Substance abuse specialists responded with surprise – and occasional incredulity – to LePage administration statements that “hundreds of thousands of dollars” in drug treatment funds have been left untapped in recent years as Maine’s heroin crisis worsened.

“Where’s the money? We are all asking that,” said Darren Ripley, coordinator for the Maine Alliance for Addiction Recovery.

The recent surge in heroin and opiate overdoses – including 14 during a 24-hour period in Portland last week – has elevated public awareness about a drug problem hitting big cities and small towns in Maine and throughout the country. It also has intensified public debate over whether Maine needs to invest in drug treatment programs or, as Gov. Paul LePage insists, in additional drug agents to target dealers and gangs bringing the deadly opiates into the state.

LePage surprised some in the treatment community when, in a July 29 radio address and in a letter to legislative leaders this month, he suggested a Maine Department of Health and Human Services fund for drug programs was under-utilized.

“For those who are addicted to deadly opiates like heroin, there is help, even if you don’t have insurance,” LePage said. “The liberal media claims that reductions in welfare eligibility for able-bodied young adults have reduced drug treatment options for addicts. This is false. DHHS has money available for drug treatment, even for those who don’t have Medicaid or private insurance. In fact, we have hundreds of thousands of dollars left over every year in this program. We have the resources to help those who need it.”

Those statements have left more than just substance abuse providers puzzled.

“Your administration claims that there are funds for substance abuse treatment that are not being used, but neither the legislature nor the substance abuse providers are aware of the funding you reference,” House Speaker Mark Eves, D-North Berwick, wrote in a letter to LePage on Friday. “We are interested in learning more about that.”

Drug recovery experts say access to clinical help depends on the level of treatment needed – in other words, residential treatment versus outpatient – and a person’s ability to pay for it.

Bob Fowler at Portland’s Milestone Foundation, which currently runs the city’s only inpatient detoxification program that serves adult heroin addicts, said this week that demand for his 16 beds far outstrips availability. Likewise, David Faulkner at Day One Substance Abuse and Mental Health Services said he “always runs waiting lists” for the 30-plus beds available for youth addicts in three locations. Faulkner, who said opiate addicts account for a growing share of the youths treated in their residential facilities, said options for adults without insurance or coverage through MaineCare – the state’s Medicaid program – are “few and far between.”

“We’re all shocked,” Faulkner said about the excess money LePage said is available. “As far as I know, it doesn’t exist. And I would know because I would be accessing it.”

DHHS provided only basic information about the unexpended funds in response to repeated requests from the Portland Press Herald over three days.

Department spokesman David Sorensen would only say the surplus has generally been “in the low six figures” and that the federal money was intended for treatment or counseling provided to uninsured Mainers.

“The pot of money would be funds available to the department for the provision of substance abuse treatment to the uninsured,” Sorensen wrote in an email. “This is money that goes to reimbursing providers for services rendered, for a combination of inpatient and outpatient care.” Sorensen added that the “supply-demand pinch” for services for Mainers with intellectual or developmental disabilities is far greater than those for heroin addicts.

Sorensen said that spending on treatment has increased during LePage’s time in office, noting that between state and federal funds the administration earmarked nearly $70 million for addiction treatment last year.

Asked whether DHHS should be letting providers know that there is additional money available, given the growing opiate problem, Sorensen appeared to dismiss the suggestion.

“DHHS doesn’t just hand out unlimited money to anyone who asks for it (anymore) without a demonstrated need defined by clear criteria,” he wrote. Sorensen later wrote that “unused funds generally are given to providers at the end of the year based on a demonstrated need.” But that contradicted an earlier email to a Press Herald reporter stating that “we’re still putting money back into the General Fund from unspent (Office of Substance Abuse and Mental Health Services) funds.”

DEMAND RISING SHARPLY

Those working in the field questioned why any treatment money would go unspent given the demand they are seeing every day and the rising numbers of overdose deaths.

