Last year I was hopeful. Things were happening: summits, task forces, community forums, much talk about the opioid crisis in the Legislature, in the news and in towns throughout Maine. I told my patients things were changing, help was on its way. Many of the state’s addiction specialists spoke before the Legislature. They spoke at libraries, schools and community forums, anywhere anyone would listen. They wrote well-researched, heartfelt pieces in the newspapers.

What did they say?

That medication is the key to successful treatment. That without it, up to 80 percent of addicts will leave treatment and relapse.

Sheriffs and police chiefs across Maine also spoke out in Augusta, in their communities, on the news and on the radio.

What did they say?

“We can’t arrest our way out of this problem”; that putting addicts in jail is a pointless waste of everyone’s time and money; that addicts need treatment for a disease, not punishment for a crime.


Even the states’ funeral home directors joined the chorus.

What did they say?

They’re sick of burying kids in their twenties.

The surgeon general just released a 428-page report: “Facing Addiction in America.”

The American Society of Addiction Medicine published guidelines for treatment of opioid addiction.

The Maine Opioid Collaborative Task Force submitted its report in May.


What did they say?

All three strongly recommended medication-assisted treatment, with methadone, suboxone or naltrexone, as crucial to opioid recovery. They recommend increasing access to treatment by increasing the number and types of providers who can prescribe it and increasing coverage for the uninsured. Why?

Because medication saves lives, reduces overdoses, reduces illicit drug use and decreases the rates of hepatitis C and HIV infection.

So much talk, so many recommendations.

But for my patients, nothing has changed. One young man or woman is dying every day in Maine from an overdose, and there is still no significant funding for the single most effective way to save those lives.

So I wondered: What would make a difference? Who could speak so our lawmakers and representatives would listen? Whose voice has been missing? Whose voice matters?


The answer was obvious: their constituents, the many thousands of hardworking Mainers who are lucky enough to have insurance and can get treatment for their opioid dependence. But many are ashamed of their history of addiction and reluctant to speak out, fearful they might lose their jobs, their sober friends, the respect of their communities. Because of the stigma associated with heroin addiction and methadone or suboxone treatment, they feel compelled to keep their history to themselves.

So I started asking patients to answer two simple questions, anonymously:

n How has being on methadone or suboxone changed your life?

n What would you like the Legislature to know about methadone or suboxone treatment?

Being on methadone made it so I was able to get a job, go to school and become a productive member of society. I was using drugs every day, on the streets and felt helpless. Methadone helped me turn by life around. It didn’t change my life, it saved it.

Methadone has allowed me to keep a roof over my head, pay my bills. I can relate to family and friends while holding my head up. I have gained a lot of my self-respect back. I attend church weekly.


Since starting the program, I’ve been stable and confident. I’ve been able to get my GED and continue on for a CRNA. I am truly excited about my future as a single mother of two. We have recently gotten into our own home. I am able to do all this because of the suboxone program.

The real question is how hasn’t it? I am clean and sober today and feel great. I was in many programs. Nothing has worked as good and as long as the combination of structure, counseling and groups alongside the methadone. I owe it my life, literally.

I’m a lot healthier, I have money in my pocket. I can go to the store and buy my grandchildren something. I am very grateful.

Suboxone has helped me in a huge way. I consider it a miracle. Without it I would have never have been able to stay clean long enough to complete any type of treatment program. It has allowed me to create healthy relationships and get my family back.

I have two new jobs and am going to the gym. I have re-established relationships with my friends and family. A far cry from the unhappy, unhealthy junkie I was a little over a year ago. I am no longer ashamed of myself. I am a working, tax-paying productive member of society again, all because of methadone.

The medicine helps me keep grounded and focused on my life goals and supporting my family.


I have left behind an illegal substance that almost destroyed my life and replaced it with a medicine that saved my life

Suboxone has allowed me to keep going forward in my life. Without it I’d be dead.

Treatment has literally saved my life. Now I can offer my son a future.

I can finally say I am proud of myself.

And on and on and on. You get the gist. The positive things that happen when people get treatment are painfully simple and ordinary. Over and over, the patients wrote how they were able to function again and do everyday tasks in a responsible way: hold a job, pay their bills, work toward a degree. They could take care of their kids, buy them some simple treats. They could go to the gym and the doctor, take care of themselves, get healthy. In other words, they could do normal.

