AUGUSTA, Maine - One of the most controversial budget cuts proposed by the LePage administration this year would have eliminated MaineCare funding for methadone treatment in federally-regulated clinics. Instead, the state suggested that about 4,000 methadone patients be redirected to office-based treatment with the alternative drug Suboxone.
The idea was widely panned by substance abuse treatment providers, and lawmakers have opted to preserve the status quo - but to also look for ways to improve treatment.
In March, doctors and treatment providers rolled out a full-court press against the plan to eliminate MaineCare coverage for methadone. They said it could put opiate addicts in danger of withdrawal, and even death, from being abruptly taken off the drug.
They said the two replacement therapy drugs are not interchangeable and they pointed out that even if Suboxone could be used as a substitute for methadone, there is currently a shortage of Suboxone providers in the state of Maine. Even some doctors who treat patients with Suboxone were opposed to the plan.
"Theoretically, I should be delighted at this." That was Dr. Meredith Norris's reaction back in February when the plan was first announced. "I should be, like, hooray! Thank you LePage for sending all these people to me. And my first thought was holy cow! How are we going to absorb that? We can't absorb that. We can barely even meet the need now for people who are Suboxone appropriate."
The LePage administration argued that moving opiate addicts out of methadone clinics and into treatment with a primary care doctor would give them more access to a full range of medical services. Dr. Kevin Flanigan is the medical director for the Office of MaineCare services. In an interview earlier this year, he cited the need for a more wholeistic approach to treatment.
"It is about getting these people the comprehensive services they need, because people who suffer from addiction don't just have addiction," Flanigan said. "That's not their sole primary health care issue. Many suffer from other medical and behavioral health conditions. Once you get to where you can get the entire package of health care services in one location we know, the literature is unquestionable - that there is going to be improved health outcomes."
Methadone is considered the "gold standard" medication for treatment of opiate addiction but lawmakers were not persuaded to eliminate it for MaineCare patients. And the compromise budget passed this week removed the proposed cut to service.
"So that was good news and reflected the understanding of the Legislature that methadone was an essential treatment for individuals with opiate addiction in Maine," says Jim Cohen, an attorney representing a coalition of methadone providers in the state of Maine. He says the budget directs the Department of Health and Human Services to convene a panel of stakeholders to evaluate ways to make methadone treatment more cost effective and better meet the needs of patients.
"We suggested that the state could re-examine its policies, hours of clinic operation, take home dosage, as well as re-examining reimbursement rates to better enable clinics to be located where patients are," Cohen says, "and in that way reduce transportation costs and reduce some of the barriers for individuals who might otherwise seek and need treatment in Maine."
Cohen says the department is directed to include stakeholders who are experts in opiate and methadone addiction treatment. The budget calls for a report back from the group by mid-November. The department did not respond to a request for comment.
