NEW YORK — The proposal to eliminate MaineCare funding of methadone treatment is difficult to comprehend and impossible to defend. What’s wrong with the idea? Plenty.

Far from saving taxpayer money, the proposal would lead to a substantial increase in treatment expenditures. Comprehensive methadone treatment, including salaries for physicians, nurses and counselors, plus laboratory tests, costs about $5,000 annually. By comparison, the yearly cost for Suboxone alone – just the medication – is approximately $6,000.

The issue is not just financial. Many doctors, although authorized to prescribe, simply refuse.

In December, a Washington state study found that only 28 percent of authorized Suboxone prescribers treated any patients. As for Maine, the mayor of Bangor was recently paraphrased as stating that “while there are hundreds of primary care doctors licensed by the federal government to prescribe Suboxone, few do.” Clearly, most patients denied methadone will revert to their illicit habits, with serious risk to themselves and their communities.

In theory, addiction treatment in primary care settings makes sense. But which physicians have sought and obtained authorization to prescribe Suboxone? A national survey published this past month found that 42 percent of authorized Suboxone prescribers are psychiatrists, who are hardly in a position to render integrated primary care.

Furthermore, integrating treatment is not as simple as it sounds. A Jan. 13 Washington Post report is sobering: “Edwin Chapman’s … waiting room was full of heroin-addicted patients there to refill their generic prescriptions for Suboxone. … Chapman is an internist, a cardiologist. This drug has transformed his D.C. medical practice – now more than half of his patients are there to seek it, addicts edging out elderly ladies with arthritis and diabetes.”

Not quite the idyllic picture suggested by those who argue in a recent Press Herald op-ed that “getting those suffering from addiction into a primary care setting … offers a significant improvement over the road we’re on currently.”

Stigma is another problem. Unlike methadone treatment, no prior approval is required for federally authorized physicians to treat patients with Suboxone. However, what will be the reaction when a local physician intends to treat 100 patients, especially if there are a half-dozen doctors in the same office who plan to do the same?

Finally, there are pharmacological problems that make transition from methadone to Suboxone difficult if not impossible. It is strongly recommended that patients (specifically including methadone maintenance patients) be partially detoxified before initiating Suboxone.

According to a publication of the federal Substance Abuse and Mental Health Services Administration: “Awaiting signs of withdrawal before administering the first dose is especially important for buprenorphine induction … to avoid severe and uncomfortable withdrawal.”

Inevitably, many opioid-dependent individuals will respond to “severe and uncomfortable” withdrawal by relapsing to self-administered drugs, and the result can be deadly. Moreover, in the case of pregnant women, withdrawal – regardless of its cause – can jeopardize the viability of the fetus.

Which treatment offers the best prospect of efficacy? Generalizations cannot provide the answer; in any individual case, the choice of treatment must be made jointly by physician and patient. But the options must be as broad as possible, and must not be curtailed by legislative fiat.

It should be stressed that Suboxone – and all approaches that offer help and hope to opioid-dependent patients – deserves the fullest support possible, but not to the exclusion of other modalities. With regard to methadone, Maine’s experience is instructive: Despite availability of Suboxone, the demand for methadone maintenance continues to rise, and rise substantially. An American Society of Addiction Medicine survey determined that in Maine, between 2008 and 2012 the number of persons enrolled in methadone programs increased 21 percent!

The bottom line: The governor’s proposal to eliminate funding for methadone treatment should be defeated. Instead, in the interests of the entire state, government should establish the best, most accessible and affordable spectrum of treatment services, and utilize every possible means to attract those who need and want them, and who are all too likely to die without them.