In an effort to bring much-needed attention to the tragic epidemic of opioid overuse and deaths in our state, a Portland Press Herald July 25 story focused on the need for more physicians to offer buprenorphine (Suboxone) as an important option for treating opioid addiction. There is strong scientific evidence that treating addiction with buprenorphine in combination with counseling improves many key outcomes – e.g., treatment results in significantly lower rates of relapse and illicit drug use, and higher rates of return to work. Despite that evidence, the number of doctors offering this treatment is low both in Maine and nationally: A recent study estimated that only 2.2 percent of all U.S. doctors have completed the training required to prescribe this medication, and it is likely that even far fewer actually offer it routinely in practice.
But the story, of course, is complicated and the numbers do not always reflect either the range of barriers or efforts underway to address this issue. To start, while it is important for patients to be able to access buprenorphine from their primary care practice, it is already extremely challenging to attract and retain primary care providers, especially in rural communities across the state. Before we place another expectation on primary care practices, we must find ways to improve primary care by developing better team-based models of care, and identifying better payment models that reflect the value of their services.
Additionally, many practices are challenged to offer this treatment because of the significant social stigma and bias about addiction and addiction treatment that remain rampant in our communities. One only needs to read public comments about this issue to see the misconceptions and lack of understanding about addiction as a chronic disease and the value of medication-assisted therapy to improve outcomes and change lives. Additional barriers include the lack of health insurance coverage for many individuals who suffer from opioid addiction; the need for complex tracking systems (e.g. urine drug screens, pill counts); and a lack of access to addiction and recovery counselors that are a necessary part of this treatment. Providers also need education and ongoing support to provide this service. If we want more providers to offer this service, we must do more to address these barriers and support their ability to offer this needed care. Additionally, we must recognize that patients suffering from addiction need not only medical treatments, but also “wrap-around” services such safe housing and sober living options, vocational services, and employment.
Even in the face of these challenges, it’s important to note that there are several efforts underway in Maine: In addition to the providers cited in the article such as Dr. Craig Smith and the MidCoast Addiction Resource Center, several provider groups and health systems in the state have efforts underway to increase the number of providers offering addiction treatment. In the MaineHealth system, Maine Medical Partners practices currently offer buprenorphine treatment in Westbrook, Portland and Scarborough, and is planning to expand buprenorphine treatment to all adult primary care practices in the next year. Penobscot Community Health Center’s (PCHCs) Seaport Community Health Center in Belfast has been offering these services since 2004 and currently provides treatment to over 80 patients, including a group-based intensive outpatient program with behavioral health and addiction counselors.
Eastern Maine Health System’s EMMC Family Medicine Center has a robust program that current offers treatment to approximately 200 patients, and Mercy Hospital is currently working with a Greater Portland collaborative to offer addiction treatment for uninsured patients. Additionally, Acadia Hospital recently secured a grant to expand access to buprenorphine treatment in up to four of Bangor primary care offices, and to develop a plan for expanding these services in rural practices throughout northern and eastern Maine.
Additionally, Maine Quality Counts and the Maine Medical Association have come together to launch “Caring for ME”, a collaborative, statewide effort to help clinicians address this issue by providing educational resources, peer support, and practical tools to help providers effectively manage chronic pain, improve the safety of opioid prescribing, recognize addiction, and provide access to needed treatment services.
With 272 Mainers dying and 1,013 babies affected by this epidemic in 2015 and thousands more Mainers actively suffering from addiction, the opioid epidemic calls for immediate and collective action. Maine is a strong and resilient state and we can find ways to successfully address this epidemic. It’s not going to be easy, but with the commitment of all of us, we can and must do it – our community is counting on us.
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