The MaineGeneral health care system is preparing to launch a new program this summer that would give it greater flexibility to treat people with opioid addiction who are seeking a medication, like Suboxone, to alleviate their withdrawal symptoms.

There is significant demand for medication-assisted treatment in Maine. An estimated 25,000 to 30,000 of the state’s residents are now seeking treatment for their addiction, according to a survey by the U.S. Substance Abuse and Mental Health Services Administration. And an average of one Mainer is now dying every day from an opioid overdose.

To help meet the demand for medication-assisted treatment, MaineGeneral has done a number of things. In the last year, its trained about 50 of its primary care providers to prescribe Suboxone. The system also has room for about 100 patients who, in the throes of addiction, need intensive outpatient treatment, according to Alane O’Connor, a nurse practitioner in Waterville.

But the program that’s starting this summer will provide a third level of care that is meant to bridge the gap from intensive outpatient treatment — where patients see a provider four times a week — to primary care, which requires far fewer visits.

Patients in the new program will receive intensive counseling and be prescribed Suboxone, but they’ll only visit their providers twice a week, said O’Connor, who has been treating opioid addicted patients for the last 10 years and helped designed the new program.

“It’s a step down,” she said. “It’s a hierarchy.”

Complicated health needs

The goal of the program, which is called Outpatient Plus, is not just to ramp up how many people can receive medication-assisted treatment at MaineGeneral, but also to provide a more nuanced range of care for patients with complicated health issues.

The new program will be staffed by providers who work in other parts of the health care system, like the emergency room. Using grant funding from the Maine Health Access Foundation, MaineGeneral has also hired a licensed alcohol-and-drug counselor who will screen new patients to determine which level of care they need.

Eventually, patients in the new program could become stable enough to step down to a primary care provider. That provider could continue to treat the patient’s opioid dependency while focusing on other, underlying medical conditions. Patients could remain in Outpatient Plus for as short as a month and as a long as a year, O’Connor said. As they continue on the medication, their doctor would try to prescribe less of it over time.

“The whole goal is to basically help them relearn how to live their life, how the next time your boyfriend yells at you, or you get stressed out driving your car, or whatever the situation is, how are you not going to use heroin,” O’Connor said of addiction treatment in general. “It’s learning new coping skills, taking care of your behavioral health problems. A lot of people have developed an addiction because they’re really treating their untreated bipolar disorder or untreated depression.”

Opioid addiction is a chronic illness where relapses are to be expected, O’Connor said, and the new level of care would also give primary care doctors a place to send patients who suddenly need more intense treatment.

She recalled one of her own patients, a woman who was stable for four years, then “had a pretty epic relapse for two-to-three weeks” after her mother died unexpectedly.

“She got some individual counseling, and she got some group counseling, and she’s doing much better now,” O’Connor said. “(She’s) a perfect example of someone who could have stepped up to the (Outpatient Plus) level of care. I don’t think she needed the (intensive outpatient program). I think she just needed tighter parameters, but we didn’t have an intermediate place to put her … A lot of these people, when they have their lives back on track, you don’t want to compromise their stability. It’s hard to work a job and go to an (intensive outpatient program) four times a week.”

Volume of care

Over the last decade, O’Connor has seen the opioid epidemic escalate.

“I used to have patients snort 30 milligrams of Hydrocodone, and now I have patients using three grams of heroin,” she said. “That’s a huge jump. There are 10 bags of heroin to a gram, so in the beginning people might have done 2 bags of heroin, and now we’re talking 30 bags of heroin. I have users that use an amount that, if you got arrested with it, it would be a trafficking charge.”

In Maine, there’s been an escalating number of deaths tied to the abuse of opioids, particularly from fentanyl and heroin. Maine overdose deaths rose for the fifth straight year in 2016, climbing nearly 40 percent to claim a record 378 people, according to figures released in February by the state Attorney General’s Office. The 378 fatalities surpassed the previous record of 272 set in 2015.

By offering new programs like Outpatient Plus, O’Connor said, MaineGeneral is trying to meet the great demand for opioid addiction treatment in central Maine.

When the program is up-and-running, she said, patients will ideally be able to call a single phone number, meet with the drug-and-alcohol counselor who was recently hired by the system and get placed in the appropriate level of care.

But O’Connor also acknowledged “the elephant in the room”: that many Mainers still can’t afford medication-assisted treatment because they don’t have health insurance.

According to MaineGeneral spokeswoman Joy McKenna, 40 percent of patients who use the system’s intensive-outpatient program don’t have insurance.

And there are other barriers that prevent patients from receiving adequate treatment, like the stigma surrounding drug addiction and the distance patients need to travel to get the treatment, said Kathryn Rouillard, a program officer at the Maine Health Access Foundation.

The Health Access Foundation wrote a two-year grant of $173,740 to help MaineGeneral expand its medication-assisted treatment opportunities for people without insurance, Rouillard said.

Barbara Leonard, president and CEO of the Health Access Foundation, credited health care systems like MaineGeneral that have been expanding the number of primary care providers who can prescribe Suboxone, a move that can be daunting for providers who aren’t used to dealing with patients who are addicted to drugs.

“Primary care providers may know that there is some sort of addiction, but until they are able to provide that treatment, that’s a core, chronic issue that they are not able to support,” said Leonard. “As we hear from primary care providers who have started doing medication-assisted treatment, they find that it’s the most rewarding work they have ever done in primary care, because it so quickly helps their patients.”

Charles Eichacker — 621-5642

ceichacker@centralmaine.com

Twitter: @ceichacker