All of our elected officials in Augusta, including Gov. Paul LePage, deserve our gratitude for their ability to come together at a time of crisis. A bill targeting the addiction epidemic passed unanimously in the Maine Legislature and was immediately signed into law by LePage. More bills on the epidemic will follow, hopefully with the same speed and support.
But our legislators aren’t the only ones coming together. The crisis touches every community, all socioeconomic levels, and families of all political stripes.
Communities, police departments, citizens, educators, social service providers, legal professionals and others, like our elected officials, are coming together to learn about the crisis and how to be a part of potential solutions.
Challenges remain, including funding and the potential role MaineCare might play under a proposed expansion. Concerns about treatment persist, as well. Some legislators and officials have expressed an interest in evaluating current programs before investing more funding, and proponents of increased access to medication-assisted treatment (like Suboxone and methadone) say the initial bill doesn’t nearly go far enough.
Wanting to understand a provider’s perspective on the diversion issue, I reached out to Pat Kimball, director of Wellspring Substance Abuse and Mental Health Services in Bangor. I intended to ask to schedule an interview because I didn’t want to put her on the spot by asking on the record for her thoughts on Suboxone diversion. Kimball was happy to address the issue impromptu on the second ring.
As someone who has personal knowledge of both the benefits of medication-assisted treatment for some people and the downside of the consequences of diversion, I found the conversation very enlightening.
Kimball didn’t hesitate to acknowledge that some amount of diversion — patients giving away or selling their Suboxone — happens, even though when it first came out “makers said it wasn’t divertable.”
She was quick to point out, though, that some of this diversion is due to the lack of insurance for some who have substance abuse disorders and due to the lack of access to medication-assisted treatment. She described this type of diversion as clients trying to help someone they know who is struggling who might think, “If I can get by on half a strip, I can give half to a friend.”
Kimball said there were also other reasons people may be or may perceive themselves to be unable to access medicated-assisted treatment, including stigma, and may resort to self-medicating with Suboxone acquired through black-market channels. However, Kimball called on the treatment community to ask itself “how do we help decrease diversion?” as an integral part of the services they provide.
She’s a strong advocate for medication-assisted treatment, asserting that the beneficial impact Suboxone has had for her clients along with “what the research is saying, the benefits outweigh the diversion piece, but the diversion piece can’t be ignored either.”
She agrees with a need to evaluate program protocols and incorporate accountability measures, especially for clients in the early stages of recovery when their decision process may still be impacted by their addiction.
Unfortunately such efforts are costly, especially for “free-standing clinics,” Kimball said. Pill counts and other accountability measures require administrative support that is not included in clinical costs, meaning clinics have to absorb these costs in their already tight budgets. Doing more to limit diversion will cost more.
Kimball said the makers of these medications should also be responsible for ensuring they’re difficult to divert, and she spoke to a societal or “generational” responsibility, as well.
Kimball recounted attending a professional conference and overhearing a conversation nearby. One of her colleagues was complaining about a knee problem, and another spoke up about a prescribed medication that was working well for an ailment he had. The second colleague offered a couple of his pills to the first, and the casualness of the exchange stuck with Kimball.
She said, “We are a generation that thinks it’s okay to share medications, and our kids pick up on that, but it’s not okay.” I agreed and mentioned that young people seem to have this misperception that experimenting with pharmaceutical drugs is somehow safer, and I worry that false sense of security contributes to their willingness to experiment with pharmaceutical opioids, enabling addictions to develop quickly.
For Kimball, addressing diversion of Suboxone is a challenge, but a worthy one to master. She said, for those clients for whom it is indicated, medication-assisted treatment is best practice treatment for their addiction, and all evidence she is aware of supports that statement. Kimball expects the issue and prescribing protocols will be addressed in an upcoming report from the task force assembled by the Maine attorney general.
Kimball balanced the accountability piece by stressing the importance of letting medical professionals address the individualized and complex needs of clients with addiction, many of whom have trauma histories and co-occurring disorders. Treating clients with addiction is complicated, yet people want to hear about simple solutions.
Treating addiction, like drafting legislation to support treating addiction, is complex, but doable. Especially if everyone keeps coming together.