After 40 years in practice, one of Maine’s best-known addiction treatment specialists is retiring.
Dr. Mark Publicker has long championed medication-assisted treatment for patients, including pregnant women. And this year he’s being nationally recognized by the American Society of Addiction Medicine for his lifetime achievement and service.
It was in his family medicine practice in Pittsburgh in the early 1980s that Publicker noticed something peculiar about many of his patients who worked in the steel industry.
“Many of them had elevated liver functions, uncontrollable blood pressure and things like gout. And I was puzzled because I didn’t honestly know what I was looking at. I thought it was industrial poisoning,” he says.
Publicker thought he was on the verge of a major discovery until someone loaned him a book about alcohol use disorder. That’s when he realized his patients had an entirely different problem. But back then, there were no resources for doctors to address and treat the chronic disease, so Publicker forged ahead on his own.
“Certainly, if you ask a direct question: ‘Do you think you have an alcohol problem?’ The answer is universally ‘No,’” he says.
But Publicker says if he leveled with his patients, told them they had elevated liver problems and asked them to abstain from alcohol for a month to see if that helped, they all said yes.
“And then at the end of the month, if they had stopped drinking, lo and behold their liver was better. And if they hadn’t stopped drinking, then I can have a conversation about, ‘What was that about?’” he says.
Early on, a local psychiatrist suggested that if he wanted to learn more about alcohol use disorder he should start going to AA meetings. It was in these group sessions, sitting at the back of the room, that Publicker says he began to learn about and appreciate the process of recovery and the remarkable ways it transformed his patients.
“And about six months into it I started to get God Bless You letters. And that was striking because diabetics never sent me God Bless You letters. Hypertensives don’t. So I said, ‘Ah, there’s something here,’” he says.
At that point, Publicker officially changed his career to addiction medicine. His decision coincided with the collapse of the Pittsburgh steel industry and an unexpected surge in the use of drugs like heroin and cocaine. Publicker designed and developed an addiction treatment program at the HMO where he worked.
Ten years later he went on to create a similar program in Washington, D.C. And in 2003, he was recruited by Mercy Hospital to serve as the medical director for the state’s largest recovery center in Westbrook.
“I started using drugs when I was 15 and at 21 I started shooting heroin and cocaine. And it was just all downhill from there. And I found out I was pregnant when I was two months clean,” says Michaela, who was interviewed as part of a Maine Public Radio series back in 2008.
Michaela was one of the patients at the Mercy Recovery Center where Dr. Publicker started a pioneering treatment program for pregnant women. He has called it the most rewarding part of his career.
“And what we did was develop an open door so a pregnant woman, whatever her stage of pregnancy, could simply walk in through our front door, we would admit them to our inpatient intoxication unit, stabilize them, give them what treatment options were available, start them on buprenorphine,” he says.
In addition to getting medication, pregnant women took part in a five-day-a-week outpatient program that included a weekly support meeting.
Publicker says the maternal addiction program had a high rate of success and the recovery center, which included 26 detox beds and treatment for a range of substance use disorders, was also sorely needed. But, faced with decreasing insurance coverage and low Medicaid-reimbursement rates, Mercy’s Chief Medical Officer Dr. Scott Rusk announced in 2015 that the recovery center would be forced to close.
“It’s very sad and I can’t tell you how upset everybody is,” he said. “We’ve been in the red for so long that we can no longer support subsidizing the program.”
As Maine’s opioid crisis escalated, nearly 250 Suboxone patients were suddenly out the door. Publicker, who went into private practice, says the loss of the maternal addiction program is still a deficit in Greater Portland. And the lack of insurance among patients remains a big problem.
“There’s a large population of people who make too much money to qualify for an ACA insurance plan, but make too much as well to qualify for MaineCare. We’re talking about working people who don’t have health insurance. And, you know, I think we need to have universal health insurance,” he says.
“He’s not afraid to speak his mind,” says Dr. Gordon Smith, the state’s director of opioid response. “He calls it just as he sees it, but he’s always been really all about his patients.”
Smith says Publicker has been a mentor to him and to other treatment providers, someone who challenges the stigma around addiction and who has also challenged the state’s approach to treatment on occasion.
“He’s going to be very much missed. On the other hand, we know he’ll be around to make comments when we’re doing good things or bad. And really, he’s been terrific,” Smith says.
As he takes down his shingle and officially closes his doors, Publicker says one trend that worries him is the dramatic, but largely unseen increase in methamphetamine use. His patients tell him that it can be found all around Portland, in expensive condominiums and on the street. But his biggest concern goes back to what jumpstarted his career.
“My actual biggest issue is alcohol,” he says.
Publicker thinks treatment for alcohol and other substance use disorders has taken a back seat to opiate dependence. Maine had nearly 400 drug overdose deaths in 2019 and may surpass that number in 2020.
While Publicker says he’s seen major advancements in education and research around substance use disorder during his career, he says when it comes to treatment for addiction there’s still a long way to go.