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Program closings add urgency to Maine opioid crisis

August 26, 2015
by Gary A. Enos, Editor
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A crisis point in the availability of publicly supported treatment for opioid addiction in Maine has caught the attention of leaders within and outside the state, but political realities make viable solutions hard to come by.

In recent weeks, two high-profile organizations have formally announced the closing of treatment programs in the state. Mercy Hospital's 250-bed Mercy Recovery Center is scheduled to close officially next week; some of the facility's services already were eliminated earlier this summer. Just last week, Massachusetts-based Spectrum Health Systems announced that it will be closing its only treatment site in Maine, a Sanford outpatient center that has offered methadone treatment since January 2014. Both of these operations have largely fallen victim to declining state funding support for drug treatment.

In announcing the program closing, Spectrum highlighted what it sees as a contrast between a treatment-focused approach to addressing the opioid crisis in its home state of Massachusetts and an enforcement/supply emphasis from the administration of Maine Gov. Paul LePage. “As a not-for-profit, we rely upon our partnerships in government; unfortunately, we feel the current administration lacks interest in supporting the evidence-based solutions we provide,” Spectrum president and CEO Charles Faris said in an Aug. 24 news release.

Parallel universes

Two summit-style events taking place in the state this week illustrate the difficulties inherent in addressing the state's opioid crisis, marked by a recent 24-hour period in which there were 14 opioid overdoses and two deaths in Portland.

A group that included a number of addiction specialists and psychiatrists met with Office of National Drug Control Policy (ONDCP) director Michael Botticelli on Aug. 25 to discuss possible federal initiatives that could help states such as Maine, while the LePage administration was preparing to conduct its own meeting the next day to be attended mainly by law enforcement representatives.

Supply reduction remains an important component of a drug-fighting strategy, says Gordon Smith, executive vice president of the Maine Medical Association and a discussion moderator at the Aug. 25 event involving Botticelli. But political differences in the state have made it difficult to achieve a broad consensus on treatment-related issues, he indicates.

Interviewed by Addiction Professional prior to the roundtable he would be moderating, Smith said Botticelli was interested in talking about a number of possible federal solutions. Many of these touch on policy areas that have been discussed for some time and likely could not be realized overnight, such as relaxing restrictions on the number of patients a physician prescribing buprenorphine can serve at any one time, and broadening the availability of methadone by considering alternative treatment sites to a clinic system that remains publicly unpopular in Maine.

Other ideas that Smith says would help include lifting a restriction that bars methadone clinics from reporting data to the state's prescription drug monitoring program (he calls that policy “outrageous”), and offering veteran physicians a waiver from meaningful use requirements in order to keep them in the workforce to offer opioid addicts medication-assisted treatment.

But the lack of Medicaid and other public funding support for treatment remains most prominent on the minds of Maine's treatment and medical community leaders. Spectrum's Faris added in his comments, “In Massachusetts, we're seeing law enforcement helping addicts get into treatment. In Maine, Governor LePage is discussing calling in the National Guard to combat the state's drug epidemic while leaving multi-million dollar grant opportunities for funding treatment on the table.”

Smith, an attorney at the Maine Medical Association, adds that many victims of the state's opioid epidemic are in the 20-to-40 age bracket with incomes under 138% of the poverty level and therefore not eligible for Medicaid in a state that has shunned Medicaid expansion.

He adds that the administration has consistently decreased reimbursement for methadone treatment. An administration proposal earlier this year to end public funding support for methadone, with an eye toward diverting methadone patients to buprenorphine treatment, did not advance in the legislature this year; it remains a topic for discussion by an appointed task force, says Smith.

Even the most at-risk individuals are not receiving ready access to treatment services in Maine, Smith says, as evidenced by the fact that some people who have received life-saving doses of the overdose reversal drug naloxone have to be rescued again within a short time. “We're not being very successful in getting people from overdose to treatment, we believe,” Smith says.

Responses to the opioid crisis in the Northeast will be a focus of a Nov. 5-6 summit in Warwick, R.I., on opioid addiction and pain management, produced by the publishers of Addiction Professional.