PORTLAND – It takes Blake Carver just a few minutes to walk down the front steps of Serenity House, shaking hands with the men gathered to congratulate the house’s newest “graduate.”

But it has been a long journey to get here — years of addiction to prescription pills followed by years of prison for burglarizing houses to feed the habit.

“I didn’t know where to go and I didn’t see a bright future for myself,” he said. “I feel great today.”

That is the good news about Maine’s painkiller abuse epidemic, experts say: Opiate addiction is treatable.

The bad news is that Maine doesn’t have enough treatment options for all of the people who want or need it.

“There are tens of thousands of Mainers who have serious opiate addictions and who have no access to care,” said Mark Publicker, a physician and addiction specialist at Mercy Recovery Center in Westbrook.

Officially, about 300 people are on waiting lists at treatment programs around the state at any time, according to the Maine Office of Substance Abuse. But experts say many more Mainers go without help because it’s not available in their communities, they don’t have insurance to cover it, they’re too embarrassed or ashamed to seek help, they can’t leave jobs or children, or they simply don’t know where to turn.

“When we have people come in here, that’s the tip of the iceberg. There’s many more people out there,” said Virginia Blake, clinical supervisor at Discovery House, a methadone clinic in downtown Calais.

Instead of getting treatment, many addicts continue to use whatever pills they can get on the street, dealing and stealing if necessary. Or they try to quit on their own and, experts say, inevitably fall back into addiction.

“People with opiate addiction cannot stop without treatment,” Publicker said. “Willpower doesn’t work with pills.”

The number of people who seek treatment for painkiller addiction has been steadily rising. Nearly 4,000 were admitted for prescription opiate addiction treatment in Maine last year, second only to the number who sought alcohol abuse treatment — about 5,500.

Despite the demand for more treatment services, Maine is struggling to maintain existing programs.

The LePage administration proposed a $4.4 million cut to substance abuse treatment funding this year, potentially closing as many as 10 small residential programs. All but about $400,000 was restored to the budget before it passed, and the remaining cut was spread out to avoid eliminating any individual programs. The budget included limits on MaineCare eligibility, however, which left an unknown number of addicts without health insurance to pay for treatment.

In a visit to Serenity House in Portland in July, Gov. Le- Page said his administration is continuing to review treatment funding. “We’re looking at every program and evaluating what are we doing,” he said.

The cost of treatment varies depending on the type of program. A month of treatment at a methadone clinic can cost nearly $400, while a month of intensive counseling can cost $1,200 or more. MaineCare provides comprehensive coverage for addiction treatment, while private insurance is variable, depending on the plan.

Every dollar spent to treat an addict saves an estimated $12 in avoided health care costs and crime-related costs that would come with continued addiction, according to the Office of Substance Abuse.

Treatment can be a long process. Detox, the process of breaking the body’s acute dependence on opiates, is not considered treatment, although it can be the first step.

“You can’t just detox and be OK, because your brain chemistry has been altered,” said Blake, at Discovery House. “This is a very involved disease.”

Treatment includes intensive counseling to understand the addiction and develop the tools to manage it. Some unknown percentage of patients will relapse, and it’s not uncommon for addicts to go through treatment two or three times. But, the experts say, many people do get well.

“I’ve seen people who I thought were never going to get clean and sober, and they did,” said Dr. George Dreher, a Portland-based psychiatrist and addiction specialist. “It can be very discouraging after you go through treatment a few times and keep relapsing. It doesn’t mean it won’t work the next time. There’s always hope. It is a treatable disease.”

Addicts may also need counseling and treatment for underlying medical problems that could lead to relapse, such as depression or stress from being sexually abused as a child. And some have to deal with new trauma related to the addiction itself, such as women who trade sex for pills. “We get a lot of women who come in here pretty damaged from having to do that,” said Blake.

The clinic that Blake supervises is one of eight in the state that provide methadone to about 4,500 addicts statewide. Its 200 patients start filing into the nondescript Calais storefront at 5:30 a.m., often before heading out to work on lobster and fishing boats.

The line of patients ebbs and flows throughout the day. Whenever a bell rings, the first patient in line enters a private dosing room.

Inside, an attendant behind a thick glass partition checks identification and enters the person’s individual dose. A machine pours the precise amount of red liquid into a small plastic cup, and the patient drinks it down as the attendant watches.

“It was embarrassing when I first came here,” said Tasheena Fitzsimmons, 26, of Calais. “When I realized how much it helped, I wasn’t embarrassed anymore.”

