Editor's note: This is Part 4 of our 5-part "State of Withdrawal" series. Click here for the other stories in the series.
This week we've been hearing from doctors and treatment providers about why they object to the state's plan to end MaineCare coverage for about 3,000 methadone patients.
The state wants to shift patients' treatment to primary care doctors who are authorized to prescribe Suboxone, a different opiate replacement drug. But there's a shortage of willing Suboxone providers in Maine.
And some people who are in treatment for addiction think the plan could jeopardize more than just their recovery.
Meet Kristen. She's a 28-year-old corrections officer and mom, who says about four years ago she was something else.
"You don't feel alive. I was like a walking zombie," she says.
Kristen says she got strung out on oxycodone and fentanyl after breaking her back on the job. She was out of work for a year. She says she was constantly tired, often in pain and eventually got so sick from an excessive amount of medication she couldn't get out of bed or take care of her two young kids.
"It feels like there's never no end," she says. "Like, I didn't think I was ever going to get better when I was at my rock bottom. I was like — there's never gonna be a way out. I'm a loser and I'm just gonna be a loser now."
A little over a year ago Kristen got help at a methadone clinic including counseling, support, accountability and a structured routine. She's working again and, as she puts it, no longer feels like a loser. More importantly, she says she has energy and can enjoy spending time with her kids.
"I feel like I'm a human being again," she says. "I don't feel like I'm gonna get sick when I wake up tomorrow morning or I'm not going to be able to get out of my bed to get my kids to school anymore. You know what I mean? Like, I can do that."
Kristen has insurance that pays for her methadone treatment, so she's not one of the patients who is directly affected by the LePage administration's plan for MaineCare patients. But Kristen says she's still worried that her recovery and that of all 4,500 methadone patients in the state could be disrupted. That's because MaineCare clients account for more than half of the patients at 11 methadone clinics in Maine. In some cases, it's closer to 80 percent. Without them, the clinics say they're vulnerable.
"Right now we only have a very small percentage that are self pay," says Jennifer Minthorn, program director for Merrimack Medical Services, which runs two methadone clinics in Portland and Lewiston. She says methadone providers are already struggling with decreased MaineCare reimbursement rates for counseling, medication and other treatment services they offer.
"So if this policy were to go into place, financially, it wouldn't be viable for us to stay in business," Minthorn says. "So, more than likely all the clinics would close. And that's a lot of peoples' jobs, livelihoods, as well as patients."
Patients such as Heather, who says she's been on methadone with the help of MaineCare for the past 2 1/2 years.
"For me, you know, my rock bottom: I was in bed and I would literally just roll over, crush a pill, snort it and roll back over," Heather says. "And that was my life until I walked into these doors."
Since that time she says she has gone back to school and just started an externship to become a drug and alcohol counselor herself. She's now low enough on her methadone dose that she says she will be OK if she's forced to stop treatment.
"For everybody else, you know what are they gonna do? They're not gonna have the resources," Heather says. "I mean, there's groups, you know monthly, weekly, daily groups here. There's always somebody here to help you when you're in a crisis or you know you feel like you're gonna make it to that next day. So, if you take that away, what are these people going to do?"
The consensus from doctors and patients in Maine is that without methadone treatment many will relapse and wind up seeking drugs and selling them back on the streets.
"And when you're there, you do what you have to do to get what you have to get. And if that means breaking the law, so be it," says Scott Harlow, an opiate addict from Bangor who says he has been in methadone and Suboxone treatment. He says he's on the path to recovery now but knows, from experience, what it's like to relapse.
"There I was, walking around going, 'Oh my word, where am I going to get my next day's dose? Where is it going to come from?'" Harlow says. "So, I had to resort to hustling and doing whatever had to be done to make sure I didn't feel sick."
Kristen says the methadone clinic is the only thing that keeps her from doing that right now. Without it, she says drug dealers will have a heyday in Maine because the need for addicts to keep from going into withdrawal will be that much greater. And heroin, she points out, is a lot cheaper than oxycodone.
"It's just going to open a whole new door to death for a lot of us, like me," Kristen says.
"Sometimes when people relapse coming off of methadone it would be to opiates but often it will be to alcohol or other drugs," says Dr. James Berry, part of the addiction medicine team at Mercy Recovery Center in Westbrook. "And then the damage will be occurring to them, their families and the community. Crime will go up, homelessness, overdoses, hospitalizations for infection."
Infections from needle-related diseases such as HIV and hepatitis C. The governor has proposed spending more money on drug enforcement agents, prosecutors and judges as a way to target drug dealers. And Dr. Kevin Flanigan of the Office of MaineCare says the state has made progress in reducing the amount of drugs diverted to the streets.
"We need to stem the tide of newly diagnosed opioid addiction patients and MaineCare has taken steps in the last two years to accomplish that through a pain management program we've been able to reduce, by nearly 50 percent, the number of opioid pills that are dispensed to MaineCare members," Flanigan says.
This, he says, has reduced their risk of developing addiction in the first place. But the strategy to end methadone treatment for several thousand MaineCare members is something else entirely, say critics of the plan.
This week the national presidents of the American Society of Addiction Medicine, the American Psychiatric Association and the American Academy of Addiction Psychiatry, among others, wrote a letter to the state warning of the "profound public and personal health consequences" for patients in recovery.
"Placing barriers to opioid addiction treatment," they wrote, "undermines our state's and our nation's efforts to bring this epidemic under control."
They asked the state to reconsider the proposal and work with addiction treatment providers to develop more clinically and cost-effective ways to address the disease.
