A proposal to build a 10-bed social detoxification center in the Bangor area to assist people withdrawing from opioids could be in jeopardy because of a legal requirement that 40 percent of its patients be uninsured.

A group that represents physicians before the Legislature is concerned that the provision could make it difficult for any agency that wins the state contract to break even since most uninsured patients can’t afford to pay out-of-pocket.

“I am really alarmed,” said Gordon Smith, executive vice president of the Maine Medical Association. “We have a desperate need for these detox beds, but I’m afraid no one is going to bid on these services.”

The social detox was a major component of a bipartisan compromise law approved this year that attempts to alleviate the state’s opioid crisis.

Detox is a short-term program for addicts – usually three days to a week – and is meant to be a steppingstone to long-term treatment programs. Maine has a lack of long-term treatment capacity. There are 25,000 to 30,000 people who want drug treatment in the state but don’t have access to it, according to federal statistics.

The state issued a request for proposals on July 14 for a detox center in a residential social setting in the northern or eastern part of Maine, giving local agencies a chance to win a government contract to operate such a facility. The detox center was part of a $3.7 million compromise bill approved by the Legislature and signed into law by Gov. Paul LePage this year that bolstered drug enforcement efforts while providing additional money for treatment. The Legislature earmarked $900,000 for the Bangor-area detox center, which would serve about 700 people per year.


The Milestone Foundation in Portland is the state’s only current detox center.

Smith said that, out of curiosity, he attended a bidder’s conference in late July, and only one person, Pat Kimball, outgoing executive director of Wellspring Inc., showed up. Wellspring is a nonprofit that offers substance abuse and mental health services.

Kimball declined to comment to the Portland Press Herald, saying the agency is not sure yet whether it will submit a bid. She said talking about the proposal may disqualify Wellspring from winning a bid. Agencies have until Aug. 24 to submit a letter of intent to bid on the detox center, and bids are due Sept. 27.

But Smith said he left the bidder’s conference believing that Wellspring has so many concerns about the finances of the detox center that it may not bid on the project.

Smith said he’s concerned that rules for bidders as outlined in the request for proposals, particularly the 40 percent rule, would make it financially unviable for a contractor.

Rep. Drew Gattine, D-Westbrook, said he doesn’t remember much discussion about the 40 percent provision, but it’s a reality – many people who abuse opioids lose their jobs and end up without insurance. LePage has vetoed several attempts to expand Medicaid, which would have covered more adults who now fall into coverage gaps, Gattine said.


“I believe it was put in to reflect the reality that people who need this service don’t have insurance,” Gattine said.

Smith said the provision may be well-meaning, but might temporarily deep-six the detox center. He said that when the Legislature reconvenes this fall, it may need to remove the 40 percent rule from the law.

“If they have to change it, hopefully they get it right the next time,” Smith said.

He said there also wasn’t any mention in the request for proposals of how much money is available for the service, although the $900,000 is written into the state law.

Smith said with such a high percentage of uninsured patients, $900,000 may not be enough. He said an agency could submit a high bid, but if it’s substantially more than what the Legislature funded, the state may have to reject all bidders.

State employees are forbidden from speaking publicly about pending bids, according to state policy.


The social detox proposal has also come under criticism from some treatment advocates for not using Suboxone, a medication-assisted treatment, to help patients withdraw from opioids. Advocates of the proposal have said that they are not opposed to Suboxone, but that there are not enough doctors currently in the Bangor area who prescribe Suboxone. Doctors have to complete training before being permitted to prescribe Suboxone.

At Milestone, about 80 percent of patients need to use Suboxone to more comfortably detox from opioids. Milestone officials have said the Suboxone helps the patients focus on future choices and getting into long-term treatment programs, while without Suboxone they are mostly dealing with the symptoms of withdrawal.

Dr. Mark Publicker, a Maine addiction expert, has criticized spending $900,000 on a social detox, which he said is an ineffective way to spend limited resources on substance abuse. He said the money should be repurposed if no one bids.

“The effective and efficient way to spend this money is to expand access to medication-assisted treatment,” Publicker said.


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