When it comes to describing her state’s opioid crisis, Dr. Cathleen London of Milbridge, Maine does not mince words.
“It’s an epidemic because it’s now killing more people than HIV. And more people than the Vietnam War,” she says. “This is an epidemic on par with the plague.”

Dr. London’s words are timely because if the Senate follows the House and slashes funding for Medicaid, states that have high rates of opioid addiction will be even harder-pressed to provide those who are addicted with treatment, counseling, and vital medication. (And in Maine, the record already is not great – the state is one of 19 that did not accept the Medicaid expansion, and some opioid patients who were getting help have been dropped from Medicaid.)

Dr. London has taken a personal approach to battling opioid addiction. While many doctors simply prescribe medicine to people with addiction, she has launched her own after-hours counseling program, a couple of evenings a week. “The evidence on what helps opioid-addicted patients is medication plus counseling,” she explains. “To offer one without the other is just substituting one addiction for the other or sending them out to try to figure it out on their own. Being as rural as we are there are not a plethora of resources. One gets creative in those situations.”

Along the way, Dr. London has collected her fair share of stories about people who needed help – and got it. One evening, while she was eating dinner with her sons who were home from college, a knock came on her door – rare, as she lives outside of town in the middle of the woods. “It was one of the county sheriffs. He was coming for help with his son. His son, like many, was addicted to heroin. And now had gotten into trouble. Would I help him?

“I said of ‘of course,’ and arranged to see him in my office. He came with his mother. Like many, he had injured his back lobstering, got addicted to pain meds, and went on to heroin. He had on his own managed to get clean for as long as six months in the past, but was using again. His psychiatrist had him on stimulants and benzodiazapenes for ADD and anxiety. What I call the Downeast cocktail. Suboxone stabilized him. And as he came off the other medications, it allowed him to engage in a meaningful way in the counseling sessions where accountability is key. His legal issues are gone and he seems happy now.”

Expanded opioid treatment covered by Medicaid and the current health care law is reaching millions of people, with spending estimated to exceed $7 billion a year by 2020. Those funds and that treatment would be lost under the repeal proposals pending in Congress. Some senators are trying to get a 10-year $45 billion pot of money to pay for substance use disorder treatment. But even if they get it services would take a net loss of about $3 billion a year, a terrible backward step.

If Medicaid is significantly cut, Dr. London warns it will affect the fight against opioid addiction across the country. “It will be devastating,” she says. “Addiction will soar” and that means drug users and their entire families will suffer.

Asked whether Maine state government could compensate for the lost revenue, Dr. London responds, “Not a chance. We have the oldest population in the country and the sickest. Much of the economy is seasonal.”

Her message to Congress?

“This is OUR problem. This is OUR plague. We have people dying daily. We are going to lose an entire generation – maybe more. This will be on your heads.”