AUGUSTA – Maine lawmakers will be confronted with a stark choice when they return next week to vote on Gov. Paul LePage’s veto of a bill to allow pharmacists to dispense an anti-overdose drug without a prescription.
They can join the 30 other states that have already done so, believing it saves lives. Or they can side with a governor who thinks that the overdose-reversing drug “perpetuates the cycle of addiction.”
LePage’s view of naloxone, commonly known by the trade name Narcan, puts him at odds with many law enforcement, health and treatment organizations who backed the bill. Such groups see naloxone as a tool needed to combat a heroin crisis that contributed to a record 272 drug overdose deaths in Maine last year. However, LePage’s view is shared by some legislators, and that may be enough to block expanded access to the drug, which is now available only by prescription.
In the Senate, an early roll call vote gave the bill more than the two-thirds majority needed to override a veto. In the House, however, support for the bill fell one vote short of the override margin.
Supporters of the bill hope that public criticism of LePage’s veto message will convince some lawmakers who stood with him to change their position. Advocates contend that, taken to its logical conclusion, the governor’s opposition to the potentially life-saving medicine effectively means that some addicts cannot, or should not, be saved.
“If your daughter were to die of an overdose, or your daughter’s best friend were to die of an overdose, would you hold on to the belief that you acted appropriately in barring access to naloxone for that child?” said Mark Publicker, the former president of the Northern New England Society of Addiction and current editor-in-chief of the American Society of Addiction Medicine magazine. “The little girl, who your daughter grew up with, dies of an overdose because you voted to limit access to a life-saving drug. How’s that going to feel?”
Bill Piper, director of national affairs for the Drug Policy Alliance in New York, said the governor’s argument essentially means that “saving lives perpetuates addiction and that it is better to let people die.”
But LePage is not alone in believing expanded access to the drug is akin to the moral hazard theory in economics: Creating a safety net enables risky behavior.
That view has also been expressed by some law enforcement officials in other states considering expanded access to naloxone. In Maine, it is shared by Sens. David Burns, R-Whiting, and Scott Cyrway, R-Benton, two former police officers who were among the eight state senators to vote against the bill, L.D. 1547, on March 31.
During the floor debate Burns argued that the bill sends a bad message to addicts who would have a “license to experiment.”
LePage captured those beliefs in his veto message Wednesday, writing, “a situation where an addict has a heroin needle in one hand and a shot of naloxone in the other produces a sense of normalcy and security around heroin use that serves only to perpetuate the cycle of addiction.”
In 2013, LePage made the same points when he vetoed a bill to increase access to naloxone for an addict’s family members. “This bill would make it easier for those with substance abuse problems to push themselves to the edge, or beyond,” he said in his veto letter. “It provides a false sense of security that abusers are somehow safe from overdose if they have a prescription nearby.”
In 2014 he called naloxone “an excuse to stay addicted.”
“Let’s deal with the treatment, the proper treatment, and not saying ‘go overdose, and by the way I’ll be there to save you,’ ” he told reporters during a news conference.
The governor’s comments were featured in a report on “NBC Nightly News,” drawing widespread rebukes from treatment and health officials. LePage has maintained his belief that the drug is doing more harm than good. During a forum held in Portland in December, he said naloxone was hurting the state’s approach to the drug crisis.
“Narcan doesn’t save lives, it extends lives,” he said.
Medical and treatment officials say those who believe naloxone will encourage addicts to continue using don’t understand addiction.
“Part of the problem is that addictions, all addictions, are still looked at by some, even in the medical profession, as character flaws, or lifestyle choices,” said Lani Graham, director of the Medical Professionals Health Program and the state’s former public health director. “That’s inaccurate. It’s a chronic brain illness.”
Graham added that the stigma associated with addiction discouraged investment and research into treatment, thereby leaving addicts few options if they’re fortunate enough to be revived after an overdose.
“That doesn’t change the fact that it can be possible to save those lives,” she said.
York Police Chief Douglas Bracy, who testified in support of the bill on behalf of the Maine Chiefs of Police Association, said the addicts his officers encounter don’t conform to the stereotypical image of a drug user.
“We’re dealing with everyday people,” he said. “Maybe it’s someone whose pain management medication got away from them, or someone else. They’re not choosing this.” He added, “We have defibrillators here. Should we not use them?”
Publicker, the addiction treatment specialist, said that expanding access to naloxone will help the uninsured.
Pharmacy chains such as Rite Aid and CVS already dispense naloxone without a prescription in about 30 states.
CVS requested the bill in Maine after receiving a letter from Sen. Angus King, I-Maine, asking the chain to expand the availability of the drug. The bill received support from both law enforcement and health organizations during the legislative hearing.
Publicker also refuted arguments that the drug in the hands of addicts or their families will encourage additional use. By the time someone becomes addicted, he said, it’s out of their control.
“Once addiction develops it’s no longer a voluntary disorder,” he said. “People are no longer seeking reward from it because it’s impossible. They’re seeking relief from the pain of the addiction itself. Without treatment that’s not possible.”
Publicker predicted dire consequences if the bill doesn’t become law. “The consequence of this is that our death rate is going to increase,” he said.
Lawmakers will vote on the governor’s veto when the Legislature reconvenes April 29.
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