Will bill capping MaineCare reimbursement for methadone treatment jeopardize addicts' recovery?

Leslie H. Dixon/Sun Journal

Kathy Alarie, CAP Quality Care Clinic nursing director and assistant director of programming, stands beside artwork created by a graphic arts student who is a client at the methadone clinic in Westbrook. The inspirational quotes on the poster are from fellow clients who receive their daily methadone maintenance dose in the booth behind Alarie.

WESTBROOK — Their stories are different, but the bottom line is the same.

Leslie H. Dixon/Sun Journal

Deanna Boivert, a registered nurse, hands out daily doses of methadone after carefully screening each client in the dosing booths at CAP Quality Care Clinic in Westbrook.

Leslie H. Dixon/Sun Journal

Clients who check in at the desk in the main lobby of CAP Quality Care Clinic in Westbrook each day before receiving their doses see informational fliers on the counter that tell them they will not be dosed if they smell of marijuana. The fliers also inform them of pending budget cuts that could affect their ability to receive treatment.

Leslie H. Dixon/Sun Journal

Each morning, clients enter a door near the side of the CAP Quality Care Clinic building in Westbrook which leads them into an inviting lobby area where they check in before going into counseling rooms or dosing booths.

Leslie H. Dixon/Sun Journal

CAP Quality Care Clinic is just off Interstate 95 in Westbrook in a business park surrounded, in part, by other medical buildings and a church group.

Opiate addicts say methadone, the synthetic drug used in maintenance treatment of drug addiction in the United States since the 1960s, stops their cravings without creating the effects of a “high.”

And that, they say, has been a life-changer.

“Methadone saved my life,” Mike, a recovering opiate addict and methadone client from the Portland area, said hours after receiving his daily dose at a Westbrook methadone clinic.

About 1,500 opiate addicts receive methadone in nine clinics throughout Maine, according to the Office of Substance Abuse. The clinics include three in the greater Bangor area, one in Lewiston, one in Waterville, one in Calais and three in the Portland area, including the Center for Addictive Problems, also known as CAP Quality Care Clinic in Westbrook.

“I probably wouldn't be alive if it wasn't for this place,” said Rob, a CAP client who works as a manager and lives with his wife and dog in a house they own. Rob has been coming to the clinic for seven years. He said he has never had a relapse.

Rob and Mike are two of seven clients, plus one letter-writer, from the CAP clinic who agreed to participate in a discussion with the Sun Journal about their methadone maintenance treatment. The male and female clients, ranging in age from the early 20s to the late 40s, asked to be identified by first names only. They jokingly called themselves the “Smith" family.

On everyone's mind was the passage of LD 1840 — a bill shifting MaineCare reimbursement for methadone treatment from a six-year cap to a lifetime maximum of 24 months. The new law, which is expected to save MaineCare $1.4 million per year, goes into effect Jan. 1, 2013. The legislation requires special authorization for MaineCare patients to continue methadone treatment beyond the two-year cap.

MaineCare, the state's insurance program for low-income people, pays for treatment for more than 63 percent of all methadone patients in Maine, said Guy R. Cousins, director of the Office of Substance Abuse Services. The state reimbursement covers medical and clinical assessment, individual and group counseling, drug screenings and medication checks, Cousins said.

Of the 500 clients who receive daily methadone treatment at the CAP program,  MaineCare pays $58 per person for 367 clients, CAP Quality Care Director Susan Sullivan said. Each MaineCare client must pay a $2 co-payment. The other clients pay through private insurance or out of pocket.

As they sat in one of the group therapy rooms at the clinic for the interview, the six clients agreed that addicts will do what it takes to get treatment. The state will pay a lot more in jail costs as addicts steal to get money to continue their treatment or revert to taking illegal drugs.

“Without methadone, people are going to die, break into houses, rob pharmacies and destroy innocent lives,” said another client, who was unable to attend the interview but wrote a letter.

The clients and clinic nurses said the recovering addicts' need for methadone is no different from diabetic patients who get daily insulin injections. It's a disease, they say, like diabetes. It may not be cured in two years, six years or even a lifetime. But the cravings for opiates can be eliminated or highly reduced through methadone maintenance treatment, they say.

“You can't put a timetable on this,” said Yvonne, who started using opiates at rave parties to “fit in.”

“If I was a diabetic and they gave me two years of sugar, then I'd have to die,” Yvonne said. She has not craved opiates in the more than two years since she came to the clinic.

The procedure

Each day, recovering opiate addicts drive to the CAP clinic just off Exit 48 on Interstate 95, either by themselves, with friends or by vans provided by agencies such as Community Concepts and Western Maine Transportation. The clinic  is a one-story industrial building in a Westbrook business park. The park also houses the Harvest Bible Chapel.

