New England editorial roundup

The Boston Globe, Dec. 6, 2013

Nelson Mandela, who died Thursday, Dec. 5 at 95, showed the world a remarkable vision of leadership that arises all too seldom. Patient and unrelenting in his efforts to overturn South Africa’s vicious apartheid regime, Mandela was a pillar of grace, magnanimity, and restraint in victory.

For his unwillingness to compromise with his country’s white-supremacist government, Mandela spent 27 years in prison. He spoke to his resolve in the brutal years in Robben Island prison, years often marked by pointless pounding on rocks in a lime quarry, by saying, “any man or institution that tries to rob me of my dignity will lose because I will not part with it at any price or under any pressure.” Mandela said his faith in humanity was “sorely tested, but I would not and could not give myself up to despair.” Finally, in the 1990s, the world anti-apartheid movement — and his own diplomatic acumen — helped force his release from prison, and he went on to become South Africa’s first president elected in a full democracy.

The apartheid regime had long smeared Mandela as a dangerous radical, but the new president’s time in office was marked by reconciliation rather than revenge. His stable hand helped maintain the nation’s status as a top economic engine on the African continent. He found some common ground between the races through sport. His sense of fairness vaulted South Africa to world leadership on issues such as gay rights. The country has much work to do; much of the black populace remains gripped in township poverty, to the unfocused attention of current leaders. Yet Mandela proved that progress was possible — and that generations-old divisions could end not in score settling, but in an honest search for peaceful coexistence. When Mandela walked out of prison, he said, “To be free is not merely to cast off one’s chains, but to live in a way that respects and enhances the freedom of others.”

The Morning Sentinel of Waterville (Maine), Nov. 30, 2013

The face of opiate addiction in Maine has long been an adult one — a woman who rifles through her grandmother’s medicine cabinet, or a man who holds up a pharmacy. This is changing, though, and not for the better.

More Maine babies than ever are being born affected by or dependent on drugs — the number is on track to reach a record 800 by the end of 2013. Gov. Paul LePage, who focused on the issue in a recent radio address, says the statistics are frightening, and we agree.

Any efforts to address the problem, however, will be undercut by a recent two-year state cap on Medicaid coverage of addiction treatment. This policy fails to recognize the severity of a statewide public health epidemic, and as long as it’s in place, the health of both addicted women and their children will be at risk.

Maine is one of the hubs of prescription-painkiller abuse in the United States, so it’s no surprise that high adult opiate addiction rates have led to an increase in drug-dependent newborns. More than 160 Maine newborns were affected by drugs in 2005, the first year the state began collecting the data. In 2012, 779 addicted infants were recorded, and about 770 have been born so far this year.

The impact of withdrawal on infants raises questions about the cost-effectiveness of Maine’s limit on Medicaid coverage for medications used to fight opiate addiction. Compared to other infants, babies born to addicted mothers are smaller, more irritable, less interested in feeding and more prone to seizures and sleep problems. It costs five times as much to care for these babies as it does to care for others, researchers have determined; drug-dependent newborns spend an average of 16 days in the hospital, compared to three for other babies. As well, some studies have found that babies affected by drugs grow up with a higher risk of developmental problems.

It’s important to note that a pregnant woman’s use of methadone and buprenorphine (the drugs affected by the Medicaid cap) also can cause babies to experience withdrawal symptoms.

But legitimately prescribed and managed by a physician, experts say, the anti-addiction medications can prevent much more serious consequences, such as premature labor and the death of the fetus, as well as allowing the fetus to reach a healthy birth weight.

Addiction is not a character defect; it is a disease. Limiting access to medical treatment for people addicted to drugs makes no more sense than limiting access to insulin for people with diabetes. And when the addicted patient is pregnant, the needless restrictions have consequences that play out over at least two generations. There is no place for these limits in an effective, humane addiction treatment strategy, and it’s time for the state to recognize this.

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