Amid positive developments in drug crisis, state must do more

Jan 30, 2020

The report from Maine’s chief medical examiner was disappointing but should not have been a surprise for anyone who has been living through the opioid epidemic.

Overdose deaths appear to be on the rise again after a slight decline in 2018 that gave the false impression that the crisis was subsiding.

But according to the state, 277 people lost their lives to drug overdose deaths in the first nine months of 2019, putting Maine on track for 369 deaths for the year, which would be a 4% increase over 2018. The vast majority of the deaths were classified as accidental, as opposed to suicide, and 84% of the time, an opioid drug was involved.

These numbers should make clear to the public that the crisis has not lifted and Maine should not lose focus on it. After wasted years in Augusta that allowed opioid dependence to take hold in every corner of the state, Maine is finally doing the right things to contain and treat this disease. We are just not doing enough of them.

In a briefing for lawmakers earlier this month, Gordon Smith, Maine’s director of opioid response, said there have been a number of positive developments over the last year.

Medicaid expansion has provided 5,000 people with access to medication-assisted treatment, and more than half of the state’s hospitals now offer that medication on essentially a walk-in basis.

The Mills administration has pushed to make the overdose antidote naloxone, often known by its brand name Narcan, more available to the police and the general public, even though some police departments still refuse to allow their officers to carry the medication, Smith said.

And he highlighted a $2 million effort to expand needle exchange programs, noting that they help guard against the spread of infectious diseases like hepatitis C and HIV while serving as an access point for people seeking treatment and recovery.

But there are still gaps in the state’s program.

Maine can’t meet the demand for housing, counseling, coaching and other support services that are critical to the long-term recovery process once people obtain access to treatment. His office has between $6 million and $7 million in combined state, federal and philanthropic funds, but it’s not enough to reach all the people who are affected by opioid use, of which the number of people who die by overdose represents a small fraction.

Another measure of the problem is the number of children who were taken into state custody last year. Smith told legislators that 51% of the 1,322 children in state care came from homes where parents had substance use disorders. Of these approximately 674 children, 20% were drug-affected newborns.

What should the state be doing? More.

The Legislature is considering bills this session that would expand treatment. One measure would remove the requirement in the state’s Medicaid law requiring pre-authorization for substance use disorder treatment, and the other would set up a $1 million fund for the treatment of pregnant women who suffer from substance use disorders.

Maine should also become a leader in the use of harm reduction. If clean needles and naloxone will keep people alive until they are ready for treatment, they should be widely available. And if, as research suggests, safe-injection sites offer a way to reduce overdose deaths as well as create an outreach opportunity for treatment, we should not let the misguided fears about encouraging drug use get in the way. Such sites are illegal in Maine, and that should change.

Maine is still in the grip of a drug use epidemic that has been building for years and that won’t go away on its own. The latest overdose numbers should offer a stern reminder that it’s too soon to declare victory.

Reprinted with permission from The Portland Press Herald

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