Some substance abuse treatment experts are criticizing a plan to create a “social detox” facility in the Bangor area, arguing it will be ineffective in helping to solve the state’s opioid crisis because the center will not use medication-assisted treatment to help people withdrawing from heroin or other opioids.

Health care providers in Bangor say they have no choice because there are not enough doctors in the area who are certified to prescribe Suboxone, the drug used to ease withdrawal symptoms.

The Maine Department of Health and Human Services is moving forward with a plan, approved by the Legislature this spring, to spend $1 million on the 10-bed facility.

A request for proposals that would solicit bids for the center – a location has not yet been determined – will likely be posted on the Maine DHHS website within a week or two, agency spokeswoman Samantha Edwards said. Once the bid is awarded, it will take several months to get the center operating.

Detoxification is a short-term process focused on treating the physical effects of withdrawal from drug use, and to remove toxins that accumulate as a result of that use. It is a prelude to longer-term treatment and recovery.

The Bangor facility would be the second detox center in Maine, joining the Milestone Foundation in Portland. The Milestone Foundation uses Suboxone to help about 80 percent of its patients withdraw from opioids, officials with the nonprofit said.

Suboxone is the brand name for a medication that includes buprenorphine, an opioid that targets the same areas of the brain as heroin or other opiates and relieves drug cravings without producing a high.

TREATMENT DEMAND EXCEEDS SUPPLY

Dr. Mark Publicker, a Maine addiction expert and representative of the American Society of Addiction Medicine, said the social detox in Bangor will be pointless.

“All it will do is kick the can down the road for people,” Publicker said. “The outcomes are going to be dreadful.”

The Bangor detox center was included in a $3.7 million bill signed into law this spring that aimed to fight the opioid crisis. Maine is in the middle of an opioid epidemic, with 272 people dying of a drug overdose in 2015, the most ever. Meanwhile, people are clamoring for treatment, but there’s skyrocketing demand and a limited supply. About 25,000 to 30,000 people want to enroll in drug treatment programs in Maine but do not have access, according to the U.S. Centers for Disease Control and Prevention. The state currently has a capacity to serve 4,300 opioid patients with medication-assisted treatment, according to an estimate by the Maine Opioid Collaborative, a group that worked for more than a year to devise a statewide strategy on how to address the opioid crisis.

In May, the collaborative recommended an expansion of medication-assisted treatment, with experts saying it’s the most effective form of treatment.

“I think it’s totally inappropriate to say we’re going to run a detox facility and not include Suboxone,” said Eric Haram, director of outpatient health at Mid Coast Hospital, which runs a Brunswick addiction program that uses Suboxone. “It’s not going to be of any help to opiate addicts. Let’s not pretend that social detox is part of the solution to the opioid crisis.”

TOO FEW SUBOXONE PRESCRIBERS

Dr. John Kelly, director of the Recovery Research Institute on Addiction in Boston, said Suboxone is the best medication for opioid withdrawal. But he said spending money to expand access to medication-assisted treatment would be a wiser use of taxpayer money. If there are not enough programs to refer people to once they leave a detox center, they will most likely go back to using within a few days.

“If you have a limited amount of money to work with, expanding access to treatment is money that’s better spent,” Kelly said.

But advocates of the detox center disagree, saying that although it’s not a perfect plan, the center will provide useful services to people struggling with addiction.

“If you wait for exactly everything you want, it may not get done, and then you never move the needle forward,” said Dale Hamilton, executive director of Community Health and Counseling Services in Bangor, which offers a wide range of health services, including substance abuse treatment. The agency is one of the leaders in a community-wide effort to create a detox center.

Dr. Allen Schaffer, chief of psychiatry at Community Health, said there’s currently not enough funding or doctors who are able to prescribe Suboxone in the Bangor region to include Suboxone in the plan.

Doctors must undergo training before being permitted to write prescriptions for Suboxone, and there’s a federal cap on the number of patients to which each doctor can prescribe. That cap is being increased this summer from 100 patients to 275, according to the Obama administration.

There are about 214 physicians in Maine prescribing Suboxone, according to the Maine Opioid Collaborative. The number practicing in the Bangor area was not immediately available.

Schaffer said there are currently too few providers in Bangor who can be tapped to prescribe Suboxone.

Schaffer said if he could, he “would drop (Suboxone) in as one of the major options” at the detox center, and that it could be included in the future.

‘A THREE-DAY SAFE PLACE’

Initially, those who go to the detox center would be given a “comfort pack” of medicines, including drugs that help alleviate nausea, stomach and muscle cramps, and anxiety.

But Publicker said for opioid addiction, the comfort medications are ineffective. Publicker said when he used to work at Mercy Recovery Center in Westbrook, which closed in 2015, sometimes they did not use Suboxone when patients were withdrawing from opioids. Those patients were miserable, Publicker said.

Dr. Mary Dowd, a physician who works at the Milestone Foundation in Portland, said patients need Suboxone to detox comfortably and be able to think clearly during withdrawal. She said that gives them a chance to make better decisions and try to enroll in treatment programs, although that’s a challenge because of the lack of treatment options.

But Schaffer pointed out the detox center has other benefits, such as being a central place that people can go for three days before seeking other treatment, including medication-assisted treatment. The center will serve about 300 people a month.

“This will be an immediate entry point into the system,” Schaffer said. “It will be a three-day safe place. Currently, there’s no place for them to make that pivot.”

Also, Schaffer said, as the state and region work to expand access to treatment, there will be more programs to refer people to in the future.

Schaffer also pointed out that the detox center will not just be for opioids, but for other substances, such as alcohol. He said as times change, so do the substances that people become addicted to.

“It is really a little bit silly to say we are only going to be dealing with one type of addiction,” Schaffer said. “For instance, bath salts were a much bigger problem in Bangor just a few years ago.”