Heroin had taken that away, the basic things we wake up every day knowing we can accomplish: that we can keep the lights on, the lawn mowed, go to our kids’ basketball games, take them to the movies. They could do these things again because they were no longer sick every day with sweats and chills and body aches, no longer doubled over with stomach cramps, throwing up, their bodies and minds obsessed with the need to get and use opioids. They were thrilled to be back living a normal life. It was a miracle to them.


Then I wondered, what would my other patients say, the patients I see in detox at Portland’s Milestone Foundation? The patients in withdrawal, sick, hating themselves, desperate to stop but consumed by cravings for opiates and powerless to quit on their own, the ones who are out of luck, who can’t get treatment because they have no insurance, no money, no sober supports. What would they want to tell the world about what their lives are like?

So I asked them: Beyond the sickness, the craving and the obsession, the inability to think or care about anything else except where your next fix is coming from, what does it feel like to be living the life of a heroin addict day after day after day?

It’s your own private hell. You don’t care about anyone or anything but getting your drug every day, and you’ll do anything to get it, anything just to feel normal.

You lose everything, your drive, your ambition, your energy. It’s like a giant hand coming up out of the ground and dragging you under.

Every day your only choice is between being dead, having the courage to overdose and end it or being the walking dead.

It’s like drowning, being underwater and you can’t come up for air, you can’t breathe.


It’s like being burnt, every day you’re burning.

It’s like digging yourself into a hole, deeper and deeper every day.

Every day you wish you could overdose and die, because you’re dead inside.

You despise yourself and what you do every day.

“Dead” was the answer I got from almost everyone I asked: “It feels like being dead.”

Is methadone or suboxone treatment the perfect solution to the opioid crisis? No drawbacks, no side effects, everyone lives happily ever after? Of course not. Do we live on a planet where anything is a pure, unalloyed good? The best thing for any patient with any chronic disease is to be on no drugs at all. And 20 percent of opioid addicts do well with behavioral treatment alone.


But what about the rest, who keep using, relapsing, overdosing and dying? Suboxone and methadone, prescribed and taken correctly and in conjunction with behavioral therapy, work wonderfully well for many, many patients.

Yes, addiction medicine is fraught with dilemmas. Some patients continue to use alcohol and illicit drugs, which puts them at high risk for overdose. They need a higher level of care: long-term residential treatment in a therapeutic community. In Maine, these beds are as scarce as hen’s teeth and always full.

Diversion is a big problem with suboxone. Unlike methadone, which is dispensed daily and only in federally licensed clinics, patients get a prescription for suboxone and fill it at a pharmacy. Many patients get more than they need and share or sell some of it. The surgeon general’s report notes that most of the patients who use street suboxone are treating their withdrawal and not abusing it. From what my patients at Milestone tell me, this is largely the case. Frequent visits, low doses and pill counts can help. Buprenorphine implants, recently approved by the FDA, may help with this problem too, but I suspect pricing will be prohibitive for most patients and insurers.

What about length of treatment? Are we committing patients to a lifetime of therapy with methadone or suboxone? When can they taper off? What is the difference between one patient who comes off easily and one who can’t get off, despite many attempts?

There are no standard-of-care answers for these questions. We know from decades of experience with methadone that even after years of treatment, most patients relapse when tapered. In most cases, treatment is better than the alternative: a relapse to heroin, a short, destitute life on the streets and an early death from violence, overdose or infection.

Every week at Milestone I see patients whose lives have been destroyed by heroin. Many of them I know well. I see them over and over again. Why? Because without money or insurance, they have no other option but to keep coming back to detox, hoping against hope for a scholarship spot in treatment. This is tragic.


However, many patients are entirely new to me, a steady stream of young men and women from all over Maine coming to detox for the first time. This is alarming. Most of them are abusing other drugs as well. Many are getting fentanyl pure or mixed with the heroin. Many have a history of serial overdoses. All have lost friends and family to overdoses.

If addiction were a virus or a deadly bacteria that was spreading all over Maine, infecting our teenagers and young adults, killing one of our children every day, and we had antibiotics that could help many of them recover and go on to live full, productive lives, would we be withholding treatment because it was costly, because it had significant side effects, because treatment could have unintended consequences, because patients might need it long term, because it didn’t conform to a political ideology?

Make no mistake: Heroin addiction is a contagion, and it is spreading from brother to sister, from parent to child, from bathroom medicine cabinet to high school party, from restaurant to fishing boat to construction site. Is there anything that can stem this flood?

Yes, treatment.

What do I tell my patients now? Hang on, try not to die, maybe next year you can get some help?

— Special to the Telegram

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