“I fielded three calls from people today who needed help and they can’t get into a place because they don’t have (insurance),” said Ripley, with the Maine Alliance for Addiction Recovery. “If there is all of this money left over, why is it not being distributed to the treatment agencies to get these people help?”

The number of Mainers seeking treatment for heroin addiction swelled from 1,115 in 2010 to 3,463 last year, according to the Maine Office of Substance Abuse. The annual budget of that office increased from $18.6 million in fiscal year 2010 to $21.5 million in the fiscal year that began July 1 – an increase of 16.6 percent over a five-year period.

In his July 29 radio address, LePage said the state had “increased funding for addiction treatment from $7 million to $17 million since I’ve been governor,” beginning in 2011. Sorensen did not respond to a request Friday for clarification about the discrepancy between LePage’s statement and the Maine Office of Substance Abuse figures.

As with other healthcare issues, the availability of heroin treatment programs is directly affected by insurance company policies, as well as state and federal reimbursement rates.

Most private insurers will not cover inpatient detoxification treatment for opiate addictions and many hospitals will only admit opiate addicts if they have another medical condition that requires immediate care. As a result, addicts who don’t have insurance or can’t afford to pay out-of-pocket for costly residential treatment often struggle to access the most advanced care that professionals say is sometimes needed to break the intense addiction cycle of opiates.

This summer, Mercy Hospital closed its Mercy Recovery Center in Westbrook that offered inpatient detoxification beds for heroin addicts and others with substance abuse problems. While Mercy continues to provide outpatient treatment to some clients – and has connected the remaining clients with a physician willing to provide treatment with the drug suboxone – the hospital is no longer providing inpatient care to opiate addicts unless they have another medical condition.

Patricia Kimball, executive director of Wellspring Substance Abuse and Mental Health Services in Bangor, said the lack of residential beds for opiate addicts combined with changes to MaineCare eligibility have created a sizable gap for services.

Kimball estimated that there are 50 people on the waiting list for the 28 beds operated by her organization. Roughly three-quarters of those people have no insurance coverage or do not qualify for MaineCare because they are considered able-bodied adults without children. While the state provides grant funds to pay for some of the uninsured individuals who request placement with Wellspring, the organization doesn’t have the money or the capacity to meet the demand, she said.

Kimball said she was “pleasantly surprised” to hear there may have been unexpended money.

“The funding that the governor is referring to, I’m very happy that it is there,” she said. “I just don’t know how to access it.”

INTERDICTION VS. TREATMENT

The discussion and confusion about any unspent treatment funds also highlights the stark difference between LePage, who wants more investment in drug agents, and providers in the treatment community.

During a wide-ranging news conference held May 29 at the Blaine House, LePage railed against the Legislature for not funding his request for additional agents at the Maine Drug Enforcement Agency. He then told a story about a traffic stop that he said was relayed to him by the Maine State Police. He said that a man was stopped for speeding on I-95. During the stop, the governor said, the man overdosed, prompting emergency service personnel to inject him with Narcan, a drug that reverses the effects of opioids such as heroin.

“It was the second Narcan shot that week (for the man), the 10th since January,” LePage said. “The 10th.”

He added, “And my friends on the other side of the aisle don’t see the problem.” LePage then argued that he had increased treatment funding.

“When is it enough?” he said. “When are we going after the bad guys? I’m not looking to put the users in jail, because quite frankly, we don’t have enough room. I’m looking to go after the traffickers. I don’t care about the users. We’ll get them in clinical therapy and that can be dealt with – if they chose to.”

Faulkner, who runs the Day One facility for youth with addiction problems, said investing in more law enforcement was fine with him as long as more money was also put into treatment, because imprisoning dealers only addresses part of the problem.

“If you have a demand, other people will come” to replace arrested dealers, Faulkner said. “So you have got to suppress the demand, and the only way to do that is treatment.”