Two years into its inception, the Maine Medical Association is beginning to see results from its efforts to persuade more doctors to prescribe Suboxone, one of the most effective drugs for the treatment of opioid use disorder.
About 200 doctors, interns, nurses and nurses have completed their training and have been given the waiver necessary to prescribe the medication since 2016. This is based on estimates by health policy experts based on federal data. Expanding Maine's ability to fight the opioid epidemic, in which deadly drug overdose requires on average more than one person a day, comes at an opportune time.
Governor Janet Mills said she will approve the extension of Medicaid as soon as she takes office in January. As a result, another 70,000 low-income domestic landowners will be eligible for health insurance, including the treatment of opioid-related consumption disorders. The Maine Medical Association, which represents physicians before the legislature, said Maine was prepared for the wave of new patients looking for appointments.
"We will certainly try to meet the demand," said Gordon Smith, executive director of the Association Vice President. "I think we will be ready."
& # 39; GOLD STANDARD & # 39;
Others are more skeptical and point out that it is not known how many of the new Suboxone prescribers will agree to accept a significant number of patients Patients And Smith warned that many treatment barriers remain, and much more needs to be done to connect patients to medical doctors.
Since 2016, the association attempts to punish the state and attempts to persuade physicians to become Suboxone intermediaries by conducting information sessions and training required to obtain federal waivers. Doctors and nurses who complete the state-prescribed training can treat up to 275 patients with opioid-related drug use with a combination of suboxone and counseling.
Suboxon, also known as buprenorphine, is an important drug-drug treatment drug that is considered by the public health community to be the "gold standard" in the treatment of opioid consumption disorder.
It is not clear how many doctors and other providers have completed training, but there are now about 200 other providers who have received the necessary federal waivers. Federal data show that buprenorphine was prescribed in 2016. Between 2017 and 2018, the number of prescribers has increased by around 100.
Many substance abuse Mainzers are uninsured and have little income because drug craving exceeds their lives and they lose jobs, family ties and often spend money before seeking help.
Without insurance or money they have one It is difficult to get treatment because there is no system to pay for consultations, therapy, prescriptions and medication management.
"HOW HELP IS IT?"
How many of these individuals are treated under the Medicaid extension is unclear, but there are some rough estimates.
Of the total Medicaid population, about 12 percent have a substance-use disorder. Federal research studies on expansion populations show that about 15-35 percent have a substance disorder. That would mean between 10,000 and 25,000. Mainers among the population of 70,000 who would be newly eligible for cover.
Not all people would use opioids, as substance use disorders also include other illicit drugs and alcoholism.
Maine has 742 health professionals who abstain from prescribing buprenorphine. If each of the 30 patients treated with opioid is taking a disorder, the state's capacity would be about 22,000 patients, without any methadone clinics. Methadone is another effective method of treating opioid use disorder but is commonly used in critically ill patients.
Dr. Lisa Letourneau, Associate Medical Director of Maine Quality Counts, a health care lawyer and a new prescriber for buprenorphine, said the increase in prescribers was good news, but expressed concern.
Many of the 742 doctors and others who refuse prescription buprenorphine are unwilling to take on a significant number of additional patients, she said. Some only received training to treat their existing primary patients who have a substance disorder. And only 333 of the doctors are listed on a federal Web site managed by the Drug Abuse and Mental Health Services Department, which would use potential patients to find a doctor. Doctors and nurses can choose to be listed on the website.
"How helpful is it if we have 742 buprenorphine prescribers if patients can not find them? What we really need is new systems that can connect people with caring, "said Letourneau. There are also other barriers, such as those who want treatment, but who live in a abstinence-based dormitory where the use of drugs with Suboxone is often banned.
[LONG WAITING LISTS] Mark Publicker, one of Maine's leading substance disorders specialists, said he did not see any improvement in treatment capacity.
"It is well known throughout the nation that half of the waived doctors either prescribe only some or only do patients in their practice," said Publicker, who has a treatment practice in Portland. "Three-quarters of my patients come from the Mediterranean coast, some even from the eastern United States, who can not find local doctors. The system is already overwhelmed.
Smith of the Medical Council said, "We still have a long way to go. "The association will continue to provide training and try to get doctors to become Suboxone providers. There are about 2,000 family doctors in Maine.
Another point is that the prescribers are not evenly distributed throughout the state. While Cumberland County has 80 buprenorphine prescriptions per 100,000 people per year, there are only 24 per 100,000 in rural Aroostook County.
However, Maine appears to be in a better position than New Hampshire in 2017. New Hampshire, which has demographic characteristics similar to Maine and is also struggling with an opioid crisis, had fewer than 100 Suboxone in the state Provider, said James Potter, vice president of the New Hampshire Medical Society.
It was difficult (in 2017) to enter a treatment program, "said Potter. "There were some long waiting lists."
Since then, New Hampshire has also campaigned to get more physicians to prescribe Suboxone, and the state now has between 350 and 400 prescribers, Potter said.
But we still do not have enough practitioners to provide the services we need, "he said.
For Letourneau, he chose to work as a front physician after his exclusive work in health care. Politics for 20 years has opened its eyes to many of the practical problems that patients face , However, she learned that many of the stereotypes in Suboxone patients, including the difficulty of treating them and time-consuming, do not apply.
It is not. This is essentially the management of drugs and the connection of patients to therapy. On the drug side, it's easier for doctors to treat than many other conditions, such as diabetes, "said Letourneau.
Meanwhile, Letourneau says, doctors can see how patients are changing their lives.
" This one patient said I was invited to his brother for Thanksgiving for the first time in ten years, "she said." The difference in her life from one year to the next was dramatic. "
Joe Lawlor may be at 791-6376 or under
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