Two years after it began, the Maine Medical Association begins to see results from its attempt to convince more doctors…
Two years after it began, the Maine Medical Association begins to see results from its attempt to convince more doctors to prescribe Suboxone, one of the most effective drugs for the treatment of opioid use.
About 200 physicians, medical assistants and nurses have completed the training and received the federal exemption required to prescribe the medicine since 2016, according to estimates of health policy experts based on federal data. The expansion in Maine’s ability to fight opioid epidemic, where overdose with fatal drug is due to approximately an average of more than one person per day, arrives at an appropriate time.
The election committee Janet Mills has said that she will approve Medicaid expansion as soon as she takes office in January. As a consequence, another 70,000 low-income beneficiaries will be eligible for care, including treatment of opioid malfunction. The Maine Medical Association, representing a doctor before the legislature, said that Maine is prepared for the wave of new patients seeking an agreement.
“We will certainly try (to meet demand)”, says Gordon Smith, Executive Vice President of the Association. “I think we will be ready.”
Others are more skeptical and point out that it is unknown how many of the new Suboxone prescribers will accept to take on a significant number of patients. And Smith warned that many treatment barriers remain, and much more needs to be done to connect patients to physicians willing to provide treatment.
The association has been childhood state since 2016 and sought to convince physicians to become Suboxone prescribers by coughing information sessions and courses required to obtain federal exceptions. Doctors, medical assistants and nurses who complete the federally-educated education can treat up to 275 patients with opioid malfunction with a combination of Suboxone and counseling.
Suboxone, also known as buprenorphine, is an important drug in drug assistant treatment, which public health experts consider to be “gold standard” in the treatment of opioid malfunction.
It is not clear how many doctors and other providers have completed training, but there are now about 200 more providers who have received the obligatory federal exemption to prescribe buprenorphine than in 2016. Between 2017 and 2018, the number of prescribers increased by approximately 100 , federal data show.
Many Mainers with substance use are uninsured and have little income because drug needs take over their lives and they lose jobs, family connections, and often go through the money they have saved before seeking help.
Without insurance or money, they have a hard treatment because there is no system for paying for consultation, therapy, prescription and medical treatment.
“HOW FULL IS IT?”
How many such people will seek treatment during Medicaid expansion is unclear, but there are some rough estimates.
Of the entire Medicaid population, about 12 percent have a substance use. Federal research of expansion populations indicates that approximately 15-35 percent have a substance use. It would be translated to between 10,000 and 25,000 headers among 70,000 residents who would be eligible for coverage.
Not all people would use opioids, as infectious diseases also include other illegal drugs and alcohol.
Maine has 742 healthcare professionals with the exception of prescribing buprenorphine. If each of them treated 30 patients with opiouse, the state’s capacity would be approximately 22,000 patients, not including metadone clinics. Methadone is another effective method for the treatment of opioid use, but is usually used for more seriously ill patients.
Dr. Lisa Letourneau, Associated Medical Director of Maine Quality Counts, a Health Care Group and a New Buprenorphine Prescription, said the increase in prescribers is good news, but she expressed concern.
Many of the 742 doctors and others with the exception of prescribing buprenorphine are not willing to take on a significant number of additional patients, she said. Some just got the training to treat their existing primary care patients who happen to have a substance use. And only 333 of the doctors are listed on a federal website, sustained by substance abuse and the psychiatric healthcare that potential patients would use to find a doctor. Doctors and nurses can choose whether they want to be admitted to the site.
“How good is it if we have 742 buprenorphine preparations if patients can not find them? What we really need are new systems that can connect people to care,” says Letourneau. Other barriers are also available, for example, for people who want treatment
“LONG WAITING LISTS”
Dr. Mark Publicker, one of the leading drug specialists in Maine, said that he is living in detention-based housing, where use of Suboxone medicine is often prohibited. not yet seen a lot of improvements in treatment capacity.
“It is known nationally that half of the physicians do not either prescribe or just do it for some patients in their internship,” says Publicker, who is conducting Portland treatment. “Three Quarters of my patients come from midcoast, and some even from down east can not find local prescribers. The system is already overwhelming. “
Smith, at the medical association, said” we still have a long way to go “, and the association continues to host training sessions and try to gather doctors to become Suboxone Suppliers. Maine has about 2000 primary healthcare practitioners.  Another problem is that prescribers are not evenly distributed around the state. For example, while Cumberland County has 80 buprenorphine per per 100,000 inhabitants, the rural Aroostook County has only 24 per 100,000.
Maine seems to be better than when New Hampshire expanded Medicaid 2017. At New Hampshire, which has similar demographics to Maine and has also struggled with an opioid crisis, fewer than 100 Suboxone providers in the state, said James Potter, vice president of the New Hampshire Medical Society.
“It was difficult (in 2017) to get into any kind of treatment program,” said Potter. “There were some long waiting lists.”
Since then, New Hampshire has also undergone a campaign to get more doctors to prescribe Suboxone, and the state now has between 350 and 400 prescribers, said Potter.
“It’s better, but we still do not have enough practitioners who provide the services we need,” he says.
For Letourneau, who decides to work as a primary physician after working exclusively for health policy for 20 years, has opened the eyes to many of the practical problems faced by patients . But she learned that many of the stereotypes of Suboxone patients, including being difficult to treat and time consuming, are not true.
“We must get away from this thought that treatment of these patients is scary. It’s not.” This is mainly about medication and coupling of patients to therapy. On the medication page, it is easier for doctors to treat than many others
At the same time, Letourneau told physicians to see patients turn their lives.
“This patient told me I was invited to his brother for thanksgiving for the first time in 10 years,” she said. “The difference in Their life from one year to the next has been dramatic. “
Joe Lawlor can be contacted at 791-6376 or at:
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