I’ve been watching with interest the recent news about Gov. LePage’s plan to cease Medicaid coverage of methadone clinics. I have to disagree with this newspaper’s assessment of the situation (“Our View: State methadone plan is bad medicine for Maine,” March 9).

As a psychiatric nurse practitioner who also holds a doctorate degree and who has worked in addiction medicine and psychiatry for more than 25 years, I agree with Gov. LePage and Health and Human Services Commissioner Mary Mayhew that Suboxone is a better choice for recovery than continued methadone use. Many of my colleagues feel the same way, though some would be hesitant to speak out publicly on such a contentious issue.

Suboxone is closely monitored, and patients who receive it do so at a doctor’s office or clinic where they receive a prescription they must take to a pharmacy to have filled. Most patients are seen by a doctor at least once per month while on Suboxone.

Methadone patients may be seen by a doctor perhaps once a year for a physical exam, but typically they are seen briefly by a registered nurse only at the “dispensing window” on the day of the methadone dispensing.

In addition, Suboxone is monitored through the state’s Prescription Monitoring Program, whereas under federal law, methadone does not have to be reported. This is most unfortunate for those of us who prescribe substances that have the potential to interfere with methadone, like benzodiazepines (anti-anxiety drugs like Valium or Ativan) or antipsychotic drugs (like Seroquel). It’s impossible for us to know that the patient is on methadone when we do a PMP check.

Mixing methadone with benzodiazepines or other drugs, such as other opiates or strong doses of antipsychotic medication, can be deadly to the patient. In fact, I have had the state Medical Examiner’s Office call me on a few occasions to tell me that a patient of mine had overdosed on methadone they acquired on the street while on a prescribed benzodiazepine I gave them. Suboxone, on the other hand, is much safer and less prone to abuse or overdose.

In addition to being at risk of potentially deadly overdoses, patients on methadone sometimes double in size with severe weight gain, they get metabolic syndrome and they experience severe tooth decay. Of course, all of these physical health issues generate a hefty tab for the taxpayer-funded Medicaid program.

Methadone patients also usually stay on it for longer than the two-year cap, receiving exceptions from their doctors. Many of my psychiatric patients have been on methadone for five to 10 years, have many physical illnesses and are still on high doses. They rarely taper off treatment.

In fact, many of my patients no longer need methadone for withdrawal from opiates but are now using it for pain management, which it was never intended for. Methadone clinic doctors are somehow managing to obtain prior authorizations to keep patients on methadone beyond the new two-year cap.

I’ve seen way too many patients oversedated on methadone. When I worked at one clinic, a patient was so sedated she left the parking lot and hit my vehicle, which I did not find out until another client told me. When patients receive “take home” doses of methadone, which is a privilege, there is a high potential for misusing the drug and/or selling it to others.

With many methadone patients presumably transitioning from methadone to Suboxone if the governor’s policy is enacted, there might need to be more providers willing and able to prescribe it. One possible solution is to allow advanced practice nurses to prescribe Suboxone, which would open up availability to the patients who may be seeking providers.

Finally, this is not uncharted territory. There are 17 other states, according to the DHHS, whose Medicaid programs do not cover methadone.

With opioid addiction a growing problem in Maine and, indeed, throughout the country, it is time for a different approach. The status quo has existed for several decades now, with addiction being treated with high doses of methadone.

It’s time for a change, and getting those suffering from addiction into a primary care setting and taking a safer, less potent Suboxone offers a significant improvement over the road we’re on currently.