AUGUSTA, Maine — Lawmakers return to work this week at the State House where one of the big issues they're expected to tackle is Maine's ongoing opiate epidemic. On Tuesday, lawmakers will hear testimony on a bipartisan plan to spend $2.4 million dollars to hire more drug enforcement agents and an equal amount on expanded treatment and recovery. But the plan does not include money for methadone and Suboxone treatment and those on the front lines say that's essential for any strategy to work.
Dr. Mark Publicker, a longtime addiction specialist who worked at the former Mercy Recovery Center, and now runs his own practice, says the plan is not only weak, but damaging because it doesn't include any money for what are universally considered the most effective medications for opiate addiction: methadone and burprenorphine, commonly known as Suboxone.
"I'd give it a zero. I'd give it a D-minus," Publicker says.
On the treatment side, the plan calls for spending a million dollars on a ten-bed detox center in Bangor geared toward uninsured heroin addicts. Publicker says there are several problems with this strategy, including the fact that it's a million dollars for ten beds out of a $2.4 million dollar budget. And it's detox for only a few days, Publicker says. It's not treatment.
"The critical point here is that detoxification itself plays no role in the treatment of opiate addiction," says Publicker. "We're spending a million dollars on a component of the disease that has absolutely no benefit."
Dr. Publicker estimates that 60 to 70 people a month could undergo detox for three or four days in the program. But because they won't be given Suboxone to block their cravings for opiates, Publicker says the likelihood that they'll even be able to engage in any kind of counseling is slim. The plan also calls for spending $800,000 on residential and outpatient treatment and $600,000 on peer support programs. But Publicker says the amounts aren't sufficient to do much good and can't work without methadone and Suboxone. He compares the effectiveness of both medications to the use of chemotherapy to treat cancer.
"The fact that the bill doesn't fund it and there's no other money in the pipeline for it is...terrible," Publicker says.
"I think it's a good start. It's good to see that there's recognition on the part of the legislature to address both the law enforcement and the treatment side," says Bob Fowler. He is the executive director of Milestone Foundation which runs the only non-hospital-based detox center in the state.
Demand is so great for services that Fowler says Milestone gets 20 to 30 calls every day and every day has to turn many of them away because the detox is full.
"While we're located in Portland, we serve clients from every part of the state so any additional resource for detox in the state will reduce the demand that we see down in Portland," Fowler says.
Fowler agrees that the bill doesn't include nearly enough money for residential and outpatient treatment especially since the state hasn't expanded MaineCare services. Fowler also agrees that expanding medication assisted treatment is essential for longterm recovery, something many other states have embraced. Jim Cohen, an attorney representing a coalition of methadone providers in Maine says he's looking for relief in a separate bill sponsored by Republican Senator David Woodsome to bolster MaineCare reimbursement rates to methadone providers. The rates have been repeatedly cut over recent years.
"That is the area where we could, with the greatest ability, make a positive impact on the addiction crisis in the state of Maine," says Cohen.
Cohen says the bill would restore counseling services as a component of treatment. But Governor Paul LePage and some other Republicans do not support spending more money on drug treatment. House Republicans made that clear in a meeting with reporters on Monday. They said Maine already spends $76 million dollars a year on drug treatment and education and they said they want a thorough analysis of how those funds are being used before they consider spending any more money.