Maine to Expand Access to Medication-Assisted Addiction Treatment

Dec 20, 2016

The Department of Health and Human Services says it will spend $2.4 million on an initiative that will provide additional access to medication-assisted addiction treatment.

The announcement surprised treatment advocates, who have criticized the LePage administration for making it harder to access methadone and Suboxone amid an opioid crisis largely responsible for more than 270 overdose deaths last year.

DHHS Commissioner Mary Mayhew says the plan is designed to benefit the 300-450 uninsured Mainers who are actively seeking treatment but who are unable to receive it. The additional dollars, most of which come from a federal grant, will create nearly 360 additional treatment slots at facilities across the state beginning Jan. 1.

“This is a public health issue, and in order to address it we must take a multidisciplinary approach,” Mayhew says.

Officials say the federal funds come from the Substance Abuse and Mental Health Services Administration, but did not disclose the state’s share of the spending. The additional treatment slots are focused primarily in northern, eastern and rural areas of the state.

Mayhew says the allotments are based on a survey of 72 agencies and 38 private substance abuse providers.

“Each slot will focus on helping the uninsured. It will include either access to Suboxone or methadone, coupled with therapy,” she says.

The announcement was welcomed by treatment providers such as Brent Miller, the director of the Discovery House in Bangor, which will receive 160 new treatment slots with the funding. The Discovery House in Calais will see a boost of 100 more.

The two locations account for 70 percent of the new slots that will be made available after the first of the year.

Miller says that’s good news for the 80 or so unininsured patients currently awaiting treatment in Bangor.

“This I hope is harbinger of the return to the realization that the only way to treat a disease is to get treatment,” he says.

Medication-assisted treatment is considered by scientists, doctors and treatment providers as the gold standard for opioid addiction. But advocates for the approach say it hasn’t been easy convincing the LePage administration to expand access.

Since taking office, LePage has successfully pushed for a two-year cap
on methadone and Suboxone treatment unless patients get special
permission to continue. He has tried and failed to end MaineCare
coverage for methadone treatment.

Lower Medicaid reimbursement rates to treatment providers have been blamed for the closure of two major treatment facilities in southern Maine, one operated by Mercy Hospital and another operated by Spectrum in Sanford.

Also, efforts to increase reimbursement rates have stalled in the Legislature amid resistance from the LePage administration.

Last summer, DHHS announced that it wanted to impose additional requirements for methadone and Suboxone providers, including additional counseling.

“I’ve been trying to close down methadone clinics since I’ve been governor. We’re raising the price and everything. I tell you, when it comes to methadone, every expert I’ve spoken to says if there’s no clinical aspect to it — if it’s just you stop by and get your drug and leave — it’s useless,” LePage said on Bangor radio station WVOM in July.

The state’s 10 methadone clinics are regulated by half a dozen state and federal agencies, and the counseling the governor was talking about is actually required to receive the drug.

Still, medication-assisted treatment advocates feel like they’ve had hard time convincing the LePage administration to buy into an expanded access effort backed by the federal government. State Rep. Drew Gattine says that’s what made today’s announcement so surprising.

“Anytime you see the department make an announcement that they’re going to expand access to treatment, in particular medication-assisted treatment, I think that’s a big deal and something that we should all support,” he says.

Jim Cohen, an attorney representing a coalition of methadone treatment providers, says the initiative is a small step toward addressing a massive treatment need statewide.

“It doesn’t end the work that we need to do. We need to continue to move ahead to address that serious need, but I think we should recognize the positive accomplishment of today’s announcement,” he says.

Mayhew rejected the notion that the administration has been resistant to medication-assisted treatment.

“That’s not true,” she says.

Mayhew says efforts that have affected methadone clinics were not designed to erect barriers to treatment, but to ensure that the state- and federally funded clinics are accountable and providing a consistent level of care.

“So that we’re not creating a fragmented approach to someone’s care and that their addiction to substance abuse is part of a much more holistic and comprehensive approach to their care,” she says.

The cumulative effect of the new initiative is unclear. According to the Substance Abuse and Mental Health Services Administration, between 25,000 and 30,000 people seeking long-term drug treatment in Maine last year were unable to get it.