PORTLAND — With heroin overdose deaths and prosecutions for heroin trafficking increasing, Maine Attorney General Janet Mills said the state has joined a multi-state task force to reduce trafficking and abuse of the opioid.
“Maine is very pleased to be working with our partners in the other Northeast and Mid-Atlantic states to combat the flow of heroin and drug money that causes so much misery for our communities,” Mills said in a Feb. 13 press release.
The Northeast and Mid-Atlantic Heroin Task Force now stretches from Maryland to Maine.
But state legislators said addiction treatment has to be emphasized to fully address the problem.
“I value the work they are doing at MDEA. What I do question is the balance. We are never going to arrest our way out of a drug problem. It is a supply and demand issue. How long have we had this war on drugs?” state Sen Anne Haskell, D-Portland, said Monday.
State and local officials have confirmed statistically and anecdotally that heroin use has increased in the last several years, and Mills added to the conclusion by saying prosecution of heroin cases has increased from about 8 percent of all prosecutions by her Drug Crimes Task Force in 2012, to almost 32 percent last year.
The latest statistics on overdose deaths released last May by Mills and the Office of the Maine Medical Examiner showed heroin played an increased role in overdose deaths, which also rose to 176 from 163 in 2012 and 156 in 2011. Mills added that 977 babies born in Maine last year “were affected by drugs.”
The term defines babies who may have been exposed to drugs before birth, according to the state Office of Child and Family Services, and those births have increased from 835 in 2013 and 710 in 2012.
Joining the task force is in line with the priority Gov. Paul LePage has made of increased enforcement to combat drug use. As he outlined in his Feb. 3 State of the State address, LePage wants more agents in the Maine Drug Enforcement Agency, and more prosecutors and judges to handle drug cases.
Mills said the task force will be especially useful in coordinated enforcement activities against larger suppliers, and moving down through networks that transport heroin north.
“Every week residents of New York and Pennsylvania are arrested in Maine for drug trafficking,” Mills said. “It makes sense for state law enforcement officers and prosecutors to be working together to take these organizations apart.”
Haskell is a new member of the Legislature’s Health and Human Services Committee, and said she expects her committee will be asked to recommend a state Department of Health and Human Services proposal to end MaineCare reimbursements for outpatient methadone treatment, in favor of suboxone.
While it is a policy proposal DHHS spokesman David Sorensen said is based on department research that found suboxone is as effective and less likely to be abused by patients, it is also written into the department budget.
A press release from Sorensen said the switch will be more cost effective and safer to patients because buprenorphine, the active ingredient in suboxone, “possesses many clinical benefits such as lower abuse potential, lower level of physical dependence, a ceiling effect at higher doses, and greater safety in overdose compared to full agonists (including methadone).”
Dr. David Moltz, medical director of outpatient behavioral health at Mid Coast Hospital in Brunswick, said Feb. 9 that suboxone and methadone are effective in treating opioid addiction when accompanied by a full program of counseling and support, although the medications work differently.
Methadone works like other opioids in the brain, Moltz said, while suboxone is more a partial substitute to block withdrawal symptoms and cravings.
“Patients do well on suboxone and methadone, and some discontinue successfully, but in all studies, most people require maintenance medication to avoid relapse,” he said.
The shift, which could affect as many as 3,800 MaineCare patients, is expected to save the state almost $1.6 million and the federal government $4.26 million over the next two fiscal years. The estimate is based on shifting 80 percent of those now receiving methadone to suboxone.
Statistics provided by Sorensen show the state spent $8.2 million for methadone reimbursements last year, as opposed to $9.5 million for almost 5,100 suboxone users.
Haskell said she needs more information, but is concerned the new policy is misguided.
“I hesitate to insert myself into that and say ‘oh no, use this,'” she said. “There are places where methadone is more effective than suboxone. I am waiting to hear more information that would sway me.”
State Rep. Peter Stuckey, D-Portland, echoed Haskell’s wariness about the budget proposal.
“There are folks for whom methadone is the needed treatment, that suboxone doesn’t get you there,” he said Monday.
Sorensen said the switch to suboxone will allow better care for addicts because it is prescribed by physicians, instead of at 11 state-licensed clinics that dispense methadone. Those physicians will also be able to better treat recovering addicts for other medical conditions related to substance abuse.
With 119 physicians who report to the DHHS that they are able to prescribe suboxone, Stuckey said he is concerned there are not enough doctors to go around, and the stringent requirements needed to prescribe suboxone may not attract new ones.
Even if suboxone fully supplants methadone for treatments, all outpatient MaineCare reimbursements will be capped at two years, unless a waiver is granted.
Haskell said she had not heard of many patients unable to get more treatments, and data supplied by Sorensen showed 814 of 878 requests to waive the two-year cap had been approved as of Dec. 20, 2014.
Stuckey concluded more spending on law enforcement should be matched by more spending on early childhood and family programs to prevent drug use.
“I look at the history of the drug enforcement efforts in our country. Either it is just a conspiracy or it is just pathetic. How long have we been fighting this war?” he said. “You want to try and improve the chances of kids finding a path through the world that works. That is the best preventive health I think we’ve got, and we don’t spend enough on it.”