FARMINGTON — Gov. LePage’s remarks at his recent town hall forum in Portland suggest a dismaying lack of insight into his state’s most serious public health problem – opiate drug addiction – and they do not augur well for our effectively addressing this problem.

So, while the governor can be applauded for grasping the severity of this problem, his recommendations, which focus so entirely on law enforcement, ignore established science and best practices, and by walling himself off from the treatment community, he is not likely to get this right.

His comments were peppered with numbers that don’t make sense to me. Let’s look at two of them.

His central claim is that treatment doesn’t work since only “36 percent of patients” complete state-supported treatment programs. But since drug addiction is viewed typically as a chronic disease, the effectiveness of a treatment program is usually measured not by the “completion” rate but by the retention rate: the percentage of people who stay in and comply with treatment.

The retention numbers I see, depending on the program and duration, are typically between 50 percent and 80 percent. I have been treating opiate-addicted patients as part of my family practice for about eight years, and my overall retention rate is 65 percent.

Moreover, the overwhelming reason why clients drop out and relapse has been loss of insurance coverage. Without that, patients cannot afford either the medicine or the counseling that is required.

But let’s take the governor’s statement as it is. What if there is a high rate of noncompliance? Noncompliance, or failure to follow through on recommended treatment, is prevalent throughout medicine, especially in the treatment of chronic disease.

Take diabetes, another major public health problem. According to an American Diabetes Association study, blood sugar goals are obtained only 50 percent of the time, even under optimal treatment conditions. In a study of 8,000 diabetic patients, only 39.6 percent were still taking their cholesterol medicine at the two-year mark, and 4 percent never filled their prescription.

We would find similar data about virtually every chronic disease we have. Fortunately for our patients, we continue to work on treatment strategies and problem-solve where we can, rather than concluding that treatment does not work. In fact, there is abundant evidence that treatment is effective at moving people into long-term recovery, improving health outcomes and saving lives.

In dismissing naloxone (also known as Narcan), the governor said that 90 percent of opiate addicts die of their disease anyway, as though this drug only delays the inevitable.

Naloxone saves thousands of lives across this country every year by reviving people who have overdosed. I have seen many patients who have come back from the terror of that experience determined to recover. I know of no public health official in the United States who would deny the benefit of widespread access to naloxone to prevent overdose deaths.

While it is hard to argue against the principle of prevention through arrest and interdiction, $3 trillion spent in the 40-year-old war on drugs, based mostly on this model, has brought little in the way of results, and yet this is the governor’s strategy.

Yes, we should look at root causes – the overprescription and overuse of prescription opiates, poverty, lack of opportunity, domestic violence, lack of access to health care and all the rest – but at the end of the day, we have to take care of the people in need before us.

If the governor is serious about his concerns, he should meet with and listen to the leaders of our drug treatment community.

Look at other state models that have worked. Expand treatment resources at the state level and expand its availability at the individual level by expanding coverage for treatment. Get rid of the two-year cap on treatment, which threatens every one of these patients with a high risk of relapse.

Instead of insulting both patients and care providers by dismissing the value of treatment, the governor should reach out to these same groups to find out what works and where the needs are.

Copy the Story Link