Medical professionals, advocacy groups and mayors across Maine warn that new opioid treatment rules proposed by Republican Gov. Paul LePage's administration would shutter methadone clinics and discourage treatment at a time when the state's opioid crisis is at its peak.
Maine saw 278 overdose deaths last year, up from 174 in 2013. About 4,000 Mainers currently receive addiction care at opioid treatment programs.
The proposed MaineCare rules would require medication-assisted treatment facilities to regularly talk to patients about withdrawing from medication and increase counseling requirements to one hour a week during the first stage of treatment. The rules would also limit initial medication levels for MaineCare patients to 40 milligrams, though state and federal law allows physicians to establish higher dosage levels, if needed.
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Charles Zelnick, a Stonington doctor, in public comments called addiction treatment "one of the most rewarding aspects" of his practice.
But Zelnick wrote that amidst an "epidemic," Maine doesn't "need more regulations or barriers on an already highly controlled practice."
LePage and public health experts agree that counseling and proper oversight of treatment is an important part of an addicted person's recovery. But the state is reviewing 14 public comments from groups and doctors who described the LePage administration's new rules as unfunded mandates that clash with existing regulations, lack evidence and create barriers to treatment.
LePage has said he wants to shut down such methadone clinics, which he's claimed don't provide adequate counseling. His spokeswoman, Adrienne Bennett, said LePage wasn't available for an interview Friday.
A 1996 U.S. District Court ruling found Maine's Medicaid program is federally obligated to provide methadone treatment and transportation to methadone clinics. Several Maine advocacy groups wrote that Maine's proposed rules violate such law.
MaineCare reimbursement for outpatient methadone treatment decreased in 2010 and again in 2012 to a weekly rate of $60 - the lowest in the nation.
Republican Sen. David Woodsome, of North Waterboro, unsuccessfully introduced a bill this year to increase the reimbursement rate. Woodsome wrote the rules could increase a patient's risk of relapse, and called on the state to suspend rule making.
Groups like the American Society of Addiction Medicine want Maine to either increase the reimbursement rate or continue a waiver program that has helped clinics meet counseling requirements. Dan Coffey, president of Acadia Healthcare in Bangor, wrote that low reimbursement rates led Acadia Healthcare to reduce its counseling services and methadone patient load.
Bennett didn't say whether LePage supports increased reimbursement. In an email, she said the rules increase clinics' focus on treatment and counseling, which LePage has called for.
Zelnick wrote that for a while, he was the only Hancock County doctor prescribing suboxone, an opiate addiction drug less potent than methadone. Zelnick said his patients must see counselors either off-site or at his office, which provides counseling one day a week.
Bennett said that suboxone treatment can get patients into primary-care settings that, unlike clinics, are required under federal law to report prescription data. Such reporting can prevent potentially fatal mixing of anti-opiate medications, she said.
But Zelnick said even though the proposed rules let methadone clinics stay open six days a week rather than seven, it would also apply to offices like his.
Such an "undue burden" could discourage more doctors from treating opioid dependence, Zelnick said.