As the Legislature reconvenes Wednesday for its second regular session, leaders are hoping for quick passage of a $4.9 million bill designed to tackle the state’s opiate addiction crisis.
But simmering ideological differences over medication-assisted treatment lurk beneath the surface of the bipartisan plan. Those differences are setting the stage for a larger debate over the best approach to dealing with an epidemic that claimed more lives in the first nine months of 2015 than all of 2014.
The proposal is a response to Gov. Paul LePage’s demand for additional drug agents and a call for treatment and recovery resources. Republican Senate President Mike Thibodeau and Democratic House Speaker Mark Eves say they are confident the plan will gain widespread support after public hearings that begin Tuesday.
The bill is the first order of business for a Legislature that will tackle a number of issues, including an expansion of Medicaid, changes to the welfare system and job training initiatives.
HEAVY FOCUS ON DRUG PROBLEM
A trio of committees will begin vetting the drug addiction proposal Tuesday. It’s one of a half-dozen bills designed to address an opioid epidemic infiltrating Maine and some other states. Data released Wednesday by the Maine Office of Attorney General showed that heroin overdose deaths in Maine through the first nine months of last year had eclipsed the number of deaths for all of 2014 – 71 through Sept. 30 compared with 57 in 2014. The statistics are even more grim in neighboring New Hampshire, where the state’s attorney general projected last week that 2015 overdose deaths in the Granite State would total more than 400.
The crisis in Maine has prompted LePage to call for a crackdown on trafficking, while state lawmakers have pursued a balanced approach that includes additional funding for treatment and recovery programs. In early December, legislative leaders released a plan to provide the governor with $2.4 million for 10 additional agents at the Maine Drug Enforcement Agency.
The legislators’ plan also would expand a program being used by the Scarborough Police Department that invites people who possess drugs or drug paraphernalia to turn them in to police and get help without facing arrest. Another $2.5 million would be allocated to treatment and recovery programs, including $1 million for a new 10-bed detox unit in Bangor, $600,000 to increase access to residential treatment for the uninsured, and $200,000 for outpatient services. Another $600,000 would be devoted to doubling the number of recovery centers throughout the state.
The treatment and recovery spending plan has been applauded by members of the Maine Association of Substance Abuse Programs, but it also has been criticized for not funding medication-assisted treatment with methadone and buprenorphine – also known as Suboxone.
Dr. Mark Publicker, an addiction specialist with the now-shuttered Mercy Recovery Center, said the Legislature’s proposal was well-intentioned but may end up doing more harm than good. Without the availability of medication-assisted treatment, he said, the other treatment initiatives in the plan will do little to address a crisis that he described as a “metastatic epidemic” that has led to death from overdose, sickness from blood-borne diseases, drug-affected babies and crime.
“From the standpoint of not allocating any money for medication treatment, we’re creating expensive programs that will fail,” he said. “If you don’t fund what works and instead you fund what will not work, you are actually, from my perspective, causing harm. It isn’t benign that you’re funding things that sound nice. You’re jeopardizing a limited amount of state funds that are critically necessary.”
BROADER STRATEGY COMING LATER
Eves, the House speaker, acknowledged that medication-assisted treatment is a key component to addressing the drug crisis. However, he said the current proposal contains initiatives that Republicans and Democrats can support.
“We felt we would be successful in all four caucuses with this proposal,” he said. “Democrats believe in medication-assisted treatment and that’s going to be part of the conversation going forward, but this is what is politically possible right now.”
Asked to address the lack of medication-assisted treatment funding, Thibodeau responded with a written statement.
“The proposed bill is a down payment on what will be a much broader strategy and a precursor to a long conversation we will be having in the Legislature to address Maine’s drug crisis,” he said. “We will be discussing multiple bills in the upcoming session that focus on increased law enforcement, treatment and education, and all of them will be carefully considered by lawmakers.”
Rep. Kenneth Fredette, the Republican House leader, deferred the topic of medication-assisted treatment to the legislative committees that deal with drug abuse issues.
Republican leaders’ unwillingness to endorse medication-assisted treatment may reflect a skepticism that it’s the best approach, grounded partly in an ideological embrace of a credo of greater personal responsibility.
Publicker said he encounters the same skepticism among some of his peers.
“They see the use of medication as substituting one drug for another, a belief based in ignorance and a lack of understanding of the disease of addiction,” he said. “I think that’s … part (of) the issue.”
MEDICAID AND WELFARE PROPOSALS
The debate is likely to surface in a legislative session where the drug issue will command attention repeatedly. Other proposals related to drug addiction include bills to provide additional treatment services for addicts, bolster drug education in public schools, increase fines for interstate drug trafficking convictions, raise state reimbursement rates to treatment centers, and establish a pilot program for police to divert people who are arrested for drug possession into treatment programs.
Also, two Republican lawmakers are pushing for the expansion of Medicaid, an effort that has failed more than a half-dozen times over the past two years in the face of firm resistance led by LePage. Now, proponents of expansion argue that doing so will help the uninsured access drug treatment. Fredette and LePage have vowed to defeat the effort.
Eves said Medicaid expansion will be a priority for Democrats, along with the advancement of job training initiatives and efforts to expand the use of solar energy.
Thibodeau has pushed for passage of changes to the welfare system, a Republican priority and an effective issue in legislative elections, which will take place in November.
Among the bills up for debate are more than 150 measures that were carried over from the first regular session, plus another 90 that were approved for consideration by the Legislative Council, a 10-member panel of legislative leaders. The new bills include a proposal to reauthorize $11 million in Land for Maine’s Future bonds that expired in November, and a proposal to impose restrictions on videotaping at polling locations.
Other bills can be introduced during the session with a majority vote by the Legislative Council. The governor also can introduce a bill at any time during the session.
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