My husband, a family physician, is, like other clinical colleagues, simply overwhelmed by the sheer numbers of patients presenting with drug problems.

His patients are waitresses, business managers, bloodworm diggers, students, health care professionals and people with disabilities. There is no “classic” profile of addiction in his practice. These are your family members, neighbors,or co-workers. Many, but not all, users come from troubled family backgrounds with many stresses in childhood.

My husband has begun routinely asking patients about the most they have ever spent on drugs in a day. One astronomical response was $5,000, an entire tax refund check. More usual responses are about $200 per day. For one addicted couple, it meant that a huge portion of every paycheck went to opiates instead of food on the table, clothes for their children or paying the electricity bill.

Consider the impact on the community level when immense amounts of money are drained out of the local economy by the purchase of illegal drugs.

Most of the addicted patients that my husband treats fall into one of four groups.

• Some patients started using as early as 12 years old as an escape from a horrible family life. These are the patients most likely to steal from grandma or become dealers just to afford the habit.

• Then there are people who, as children, grew up in an environment of drugs among family members or neighbors. As one patient put it,”If you hang around the barber shop, you’re gonna get a haircut.”

• Some people got hooked on prescription drugs, turned to street narcotics when prescriptions ended, and ended up on heroin as the cheaper alternative.

• Finally, there are the recreational users, starting first with alcohol or marijuana, and moving eventually into opiates.

One can see that it is a very complex issue about why and how people become addicted.

It’s true that clinicians have been part of the problem. Several years ago, physicians were chastised by experts for not controlling their patients’ pain well enough. They were told to treat pain as the fifth vital sign and to increase doses until the pain was relieved. Prescriptions for new opiate pain relievers started to skyrocket, especially in a state such as Maine with historical injury-prone industries such as fishing, farming, logging, and factory work.

As a response to this epidemic, my husband became one of the physicians in Maine certified to treat addicted patients with Suboxone (buprenorphine). It ends the craving for narcotics but does not provide a high. Counseling also is required, helping many patients to deal with their personal challenges for the first time. Using opiates allowed them to “treat” their personal pain by getting high and ignoring the problem.

This is some of my husband’s most rewarding work as a physician because he has seen so many lives turn around. Within the first few years of treatment, patients solve legal and financial issues, get their driver’s license back, move away from bad influences, get more rewarding jobs, and get their children back. Suboxone treatment also has helped his patients get off government supports. The great majority of people in this treatment program succeed.

There is a notion in public discussions that all people receiving Suboxone treatment are MaineCare (Medicaid) recipients. Many of my husband’s patients were indeed Medicaid patients, but a remarkable number have private insurance or are self-pay. A major issue this year has been the number of young patients kicked off MaineCare who then could no longer afford Suboxone.

Another system problem is the lack of enough Suboxone prescribers to treat all those needing help. The waiting list in my husband’s practice is more than six months long.

Clinicians originally thought that all people could be tapered off Suboxone after a few years. However, because of chemical brain changes through prolonged opiate use, many people have to be on Suboxone much longer. Think of treating addiction as treating a disease like diabetes, not like treating a cold.

Perhaps we have to concede that the tradeoff of a stable, crime-free life is worth the cost of extended treatment. Here’s another irony: When a few of his patients were arrested for infractions committed before they started treatment, they had access to street drugs in prison, but Suboxone treatment was forbidden.

Here are some policy suggestions from a clinician on the front lines.

• Develop incentives to encourage more clinicians to consider Suboxone treatment for their patients.

• Consider a change in law, like that proposed by Sen. Susan Collins, R-Maine, to permit nurse practitioners and physician assistants to prescribe Suboxone, if they receive the same training and certification.

• Reconsider pushing addicted individuals off Medicaid, since for some, it’s the only way they can get treatment.

• Recognize the chronic nature of treatment, which may be as long as for other conditions such as hypertension or diabetes.

Lisa Miller, of Somerville, is a former legislator who served on the Health and Human Services and Appropriations and Financial Affairs committees.

Only subscribers are eligible to post comments. Please subscribe or to participate in the conversation. Here’s why.

Use the form below to reset your password. When you've submitted your account email, we will send an email with a reset code.

filed under: