BAR HARBOR — Questions of how to respond to increasing opiate abuse in Maine and whether the state should expand MaineCare were central when Governor Paul LePage and Attorney General Janet Mills separately addressed the annual meeting of the Maine Medical Association at the Bar Harbor Club Saturday.
LePage said that education, prevention, law enforcement and treatment are all important in combating drug abuse, but he would like to see more resources for enforcement.
He’s concerned about recent efforts to legalize recreational marijuana because of the message that might send, he said.
“People say it’s not a gateway drug. Well, maybe it’s not. I may be wrong here, I don’t know. I just know that some kids are dying. And they’re dying for no reason. They’re dying because the state of Maine is being ineffective.
“I could care less about putting an addict in jail, because I don’t want them in jail. We have too many in jail. We’ve got to find ways to get them treated.
“But I am very interested in getting at the business side of the supply chain, which is the people that come in from Connecticut, Massachusetts, New York, Pennsylvania—and sell their poison to our kids.”
LePage said the Maine Drug Enforcement Agency recently arrested a 31-year-old heroin dealer from Connecticut who goes by the street name Smooth.
“Smooth is not an addict. Smooth doesn’t even touch the stuff. He’s the guy I want. I want to have him in Maine for the next 25 years. I want him to be my guest.”
During her remarks later in the day, Mills said that Maine saw 208 deaths in 2014 from pharmaceutical opioids and heroin, up 18 percent from 2013.
“And you know that the deaths are just the tip of the iceberg,” she said.
Addiction is not limited to young adults; the average age of overdose victims in the state is 43. Five percent of Maine babies are currently born “drug-affected.”
Mills told the doctors that a large majority of Mainers arrested for heroin possession say they “started on pills,” any of a variety of prescription medications that contain opiates.
Trafficking of prescription drugs such as oxycodone and over-prescription of this family of drugs are priorities for her office. The boards that license nurses and other professionals handle lots of cases of prescription drug diversion and misuse, she said.
“The Maine criminal code is a tool that can be used in your offices,” she said. “Remind patients that it’s a crime to possess a drug that’s not in its prescribed container or to use a drug in a manner other than how it was prescribed.”
There’s no patient privilege when a doctor or pharmacist suspects an attempt to obtain drugs by deception, she said.
Mills encouraged the doctors to support drug education in schools and other venues. “It should be part of health education that you don’t take heroin, it takes you,” she said.
“We need your help getting these kinds of messages to the schools and communities; we need your help promoting treatment programs and funding treatment; we need your help reducing opioid prescriptions,” Mills told the group. “We’ve partnered so much before, so many times on such good causes: tobacco, domestic violence, elder abuse. Let’s put our heads together again. Let’s make Maine the first state to successfully address the scourge of opioid abuse.”
The Maine Medical Association has opposed the LePage administration’s decision not to expand MaineCare, the state’s Medicaid program, under the federal Affordable Care Act. The association is a member of the Cover Maine Now coalition, advocating expansion.
Dr. Cathleen London, a physician at Calais Regional Medical Services, asked the governor why his administration has chosen not to expand MaineCare.
“I’m in a rural hospital that is threatened every day, and as you said, we’re a very large state. So we have these critical access hospitals that are dependent on Medicaid dollars,” she said.
The governor responded by saying increased funding would not solve the issue of a lack of coverage. “It’s not enough to just put money at it. Free is not always good. If you don’t have stake in the game, it’s not good. You have to have self-respect and self-control. And that’s what’s wrong with Medicaid.”
He said Maine is more in need of federal funding from the Medicare system, given the age of the population, than from Medicaid. “They took $800 million out of Medicare” to fund Medicaid expansion, he said, but Medicare “is where we need the help.”
Maine uses the federally operated health insurance exchange established by the Affordable Care Act. The LePage administration opted not to create a state-run exchange.
“Right now, with the exchanges, we’re down to about 40,000 people uninsured,” LePage said. “Some people are paying $1.74 to $20 a month for their health care.”