Friday, October 12, 2012

Methadone and Suboxone Treatment to be cut in Maine


Heroin addiction soars in Maine as treatment cuts take effect

The American Society of Addiction Medicine reports that misuse of prescription drugs has dropped about 15 percent nationally since 2010, while heroin use has doubled since 2007.

     Publicker said he's unaware of figures that document heroin use in Maine, but he's seen a sharp rise in the number of patients reporting that it's their drug of choice.  Stuart Gitlow, the acting president of the society, said progress has been made against the misuse of prescription drugs through public education efforts that highlighted the drugs' highly addictive nature, together with an effort to get doctors to limit painkiller prescriptions and more closely monitor the patients using them,  While that curbed the availability of those drugs to abusers, heroin became a cheaper, more readily available alternative, he said, particularly in New England, where high-grade heroin can be found. He said the drug in southern New England, where he's based, is so pure that some users start out snorting the heroin, avoiding the deterrent of self-injecting.

     Prohibition sure makes strange bedfellows.  For better or worse the fate of people in physical pain and opiate addicts are intertwined.  Pain is already undertreated in this country and as the article correctly notes a decrease in painkiller prescriptions correlates with an increase in heroin use.  This is likely to hurt older people in pain more than street users who have greater access to market alternatives.

     The state will impose a two-year cap on the use of buprenorphine and methadone, the two most effective drugs for treating heroin addiction. The limit will be applied retroactively, so some who rely on the treatment currently may be cut off immediately, Publicker said.

He said he's joined a task force that has been formed to try to carve out an amendment to the limit that would allow treatment to be extended if a doctor certifies that a patient is making progress socially -- such as getting a job or going back to school -- and has remained crime-free.

    Now this is really scary.  The article does not make clear if this is only effects people on low-income government insurance or all persons regardless of their insurance or are paying out of pocket.  Cutting off people who have been on opiate replacement medications for years is a recipe for disaster.  Methadone and Suboxone is not a cure for opiate addiction by any means, but for some people it is a line-line to living a life with some semblence of normality.

     Also note that this law only affects poor people on methadone and suboxone.  People paying out of pocket or on private insurance will not be affected.  It is ostensibly being offered as a cost savings measure which is very short sited.  For every dollar spent on methadone treatment the state will save several dollars on enforcement, crime and disease.


     Methadone and Suboxone are the most successful treatments available to opiate addicts.  Once you have been on them for a while there is no appreciable "high" nor are they impaired.  Most addicts "mature out" of opiate addiction within ten years, but some may need to be on methadone for the rest of their lives.  Many of them have completely normal and fulfilling lives, although they don't advertise the fact that they are on methadone due to stigma.  It would be terrible if the state overrode their doctor's medical opinion and forced them off methadone and into the arms of the black market and criminal justice system.  It is not only morally wrong but also fiscally irresponsible as methadone is cheaper than police and prisons.



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