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Providers See Rise in Heroin Abuse in Maine
09/26/2012   Reported By: Susan Sharon

The director of the Northern New England Poison Control Center says there has been a recent rash of heroin overdoses in Portland and Augusta. The information is anecdotal. But as Susan Sharon reports, it's raising concerns for treatment providers, even as the state looks to cut back methadone and other treatment for Medicaid patients in addiction recovery.

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Calls to the Poison Control Center in Portland started coming in a few weeks ago. Center Director Dr. Karen Simone says she's been getting them from hospitals and other health care facilities.

"They're seeing severe heroin overdoses, more than they normally would," Simone says. "And then when speaking with individuals who work more closely with people who are using drugs on the street, they noted also that there had been rumors that there was something going on, and that people were having problems."

In other words, there may be a particularly potent form of heroin on the street. Simone says the heroin health care providers have been bracing for this potential situation, as a crackdown on the illicit use of prescription pain medication forces addicts to switch to cheaper, more accessible opiates such as heroin.

"Simply limiting supply of one drug will only fuel the use of another," says Dr. Mark Publicker, an addiction specialist with the Mercy Recovery Center in Westbrook. Publicker says as bad a drug as the prescription pain medication Oxycodone is when it's abused, intravenous heroin is considerably worse. And Publicker says he's noticing a disturbing trend.

"We have been seeing at the Recovery Center, in our in-patient unit, a wholesale increase in intravenous heroin addiction," he says. "It's worse in the sense that we're now dealing with a population of novice users who aren't voiced in clean needle use, don't have access, for the most part, to clean needles, and may not know about the dangers of sharing needles."

What that means, says Dr. Publicker, is that heroin can potentially cause more harm through the spread of HIV and Hepatitis C.

One of the big challenges with combating heroin addiction is access to treatment. People who don't have health insurance generally can't get it. And in Maine, Medicaid patients who are in recovery using Methadone or Suboxone to help get them through the process are going to face new, retroactive, two-year limits on the use of both drugs beginning January 1st.

Dr. Stuart Gitlow, the acting president of the American Society for Addiction Medicine says for many opioid addicted patients, medicated assisted therapy is the most effective treatment. But he says, increasingly, states are moving to impose limits on it.

"We know there are limitations in Kentucky and Tennessee, in Connecticut, in Maine. And each state is looking at it from different perspectives," he says. "Their concern is always how do we cost-contain this? One way of doing it is to say, 'We're only going to allow medication treatment for six months.' Another way of doing it is to say, 'We're only going to allow a 16-milligram dose, even though the FDA indication allows up to 32 milligrams and that will lower our costs."

Gitlow says it may lower costs on a short-term basis. But when the patient then relapses, the cost to society goes up. It's just as noticeable to the state agency that imposed the limits in the first place.

What's also troubling, he says, is the increasing number of young people 12 and older who are heroin users. Gitlow says he sees this in his own practice in Rhode Island. And so does Dr. Mark Publicker in Maine. Publicker says he's currently serving on a task force to develop protocols for the new, retroactive two-year limits on Suboxone treatment.

And he's encouraged by some of the preliminary recommendations that include exemptions for certain patients. "It will focus on protecting patients who have unstable medical or psychiatric conditions, focus on maintaining therapy for patients that are doing well."

Publicker says he can live with those changes if they are approved by the LePage administration. But he says he's still concerned about the fact that there is no mention of either addiction or addiction treatement in two recent reports from the Legislature and the Attorney General's Office about the state's response and plan for dealing with Maine's prescription drug problem.


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