There’s methadone to Gov. Paul LePage’s madness.

Bad puns aside (and I admit that one seems to make no sense, but bear with me), LePage has a valid point when he criticizes drug-abuse treatment programs that dispense methadone. Most of Maine’s nine dispensaries for this stuff are run by for-profit corporations that accomplish little more than switching their clients from one dangerous drug to another, while providing an ineffective level of the counseling required to address the causes of their addiction. These operations have no financial incentive to end anyone’s dependence on opioids. In fact, quite the opposite.

Trouble is, LePage, as is often the case, obscures his best arguments against methadone clinics with inaccuracies and contradictions that make it easy for critics to dismiss his entire contention.

“I’ve been trying to close down methadone clinics since I’ve been governor,” he told WVOM radio on July 12. “When it comes to methadone, every expert I’ve talked to says there’s no clinical aspect to it. … It’s no help. It has to be a program administered by clinicians.”

Unlike most of what LePage says, this is more or less true.

Simply giving addicts methadone and sending them on their way results in a significant number of them selling their dosage on the street and using the money to buy heroin. It’s sort of the equivalent of handing students a copy of “War and Peace” and telling them to keep reading until they become experts in Russian literature.

(Actually, I think that’s the teaching method they used at Trump University.)

Effective use of methadone requires a comprehensive program. According to the National Institute on Drug Abuse, it’s most effective when treatment is lengthy and doses are high. “Combined with behavioral therapies or counseling and other supportive services, methadone enables patients to stop using heroin (and other opiates) and return to more stable and productive lives,” NIDA director Dr. Nora Volkow writes on the organization’s website. “Methadone has also been shown to reduce addiction-related death, criminal recidivism and the rate of HIV. The increased incidence of adverse methadone-related consequences demands that we intensify our efforts to mitigate its potential misuse or abuse, starting with physician and patient education. That said, we must not lose sight of methadone’s powerful benefits as a therapeutic medication for both pain and addiction.”

Instead of following Dr. Volkow’s advice, LePage has twice cut reimbursement rates to methadone clinics for treating Medicaid patients, causing a reduction in the amount spent on counseling. He’s limited Medicaid payments for methadone to two years, much too short a time in most experts’ opinions. His Department of Health and Human Services is currently pushing through rules that would force many profit-driven clinics to close (good) while simultaneously making it less likely charitable clinics would pick up the slack (bad). LePage says his next budget will cut off all funding for clinics that don’t offer enough counseling. And he keeps repeating the factoid that only 10 percent of heroin addicts ever recover, an assertion for which there’s no reputable evidence.

It’s almost as if the governor wishes those smack-heads would just die. Which is consistent with his opposition to allowing widespread use of Narcan, the drug that revives people suffering from overdoses. In vetoing a bill to make it more available, LePage dismissed that treatment because it “does not truly save lives; it merely extends them until the next overdose. Creating a situation where an addict has a heroin needle in one hand and a shot of [Narcan] in the other produces a sense of normalcy and security around heroin use that serves only to perpetuate the cycle of addiction.”

I’m pretty sure no addict ever tried that two-handed approach. Narcan isn’t normally administered by the person having the overdose – they’re too busy, you know, overdosing – but by family, friends or emergency personnel.

For all of LePage’s blather, he’s still right about private methadone clinics, often owned by out-of-state chains more interested in profiting off the misery of addicts than curing anybody. If the governor could take a break from perpetuating myths and misconceptions, he might have time to develop a comprehensive program that has (here comes that pun again) a reasonable amount of methadone in its madness.

Punish my wordplay by emailing [email protected]


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