The clients receive a daily dose of methadone, counseling, friendship, hope and structure — an important part of their recovery, the clients said.

Under Maine law, new patients are required to attend the clinic seven days a week, but many receive “take-home” doses for at least one of those days if they meet certain criteria, such as being stable, after the first 90 days of treatment.

The procedure is simple, said Kathy Alarie, nursing director and assistant director of programming.

Patients come in at 7:30 a.m., check in at the front desk waiting area, a cream-colored room much like a doctor's office. They wait to go into one of several small "dosing booths."

Once in the dosing booth, the client stands at a small window where a nurse screens the client to make sure he or she is not under the influence of a non-prescribed drug, then administers the methadone in "drink" form.

The client is given cherry-flavored liquid methadone, the same type used in most clinics throughout Maine.

The nurse makes sure the client has swallowed the dose before he or she is allowed to leave.

While the dosing period is going on, the building doors are locked to ensure that no one enters with the intent of robbing the clinic.

Once the dosing is finished, some clients go to group or individual counseling sessions. All patients are assigned to a counselor and are required to meet with them on a regular basis. The ratio of counselor to patient has increased drastically under recent state budget cuts, said Lori Beisel, clinical supervisor and a registered nurse.

The face of an addict

Methadone maintenance clients come from all walks of life. They include doctors, lawyers, business people, single parents, and people who are unemployed, depressed or mentally unstable. All say they resent the stigma placed on them as methadone treatment clients.

“They look down on us because we're addicts,” Rob said.

Andrea has a college degree in business and has started her own cleaning business since coming to the CAP clinic. She pays for her treatment.

“I lost MaineCare and I choose to pay on my own, even though I really can't afford it,” said Andrea, who makes $150 a week working 25 hours. She pays $100 a week for her treatment.

“If I come off methadone and do it the wrong way, I'm going to be right back on it," she said. "I chose this. There is no price to my life.”

Other clients, including Jeanne and Rhonda, say the clinic has given them hope and stability. It's a daily opportunity to bond with other people who are struggling.

"The best thing you have is respect for yourself," said 49-year-old Amy, who has been an addict since the age of 14 and has come to the methadone clinic every day for the past seven years.

Her mother was murdered and she was adopted at a young age. “Its been a very long, hard road,” she said of her struggle with addiction.

With the encouragement of her CAP counselor, Amy has received her Reiki II certification to practice the Japanese energy therapy.

“I just want to be treated with kindness and respect,” she said. "This is where I belong now."


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We're paying for both the addiction and the 'treatment'

These articles are good, and informative-but there's one little problem that doesn't get addressed in them:

That we, the taxpayers of this state, are financing not only the treatment from opioids discussed here, but also the initial addiction to them.

How much do we pay for prescriptions for Oxycontin, Oxycodone, Vicodin, Ritalin, Focalin, and a few others that are covered with or without prior authorizations from Maine Care?

How many addicts are we creating by doing so?

Doctors are willing to give out prescriptions for these drugs knowing they will be dispensed without question, and never give a thought to the potential for abuse or addiction in doing so.

This is not a diatribe against people who have genuine pain from long-lasting medical problems, but rather a question of why they're being dispensed so freely without a thought given to the patient's potential for addiction.

If the addiction was not being enabled so heartily by doctors, the treatment for addiction would not be quite so expensive or prevalent, and the clinics would not have to exist.

So we're paying at both ends-or twice over.

Robert McQueeney's picture

Is this black mail?

“Without methadone, people are going to die, break into houses, rob pharmacies and destroy innocent lives,” said another client, who was unable to attend the interview but wrote a letter.

I just re-read this article, and the above quote struck me. This person is attempting to blackmail the public saying do this for me, or I assure you bad things will happen. This is nothing more than a protection racket.

Why will it be our fault you are committing crimes if we don't spend huge sums of money filling your habit?

Robert McQueeney's picture

There has to be a limit

I'm all for helping people out, when they are down, and are willing to do what they can and just need a little more in the way of help. But this is incredibly expensive, and the money goes to people, who, by and large, chose to do everything it took to get addicted to the drugs. You can not convince me that they did not know there was a real risk of addiction, not with all the advertising and education out there.

Then we read about people, in this very article, who have been coming here for 7 years. At what point is there any real weaning off the drugs? Are we just replacing their habit, on the taxpayers dime? If these people really want off the drugs, they'd be off them well before 7 years have passed. This is a situation where John Q. Taxpayer is buying the drugs for people. This, in my opinion, is just wrong. If this is a weaning off program, then get to the weaning off. If it is a maintenance program, I have to ask why are taxpayers paying for addicts drugs?


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