drug use. It’s not an area that has drawn intense focus, yet it could have lasting impact, and there’s a lot of work to do.

Thankfully there are many programs that have been shown to decrease or delay youth drug use.

Well-studied drug prevention programs are listed both by the Substance Abuse and Mental Health Services Administration and the registry Blueprints for Healthy Youth Development. They range in cost from $17 per participant in the first year to $173, and usually aim to boost young people’s emotional development and feelings of connectedness.

Quality early childhood education, mentoring programs, public health nurses, and school social workers and counselors can all help.

“Prevention” may sound vague and broad, but there are specific things schools and community organizations can do to develop connections and address childhood trauma. Preventing future addictions will take work on many fronts. With community support that work should become a priority.

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