Fitzsimmons has been coming to the clinic for three years and has gradually reduced her dose from 135 milligrams a day to 24, she said. She works with the counselor in hopes of getting off the medicine entirely someday. But she is under no time limit.

“It’s unique for every person,” said Blake, the clinical supervisor. “The brain is healing and they are changing their lifestyles.”

Methadone itself is a highly addictive synthetic opiate, and it’s commonly prescribed for pain in pill form. In controlled doses, addicts get just enough of the drug to keep from experiencing cravings and withdrawal.

“I feel completely normal,” said Rick Fitch, 30, after drinking his daily dose. He has been coming to the clinic every day before work for two years, he said.

Some addicts and treatment counselors view methadone therapy as trading one addiction for another. Methadone providers, on the other hand, say the clinics have reduced emergency room visits, crime and other problems.

The daily doses come with required counseling visits and periodic urine tests to make sure patients are taking only the methadone they get at the clinic. Anyone caught taking other drugs, some of which can cause deadly interactions with methadone, faces additional counseling and monitoring, and may get cut off from the treatments.

Methadone was the first opiate-replacement therapy drug in Maine, but it is no longer the most common. Dozens of Maine physicians have been trained and certified to treat opiate addicts with a drug called buprenorphine.

The drug, usually prescribed under the trade name Suboxone, contains an addictive synthetic opiate as well as an opiate blocker that’s intended to discourage abuse. Buprenorphine carries less risk of contributing to overdoses, because it doesn’t last in the body the way methadone can.

“It is extremely valuable. It can save people’s lives,” said Publicker. He has 100 patients at Mercy Recovery Center who receive prescriptions for the drug — the maximum allowed for one doctor.

But buprenorphine is no wonder drug. It controls cravings and prevents withdrawal, but addicts still need counseling and treatment.

Suboxone patients manage their own medication and don’t have to show up every day for a dose. They do face regular urine tests and other monitoring to make sure they are taking the medicine, and not other drugs.

Not all addicts in Maine have access to the drug.

Some of Dr. Steven Weisberger’s patients drive two hours to his office in Jonesport to get refills of their Suboxone prescriptions. He has the maximum 100 addiction patients and 25 on a waiting list.

Not only is there a shortage of addiction doctors and treatment centers in his part of the state, there are shortages of psychiatrists, substance abuse counselors and pain specialists to help care for his patients, Weisberger said. “In Washington County, you’re on your own,” he said.

Physicians who prescribe Suboxone as part of their primary care practice can get treatment to addicts who wouldn’t otherwise seek help, said Dr. Ira Stockwell, a licensed Suboxone prescriber in Westbrook.

“I think more family practice doctors should do it,” Stockwell said.

James Cox, 31, a recovering addict from Jonesboro, takes 4 milligrams of Suboxone a day, in a thin strip that dissolves under his tongue.

“It’s not sober, but it’s pretty damn close for me,” said Cox, who has been taking the drug for three years and is gradually reducing his dose. “Basically, it keeps me going. I can go to work. I can be with my kids. I can be a father.”

Many adult addicts go through treatment without taking replacement drugs. They may detox in a jail or in a hospital, then enter outpatient or residential treatment.

Replacement drugs are not typically prescribed to teenagers. But treating kids also can be a slow process, said Don Burke, outpatient director at Day One, a South Portland-based treatment agency for teenagers and young adults in southern Maine. Nearly all of Day One’s patients — more than 400 a year — have been referred by schools, courts or parents.

“They’re not embracing treatment,” Burke said. “They’re in a battle with it.”

Residential treatment is the most intensive, and allows addicts to begin recovery in a supportive, sober environment. But it is not an option for many women who have children to care for, said Nikki Oliver, program manager at Crossroads’ halfway house in Portland. Budget cuts have left the agency with space for only two mothers to bring their children to a 60-day residential treatment program.

“The waiting list is really long (for the two slots), so they have to make a choice between the treatment and their children,” Oliver said. Even after a two- or three-month residential program, recovering addicts need outpatient counseling and community support to prevent relapse, Oliver said.

“If it was about just putting down the drink or the drug, it would be no big deal. It’s a disease that needs treatment,” she said.

Blake Carver said the three months at Serenity House, a treatment center for men, changed his life.

“You understand now it’s possible to get over these things that seemed so bleak before,” he said.

And, on his graduation day, he promised his housemates that he would prove it by staying clean.

“You watch and you see.”

Staff Writer John Richardson can be contacted at 791-6324 or at: [email protected]