The Maine Department of Health and Human Services announced Monday that it will expand access to medication-assisted addiction treatment, creating 359 new slots with a program that is scheduled to start Jan. 1.
The initiative will be funded by state and federal money, with funding from the Substance Abuse and Mental Health Services Administration being used to treat uninsured patients, the Maine DHHS said in a statement released Monday night.
The new program comes as Maine and the nation face record numbers of overdoses. Through September of this year, Maine experienced 286 overdose deaths, more than in all of 2015, according to the Maine Attorney General’s Office. Between 25,000 and 30,000 people seeking long-term drug treatment in Maine were unable to find care, according to the Substance Abuse and Mental Health Services Administration.
The DHHS said its study showed that about 300 to 450 people in the state are on the wait list for medication-assisted treatment, which combines behavioral therapy and medications to treat substance use.
The department is proposing new treatment slots using Suboxone or methadone at Acadia Hospital, Crooked River, Central Maine and Discovery House locations in Bangor and Calais. It said the announcement follows conversations with providers in the state to target those areas and individuals most in need.
DHHS declined to comment Monday night on what prompted the announcement or how the department secured funding for the additional spots. DHHS Commissioner Mary C. Mayhew and Chief Medical Officer Dr. Christopher Pezzullo are expected to give more details on the plan Tuesday.
Medication-assisted treatment providers greeted the DHHS announcement with cautious enthusiasm.
“It’s a wonderful thing, especially if they get people into treatment that couldn’t access it before,” said Dr. Ann Dorney, a physician at Reddington-Fairview General Hospital in Skowhegan.
Dorney is one the few doctors in Maine who actively prescribes Suboxone, a drug used to treat opioid addictions. She questioned whether the state had enough providers to meet the health department’s new goal. Of the roughly 2,000 primary care physicians in Maine, only 214 doctors, including primary care physicians and addiction specialists, are prescribing Suboxone, according to numbers released this year by two health care advocacy organizations, the Maine Medical Association and Maine Quality Counts.
And drug treatment provider shortages persist beyond Maine. Across the country, only 2.2 percent of doctors in the U.S. have completed required Suboxone training, according to a study published in July in the Journal of the American Medical Association.
Part of the problem, Dorney said, is that physicians are wary of taking on patients in the worst throes of addiction who might benefit from medications like Suboxone but also require intensive counseling.
“Medication-assisted treatment stabilizes someone so they’re not thinking about opiates all the time,” Dorney said. “The counseling is the treatment.”
It can take years of counseling for individuals to find the initial triggers and causes of the addiction, she said.
Another issue is the stigma that surrounds addiction, said Eric Haram, a behavioral health and health care consultant who has helped states around the country implement medication-assisted treatment programs.
“There remains a lot of mythology around the problem, that it’s an economic issue, that it’s a moral failing,” Haram said. “That’s been one of the reasons why it’s been difficult to recruit (new providers).”
Even those providers who do recognize the scope of the problem may steer clear of the field for fear that they cannot adequately provide for their patients.
Maine has been slow to expand access to medication-assisted treatment and has even tried to end some programs. Last year, the LePage administration proposed ending methadone treatment as a MaineCare benefit, arguing that the state could transfer thousands of methadone patients to Suboxone. The proposal failed after outcry from the treatment community, which noted that methadone can be more effective, especially for individuals with more severe opioid addictions.
With its latest announcement, the state is sending a message to physicians and other drug addiction providers that it is willing to support their drug treatment efforts, Haram said.
Federal lawmakers also have tried to increase treatment access by raising caps on the number of patients each provider is allowed to treat from 100 to 275, and by expanding the categories of providers that can prescribe drug treatment medications. In July, Congress passed the Comprehensive Addiction and Recovery Act, which allows certified nurse practitioners and physician assistants to prescribe Suboxone.
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CORRECTION: This story was updated at 5:24 p.m. on Dec. 30, 2016, to clarify that doctors prescribing Suboxone include primary care physicians and addiction specialists.
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