AUGUSTA — The state Department of Health and Human Services will direct $2.4 million in existing funds to support the expansion of medication-assisted treatment for opiate addiction, an apparent policy shift for an administration that has been slow to embrace that option.
The creation of 359 new slots for uninsured Mainers is the latest effort to combat the state’s worsening drug crisis, which has led to a record number of overdose deaths – 286 for the first nine months of 2016.
It’s also the first major initiative under Gov. Paul LePage that incorporates medication-assisted treatment, a combination of medication and behavioral health counseling that LePage has often criticized but studies have shown to be highly effective in treating alcohol and opioid addiction.
DHHS Commissioner Mary Mayhew, who announced the initiative at a news conference Tuesday, said the governor’s criticism has not been with the medication itself, but with how its administered.
“We raised a lot of concerns around the approach being taken to methadone,” she said. “We talked about our concern of having those clinics function more as islands at the same time the federal government has been encouraging this integrated model.”
The state’s support is contingent on Suboxone or methadone being paired with therapy.
“The medication alone cannot help to support their pathway to recovery,” Mayhew said.
TREATMENT SLOTS ADDED AT FIVE LOCATIONS
Beginning Jan. 1, the state will expand medication-assisted treatment at five locations. Two methadone clinics in Bangor – Acadia Hospital and Discovery House – will account for 210 slots, and a clinic in Washington County, also run by Discovery House, will add another 100. The other facilities are Crooked River Counseling in Oxford County and Central Maine Counseling, which will expand at locations in Lewiston and Biddeford.
Asked why the increase in capacity is limited to certain areas, Mayhew said this is where the need was identified. It was based on interviews with 72 different agencies and 38 private providers.
“This was a process where we worked closely with providers to evaluate their current wait lists,” she said. “Based upon that analysis, that is where we identified these gaps.”
Going forward, the Office of Substance Abuse and Mental Health Services will continue to evaluate need, especially Downeast and in western portions of the state.
Mayhew said that in addition to the new slots created, she hopes more physicians across the state will become certified Suboxone providers, along with nurse practitioners and physician’s assistants, who also now can prescribe under a new federal law. Suboxone, unlike methadone, is not administered in a clinic-style setting.
A recent report by the U.S. surgeon general on addiction – the first of its kind – focused on treating substance-use disorder as a chronic brain disease and highlighted medication-assisted treatment as an effective option for those with opiate addiction.
According to DHHS, 8,627 Mainers received medication-assisted treatment in fiscal year 2016. However, only 215 slots were available for those without insurance. The 359 additional slots announced Tuesday will be added to that total. Many of those uninsured likely will be Mainers who either lost MaineCare when the state tightened eligibility requirements or who would receive insurance if the state opted to expand as allowed under the Affordable Care Act.
Asked whether there would be a cap for uninsured patients, knowing that recovery is not one size fits all, Office of Substance Abuse Director Sheldon Wheeler said there would be no cap and that the department would commit to funding these slots for the foreseeable future. The $2.4 million comes from a mix of General Fund dollars within the Office of Substance Abuse and federal grant funding, but neither Wheeler nor Mayhew could provide an exact breakdown.
HOPING FOR SHIFT IN STATE’S APPROACH
Rep. Drew Gattine, D-Westbrook, outgoing co-chair of the Legislature’s Health and Human Services Committee, called the announcement an “important first step,” but he also drew attention to the apparent policy shift by the LePage administration, which has been critical of medication-assisted treatment.
“It’s surprising, given the department’s history of reducing services and fighting against legislative attempts to expand access, so I hope this signals a change of heart and renewed openness to increasing availability of treatment,” Gattine said. “Maine has a severe lack of treatment capacity statewide, especially in rural areas, so we need to be aggressive and take advantage of every opportunity possible to expand capacity.
“I remain eager to partner with the administration in working to provide adequate care for our state’s families,” he said. “I hope this is a sign of a new willingness to work with providers and legislators on combating the still-worsening drug crisis.”
Malory Shaughnessy, executive director of the Alliance for Addiction and Mental Health Services of Maine, was happy to see the administration embrace medication-assisted treatment after many months of pleading by providers.
“The concern I have is how they chose to expand and with whom,” Shaughnessy said. “It seems like a very closed process.”
Shaughnessy said that while the areas identified by the state do sorely need more treatment, the rest of the state is not immune. She said many providers have been told by the state to operate without waiting lists even though they are regularly turning people away.
Mayhew said the department has “worked tirelessly” to address the state’s needs, but she also has tried to bring accountability to all services provided.
“We’ve raised this concern in the past that there has been too much of a focus on continuing to provide the same level of funding to the same contracts, year after year, without the kind of analysis around the demand, the changing type of demand and the changing need around services,” she said.
The federal Substance Abuse and Mental Health Services Administration estimates that there are between 25,000 and 30,000 Mainers with substance use disorder who want treatment. Mayhew, however, said that number is a little misleading.
“You have to go down and look at how many acknowledge (that they are addicted), and then of those, how many are actively seeking treatment, and of those, how many are unable to access treatment,” she said. “That’s a much smaller percentage. That’s what we’ve been focused on.”
PILOT PROGRAM USES RELATIVELY NEW DRUG
Dr. Christopher Pezzullo, the state’s chief medical officer who appeared at Tuesday’s news conference, said the state has launched other initiatives to combat the drug crisis, including the creation of a 10-bed detox facility in Bangor and the upcoming launch of a Vivitrol pilot program for women at Penobscot County Jail. Vivitrol, like Suboxone and methadone, is used in medication-assisted treatment but it’s still relatively new.
Pezzullo also said that stigma around drug abuse persists, creating barriers to treatment for some.
“So while many might be dealing with a substance use disorder, they may not yet be ready to enter treatment or may not see their issue as a problem,” he said.
Mayhew, too, said the state’s response is ongoing.
“This is a public health issue. We must take a multidisciplinary approach,” she said. “(But) there are no easy answers. No silver bullets.”
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