I recently attended the American Society of Addiction Medicine’s annual conference in Baltimore, where I listened intently to the nation’s leading physicians, scientists and policymakers speak about innovative developments and strategies to treat the disease of addiction.
Gov. Peter Shumlin of Vermont gave a rousing speech on the many aggressive measures he has employed to address the heroin crisis in his state, including expanding health insurance coverage and decriminalizing drug use in favor of expanding access to treatment. He also spoke about increasing the availability of naloxone, a life-saving medication that can reverse an opioid overdose.
As a board-certified addiction medicine physician practicing in Portland, the more I heard about the proactive measures being taken around the country to address the terrible epidemic of heroin addiction, the more frustrated I became at the lack of evidence-based action taken by our officials in the state of Maine.
Last week, Gov. LePage vetoed a bill, L.D. 1547, that would have expanded access to naloxone. Naloxone (brand name Narcan) is an opioid antagonist that acts as an antidote to drugs such as heroin, fentanyl and oxycodone. This medication is effective, fast-acting, safe and non-addicting.
The legislation would have allowed pharmacists to dispense naloxone to at-risk individuals and their friends and family members without a prescription. The bill also would have allowed police and firefighters to obtain supplies of naloxone.
Public health experts (such as the U.S. Centers for Disease Control and Prevention) have called for such measures in an attempt to stop the rising number of Americans whose lives are being cut far too short because of drug overdoses. Last year, this number soared to 272 in Maine.
Literally adding insult to injury, LePage speculated in his veto message that “naloxone does not truly save lives, it merely extends them until the next overdose” and that the medication “produces a sense of normalcy and security around heroin use that serves only to perpetuate the cycle of addiction.”
His statements are not only offensive to those struggling with the disease of addiction, they are also wrong. The medical literature has repeatedly shown that naloxone does, in fact, save lives. Communities that employ overdose prevention programs with naloxone have lower rates of drug overdoses than those that don’t, according to the CDC. Furthermore, many studies show that increased access to naloxone does not result in increased levels of heroin use – in fact, it may actually reduce usage of the drug.
The governor’s statements would seem to indicate that he believes that those who are addicted to drugs will never get better and should be punished by not having access to a life-saving medication.
Would he deprive family members’ access to an epinephrine pen for their loved one who has a severe allergy because it may enable them to irresponsibly eat peanut butter? How about restricting access to insulin for diabetics or chemotherapy to those with lung cancer because it may enable them to continue to eat ice cream or smoke cigarettes? His logic is faulty, and his statements serve only to perpetuate the stigmatization of individuals with addictions as bad people who make bad choices.
I have treated many patients in recovery from the chronic brain disease of addiction who have either experienced an overdose themselves or witnessed one among their friends. Never have I heard that they considered using more drugs because they knew that if they overdosed, they would be rescued later.
Addiction is characterized by impulsivity and the continued use of a substance or behavior despite negative consequences. What I have heard are many heartbreaking stories of promising young individuals who suddenly died, leaving behind distraught parents, friends and sometimes young children.
I have come to accept that many in the public would hold misconceptions about those with addictions. However, I find the continued ignorance of the governor of a state of over 1 million people absolutely inexcusable and irresponsible.
There is no doubt in my mind that LePage’s decision to veto bill L.D. 1547 will needlessly endanger the lives of Mainers. It calls into question his ability to lead our state during a time of unprecedented public health crisis.
As a physician on the front lines, I strongly encourage the governor and other policymakers to educate themselves on the science of addiction (www.drugabuse.gov) and to craft informed, evidence-based policies (such as those that expand affordable access to addiction treatment medications such as buprenorphine, methadone and naltrexone). Enough is enough.
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