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Preventing and Treating Opioid Addiction in Maine

Maine is implementing an innovative, multimodal approach to preventing and treating opioid abuse. In recent years, we have pursued the following initiatives:

Strengthen opioid prescribing limits

About 75% of those addicted to heroin first became addicted to a prescribed opioid.

In 2016, Gov. LePage introduced, gained bipartisan support for, and ultimately signed a law to:

Cap opioid prescriptions at 100 morphine milligram equivalents (MME), with reasonable exceptions for certain conditions.

Limit opioid scripts to 7 days for acute pain and 30 days for chronic pain.

Require prescribers to check the Prescription Monitoring Program (PMP) before prescribing opioids.

Mandate the use of electronic prescribing for opioids to prevent diversion.

Add 3 hours of opioid addiction training to prescribers’ continuing education requirements.

Establish Medicaid rules for opioid prescribing

The LePage Administration proposed Medicaid rules for the prescribing of opioids to align with rules governing the Prescription Monitoring Program. These rules include parameters for appropriate opioid prescribing such as with acute injuries and flare ups, for postoperative pain management, and during painful procedures and recommends multimodal therapies in general for all chronic pain patients. The rule sets out prescriber requirements, limitations, and exemptions that comply with state and federal laws, and provides guidelines for prior authorizations and medical records requirements.

Reform methadone clinic treatment

Methadone is a tool in the fight against opioid abuse. However, it must be delivered in accordance with an evidence-based model. Maine implemented rulemaking changes to ensure that members receiving Methadone 24/7 addiction treatment receive comprehensive, quality care including:

A formal plan of care for each member, to include specific goals submitted to DHHS within the first 60 days of treatment and an established treatment baseline for each member.

After 24 months of treatment, providers are required to submit additional documentation in the form of a prior authorization regarding the member’s response to treatment.

Counseling is now required to be provided for each member receiving methadone, in accordance with federal standards.

Promote a new model of MAT through Opioid Health Homes

The LePage Administration recently committed $4.8 million to a new Opioid Health Home (OHH) initiative, which places opioid-addicted Medicaid recipients and the uninsured alike in a primary care “health home” using a team-based approach to coordinate physical, behavioral, and addiction care. It involves a range of qualified staff, including a Clinical Team Lead, Medication Assisted Therapy (MAT) prescriber, Nurse Consultant, Licensed Alcohol and Drug Counselor, Certified Clinical Supervisor, and Peer Recovery Coach. The goal is to improve outcomes and quality of care for those undergoing treatment for opioids addiction.

Initiate a Vivitrol pilot project

Vivitrol is a medication-assisted treatment option that provides a monthly injection to block a patient’s opioid cravings. In partnership with Penobscot County Jail and Penobscot Community Health Care, a pilot launching this spring targets incarcerated women. Through this pilot program, Maine DHHS will begin administering the medication two months prior to each individual’s release. Upon release, we ensure continuing care including counseling and housing assistance through Penobscot Community Health Care.

Help pregnant women with substance abuse disorder achieve long term recovery and improved birth outcomes

Every year, more than 1,000 babies are born substance-exposed in Maine, accounting for nearly 1/10 of all births in the state—a sixfold increase since 2008. Maine DHHS has developed strategies to connect prenatal families directly with public health and community-based resources. Those strategies include:

Increasing the number of pregnant women screened for substance abuse using SnuggleME, an evidence-based screening tool.

Increasing reporting requirements around treatment during pregnancy to evaluate gaps and barriers to prenatal substance abuse treatment.

Integrating prenatal care and substance abuse treatment, ensuring the best outcomes for the mother and baby.

Provide support and ensure substance treatment for families in the child welfare system

With more than 60% of the children coming into the State’s protective custody due to parental substance abuse, Maine placed a stronger emphasis on programs designed to reach at-risk families. Parents receive substance abuse treatment through the Matrix Model Intensive Outpatient Program and parenting education through the Positive Parenting Program (Triple-P). The goals of these initiatives include:

Support more than 250 families annually.

Improve parental competence in managing common child behavior challenges.

Decrease use of punitive methods to manage children’s behavior.

Decrease parental stress and increase parental confidence.

Reduce parental substance abuse during treatment.

Increase funding and accountability for addiction treatment

From 2008 to 2017, Maine has increased spending on substance abuse treatment for Medicaid members and the uninsured from $57 million to $82 million—a 43% increase—and now serves 20,000 low-income, addicted Mainers.

Further, Maine DHHS is now prioritizing direct funding at the individual, fee for service level, ensuring that the system is person-centered and focused on accountability for measurable outcomes to ensure people receive the right treatment in the right location at the right time.

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