I usually appreciate the editorial stances taken by the BDN. In their column from Friday, “LePage is finally saying the right things about opiate addiction treatment”, the author extols the value of Opiate Replacement Therapy (ORP) with no acknowledgement of the systemic limitations placed upon it by DHHS nor inclusion of the value of any other pathway to recovery.
ORP is most often block funded for Maine Care recipients and the uninsured. The current rate structure allows for little if any counseling. It does not allow for case management services: fulfillment of basic life needs like housing and coordination of medical services. It does not contain provision for dual diagnosis treatment nor does it take into consideration one of the most basic aspects of addiction recovery which is that the majority of people active in addiction are survivors of childhood abuse and trauma.
The single best course of action DHHS and the legislature can take to support treatment for addiction in Maine is to expand Medicaid eligibility as most other states in our country did many years ago. This makes medical detox and rehab stays a possibility. It makes a variety of Outpatient and Intensive Outpatient programs accessible and most of all, it increases access to treatment for other physiological health problems. If we choose only to treat opiate addiction and ignore Hepatitis, we’re surely missing opportunities to realize further savings and achieve better health outcomes.
The most obvious deficit in our efforts to reduce addiction in Maine is a continued deficit in prevention and education. Common sense dictates that an ounce of prevention is worth than a pound of cure. While there is a great deal of research that extols the value of OPR, there is even more research that consistently and without exception demonstrates that every dollar we spend in prevention saves anywhere from $5 and $18 in other social costs.
In the midst of an “opiate epidemic” it’s very easy to overlook the obvious problems of alcoholism, which remains our biggest killer by far. It’s easy to overlook addiction to stimulants, benzodiazepines, and nicotine. It baffles me that we respond to this epidemic as though it’s new. It’s not.
Addiction has been a major threat to our culture from it’s inception. There remain numerous issues pertaining to it’s causes and solutions that divide us. Our Governor stated in his address, “Too many people are dying”, which begs the question; what would an acceptable number be? What amount of progress will allow us to sweep this issue back under the rug? Historically, that is exactly what we have done.
Yet again we have the opportunity to make serious in roads in prevention, education, and treatment. Shall we do just enough to get it out of the headlines for a while or shall we commit to further progress of one of our greatest cultural threats?