Included in the massive cuts being proposed for MaineCare, the state’s Medicaid program, are a rate cut from $72 a week to $60 a week per patient in an opioid treatment program (OTP), and a plan to limit medication-assisted treatment (MAT) with methadone or buprenorphine to two years.
The plan has the united support of Gov. Paul LePage, Department of Health and Human Services Commissioner Mary Mayhew, and Director of MaineCare Stefanie Nadeau.
There are some historical points that are important here, all focusing on the fact that for some reason, opioid addiction has been prevalent in this rural state. Kim Johnson, the former Single State Authority for the Substance Abuse Prevention and Treatment Block Grant (SSA), who has since gone to the Network for the Improvement of Addiction Treatment (NIATx), was an ardent supporter of OTP expansion in the state to respond to this demand. Guy Cousins, current SSA for Maine, also is a strong supporter of OTPs. (The SSA in Maine is the director of the Office of Substance Abuse.) But Governor LePage entered office with a different viewpoint.
Maine was one of the first states to note opioid overdoses. In 2006 the Community Epidemiological Work Group meeting heard a presentation about overdoses of methadone and morphine—this was methadone prescribed for pain, because Maine was, like many states, substituting the less-costly methadone for more-costly analgesics in hospital formularies.
With an increase in buprenorphine prescriptions in the state to treat the growing opioid addiction came an increase in buprenorphine abuse. The manufacturer sent researchers to the state who determined that many people abusing buprenorphine were actually using it for something akin to its intended purpose—to stave off withdrawal symptoms. Despite the support of Ms. Johnson and Mr. Cousins, there still was—and still is—a woeful shortage of OTPs in Maine.
It’s ironic that a state with a severe opioid addiction problem, which is the heart of the prescription drug abuse epidemic, would decide to cut back on treatment. The people who should be leading the education of residents are sending the wrong message. This takes us to NIMBY (“not in my backyard”). It took CRC Health Group a year to win a settlement allowing it to open an OTP in Warren, Maine; yet the town is still delaying an administrative review of the proposal.
Mark Parrino, MPA, president of the American Association for the Treatment of Opioid Dependence (AATOD), sent MaineCare Services an eloquent letter on June 14 protesting the two-year limit and the rate reduction, citing the Research Triangle Report findings that quality OTP treatment should cost $143 per patient per week, and that 85 percent of the costs are for labor. “In our judgment the State of Maine has engaged in a disastrous course which will have severely detrimental consequences to the patients in treatment and their families.”
And noting that limiting treatment to a two-year period “goes against all established evidence,” Mr. Parrino also called it a dysfunctional policy. More than 45 years of research have found that more than 75 percent of patients will relapse if their treatment is terminated, he wrote. “Many studies have demonstrated that this high a relapse rate applies to both patients who voluntarily end their treatment and patients who are involuntarily discharged.
“If Maine is of the judgment that it might be saving money by doing such a thing, this is a very risky bit of business since the State will inevitably push patients back into emergency rooms, which are far more expensive,” wrote Mr. Parrino. It would also push people into the criminal justice system, he said.
If Governor LePage asks Maine’s experts in addiction—Mr. Cousins and Marcella Sorg, PhD, of the Margaret Chase Smith Policy Center, come to mind—what they think, we are sure he would obtain good information. It would also help make the state’s population aware that their friends and neighbors are the people who need help. Gov. LePage could also look at the state’s own report on drug use issued in March, which shows that after alcohol, opioids are the second-highest treatment drug named at admission to treatment.
Why don’t governors ask their staff with expertise in addiction before making changes in addiction policy? Could it be because they don’t want to hear the answer?
Source:
AT Forum
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