On her first full day in office, Maine Gov. Janet Mills (D) took a promising and decisive step toward tackling the state’s opioid crisis. In a reversal of the prior administration’s recalcitrant stance, Mills signed an executive order to expand the state’s Medicaid program, which would extend health care coverage to tens of thousands more low-income residents, including those dealing with opioid addiction.
“A major part of the health care crisis is the opioid epidemic,” Mills said during her inaugural address on Jan. 2. Drug overdoses killed a record 70,000 people in the U.S. in 2017, and Mills said her administration would create a director of opiate response to “marshal the collective power and resources of state government,” in honor of the 418 Maine residents who died of drug overdoses that year. Maine is among the states that had the biggest increases in overdose deaths between 2017 and 2018.
Mills’ inauguration has created a swell of hope among public health and addiction experts, who looked forward to the prospect of Medicaid expansion in Maine. They also welcome Mills’ progressive attitude toward opioid addiction, which differs significantly from the views of her predecessor, former Republican Gov. Paul LePage.
LePage was known for being unsympathetic to the notion that opioid addiction is a medical problem. He framed the opioid crisis in divisive racial terms, as a “war” against black and Hispanic drug dealers. Instead of treatment, he focused on law enforcement tactics.
Gust Stringos, medical director of Redington-Fairview General Hospital in Skowhegan, Maine, characterized the former administration’s approach as: “Why are we treating these people? They’re just bad people anyway.”
“Attitudes like that spill over into stigmatization in the hospital,” he said.
“Maine’s 2017 overdose data show how failed these tactics have been,” said Regina LaBelle, the former chief of staff at the White House Office of National Drug Control Policy during the Obama administration. “Maine was the only state in New England that refused to embrace evidence practices that could have curbed the opioid epidemic.”
Andrew Coburn, a research professor emeritus at the University of Southern Maine’s Muskie School of Public Service, was encouraged by the prospect of a drug czar to organize the state’s response to the crisis, as well as Mills’ previous efforts to expand access to naloxone, the overdose reversal antidote, in her previous role as Maine’s attorney general.
“I believe the state’s strategy will change dramatically,” Coburn said.
In some ways, it already has. Although Maine voters passed Medicaid expansion in November 2017, LePage refused to implement the expansion during his time in office. Now, under Mills, health insurance coverage will reach an additional 70,000 low-income people. For those with opioid addiction, that new coverage could help them access and afford treatment, such as the addiction medication buprenorphine, which can cost more than $100 a month without insurance, said Leighton Ku, a professor at George Washington University’s Milken Institute School of Public Health.
“Medicaid expansions will also help the hospitals, clinics and doctors who provide care since it will mean they will get insurance payments, whereas they often get no payment now,” Ku said.
For doctors who treat addiction on the ground in Maine, health care coverage under Medicaid can change the course of their patients’ lives.
Stringos, a family practice physician in Skowhegan, which has a population of about 8,000 and is located in one of the poorest counties in Maine, said about half of his patients are being treated for opioid addiction.
“Many of them were on Medicaid and then lost it in the era of LePage,” he said. Stringos recalled one patient who was doing well in addiction treatment until she turned 21 and lost her insurance coverage. It was a tumble after that. The patient dropped out of treatment for a year and became pregnant. Being pregnant qualified her for Medicaid again and she returned to treatment, but otherwise, health care ― and treatment ― would have been unavailable to her.
“If she had been able to stay on Medicaid in the first place, she wouldn’t have gotten pregnant and wouldn’t have relapsed,” Stringos said. “That’s a typical story of people losing insurance and what happens.”
Labelle applauded Mills’ swift action to prevent more stories like this one. “Tackling the opioid epidemic takes gubernatorial leadership,” she said.
“The fact that she’s chosen to take it on is a good sign for the thousands of people in Maine who have been touched by the epidemic.”