Even as families, their communities, and health care providers struggle to keep up with the rapidly worsening opiate addiction crisis our governor and his staff are AWOL.
The governor was one of only seven out of 50 governors who would not sign the recent National Governor’s Conference Compact to Fight Opioid Addiction on the importance of providing treatment in their states. Gov. LePage’s posturing on the national stage mirrors his ill-informed and ill-advised policies here at home where he seems to be doing everything he can to thwart treatment. That’s right, thwart treatment. As a provider I have to claw my way through DHHS red tape in a struggle to get paid, a struggle I am losing by the way. But it gets worse. The governor and his staff are proposing new rules to make treatment even harder to deliver and, for those in need, harder to come by.
One simple example. Urine drug screens are a key stone of treatment supervision, as vital, sometimes more so, as pulse and blood pressure. It is through a urine drug screen that we can determine if someone has relapsed, is taking drugs illicitly, or if they are perhaps diverting their prescribed medicine. Such a test costs me $9 in supplies. The state has chosen in the past to pay me $6, so I lose money on every test. But it gets worse. I was recently told by DHHS I cannot bill for that test at all, that even though this test costs me money it is just part of my cost of doing business. So there is $1,300 I will not see and the hard math is that at that rate I lose money on every client I see.
Now, we have been informed of another rule change that is being proposed. This will require both suboxone and methadone based treatment providers to be open six days per week and to offer psychotherapy type services to every client. There is no body of evidence, no professional guideline, and no federal policy that calls for anything like this. Indeed, at the federal level and at the level of those experts looking at our opiate crisis, treatment needs to be expanded and more widely available. But these DHHS rules will have the opposite effect here in Maine.
It is bitterly ironic to me that at a time of increasing public recognition and concern about our opioid epidemic that I as a provider am getting institutional opposition, not support, from the Department of Health and Human Services. I get a definite sense of opposition through administrative barriers and hoops in my dealings with DHHS, not the needed response “that this is vital, how can we help?”
The governor has made it clear in several recent statements that he does not even believe in drug treatment. Even though we know that the $700 billion “War on Drugs” has been a failure through its reliance on the lock-em-up philosophy, that is where the governor puts his faith.
The public is rightfully in great distress over this problem. They live the havoc and misery in their families and communities. They need to know how the government that is supposed to solve their problems is indeed creating ever more difficulties for the delivery of this care.
This is a perfect storm. We have the highest incidence of opiate addiction among young adults in the country, every week five or six citizens die of an unintentional drug overdose, and our governor turns a deaf ear to the treatment community and every addiction specialist who might advise him. If you care about this issue or some afflicted by it, I urge you to write to the governor or call your representative to ask him why this is happening. The governor needs to know that you care even if he might not.
Steve Bien, MD
Farmington Maine
Steve Bien is a family physician in Farmington, Maine. He provides buprenorphine-based addiction treatment as part of his primary care.
I applaud you for speaking out, The sad fact is many will relapse and some will never recover. This makes tax payers very Leary of supporting treatment options, What they don’t understand is how much Time, Money, Property crimes etc can be freed up by having treatment options.
We can keep chasing drug dealers and locking up users and keep seeing the same results we have thus far, or we can admit that people who want to use drugs are going to and there is little that can be done to stop them if that’s what they choose. I am not advocating not punishing the crimes they commit, I just don’t think it matters whether they are an addict or not.
Would anyone reading this who does not use heroin Go out and buy heroin tomorrow if it were legal to buy/sell? I think 99.9% of people would say No. If that is true, don’t you believe it would be more prudent to chase the people who own the planes/boats bring heroin into this country? To crack down on big pharma a bit with controlled substances? We could easily limit the flow to a point where supply/demand pricing would put this out of reach of most and would only be available in large cities.
This is a really good series on Oxy, The people it has affected, The pharmaceutical company behind it and what they knew about the addiction problem and when. The LA Times also did an expose back in 2012 that was pretty eye opening.
Anyone who runs a business legally is forced to do certain things that lose money thanks to an out of control government. On the other hand government guarantees you get paid for treating customers that otherwise could not. I never had that luxury.
Doctors overprescribing opioids is a huge factor in today’s drug abuse.
Heroin ultimately is the biggest problem and most of it comes across the Mexican border. If only there was someone out there with the vision to build a wall…..
Thank you for speaking out about this Dr Bien. Unfortunately our governor isn’t providing the necessary leadership on this issue. The fact that “We have the highest incidence of opiate addiction among young adults in the country” is very upsetting. If they’re young adults when they become addicted that means decades of problems for them and for taxpayers. I’d like to see us do more for our teenagers who are at risk in this area. (I’m a high school teacher.) Money invested sooner could totally turn someone’s life around and probably save money down the road.
I hope that Dr.’s nationwide take some ownership in this epidemic. Prescription drug abuse is at an all time high and it is you folks that are putting it on the street.
Let me try again….. As Capt. Planet sez ‘Doctors overprescribing opioids is a huge factor in today’s drug abuse… The Governor does not write drug prescriptions. Where does the whole thing start.. With the doctors I say..
Dr. Bien, while I agree with much of your assessment of our Governor’s and DHHS stance, how many prescriptions have you, personally, written for opiates over the past 10 years? I ask because I have attended many forums on our state’s opiate crisis and every expert who has spoken at each forum lays the largest part of blame at the feet of the medical community which has been over-prescribing opiates to patients for the past decade. Have you been a part of the problem? Have others in your practice?
How about blaming where the blame lies? I used to blame the doctors, too. But then, I got to thinking about where these drugs come from? Why are they so addictive? People look at the surface of a problem and don’t follow it all the way back to its source. The source is the drug company (s) who lied in the first place and said these drugs weren’t addictive. We all know that’s not true. So, since the big tobacco companies got sued for lying about nicotine not being addictive, why hasn’t any authority figure had the guts to go after the drug companies? Makes since to do that. Think of all the money that insurance companies and MaineCare have paid out over the years? Don’t you think the reasonable answer is to make them pay? And that way, the funds could also help with counseling and Suboxone treatment.
I’m sure the entire world would like to build a wall around us….such elitism is mind boggling…addiction is a DISEASE not a character flaw.