New laws aimed at opioid epidemic survive governor's veto

By Scott Thistle, Portland Press Herald | Jul 16, 2018
Portland paramedics respond to a call of a heroin overdose on Congress Street near the intersection of India Street. The 29-year-old woman was found unconscious by a passerby after she had injected herself with a quarter-gram of heroin. Portland Press Herald staff photo by Derek Davis

After two years of virtually no progress, the most recent session of the Legislature finally produced what treatment advocates regard as meaningful responses to Maine’s epidemic of opioid abuse.

Three new laws moved forward earlier this month, despite veto attempts by Republican Gov. Paul LePage.

The first funds the creation of a so-called $6.6 million “hub-and-spoke” initiative to align treatment and recovery programs to ensure that fewer people who need help slip through the cracks or relapse without intervention.

The money in the legislation helps pay for medication-assisted treatment – such as methadone and Suboxone – for the uninsured, who are the most likely to lack access to treatment. Some 400 to 500 people will gain assistance.

Also approved over LePage’s veto was a $75,000 needle-exchange program, part of a harm-reduction strategy that is meant not only to help stop the spread of infectious diseases such as hepatitis C and HIV, but also to create new access points for entry to treatment and recovery programs.

The Legislature also approved funding for an expansion of the state’s drug court, which steers offenders into treatment programs and now operates in five of the 16 counties.

“I’m much happier with this immediate past session than I was a year ago – definitely,” said Malory Shaughnessy, executive director of the Alliance for Addiction and Mental Health Services in Maine. “Do we have farther to go? Definitely.”

The alliance includes 35 state-licensed substance use disorder and mental health treatment agencies that serve about 90,000 clients each year. It was one of dozens of organizations and individuals that have been pushing for legislative action.

 

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Shaughnessy; Rep. Jay McCreight, D-Harpswell, who co-chaired a special legislative task force on the opioid crisis; and others acknowledged that the legislation could help hundreds of people each year. However, they said those numbers pale in comparison to how many people could be helped if Medicaid is expanded.

LePage is currently appealing a Kennebec County Superior Court order that he submit an expansion plan to the federal government, which would make another 70,000 to 80,000 people eligible for health insurance. LePage argues that the state does not have the money to cover its share of the expansion, estimated at between $30 million and $60 million annually.

“Medicaid expansion is the big one,” McCreight said. “It would save a lot of lives and not just for opioids.”

The state’s largest needle-exchange program – in Portland and run by the city – distributes and collects 180,000 syringes each year. The exchange also distributed 3,000 doses of the overdose antidote naloxone in 2017. Those doses were used to save 275 lives, according to legislative testimony from Zoe Odlin-Platz, Portland’s community health promotion specialist.

“Ensuring proper disposal for used needles, access to testing for HIV, hepatitis C and STDs, referrals and support help to build foundations of trust,” she told lawmakers in January. “From trust can come positive change like recovery.”

In his veto letter on the needle-exchange bill, LePage wrote, “I do not believe it is the government’s responsibility to ensure that we provide the safest possible path for a person to participate in dangerous, destructive and deadly behavior.”

He said he was working with the Maine Department of Health and Human Services to “make it a priority to invest in evidence-based treatment options that will produce the best outcomes for individuals dealing with addiction.”

But in the debate on the needle-exchange override vote, lawmakers pointed out that the cost of treating one case of hepatitis C can easily exceed $80,000 – more than the total appropriation for the exchange program.

Rep. Karen Vachon, R-Scarborough, a sponsor of both the hub-and-spoke bill and the needle-exchange bill, said she has faced resistance from her more conservative colleagues but that mindsets in the Legislature are steadily changing.

“When people are dying, you are always thinking, ‘My gosh, we are not doing enough?’ ” Vachon said. “And is what we are doing even right? Is it working? … And can we possibly be doing more? But we have made some progress.”

The drug court bill provides access to treatment for defendants who have either pleaded guilty or been found guilty of serious offenses that were drug- or alcohol-related. Once admitted to the court, participants are required to meet with the presiding judicial officer every week and maintain regular contact with their case managers and probation officers.

They must also maintain a job, attend school or perform community service; maintain stable and sober housing; undergo frequent and random drug and alcohol tests; and participate in treatment or self-help groups. In place since 2001, the courts have proved to help dramatically lower the recidivism rates and enhance the chance for recovery.

Leigh Saufley, chief justice of the Maine Supreme Judicial Court, proposed the drug court expansion, with LePage’s support, in an address to the Legislature in February.

After 376 Mainers died from drug overdoses in 2016, the Legislature grappled with policy solutions to stem the tide of addiction and death, but ultimately failed to produce any substantial solutions. The few laws it did manage to pass, including one that made the overdose antidote naloxone available without a prescription, were either stalled or delayed by LePage’s administration – and in 2017 Maine set a new grim record for opioid overdose deaths at 418.

In the last few weeks, lawmakers, acting largely on bills that were recommendations from a special legislative task force on the crisis, have made more progress than they did in the previous two years.

Shaughnessy, the director of the association of treatment providers, said there are concerns that the LePage administration will not move quickly to put policies in place for laws enacted in the recent session.

LePage managed to delay the law expanding access to naloxone for nearly two years by using administrative means to slow down the rulemaking process before the Board of Pharmacy.

“It’s a travesty, what we have seen,” Shaughnessy said. “Efforts by the provider community and efforts by the recovery community and efforts by the Legislature to push things through, to get pieces pulled together to provide more coverage, to provide more treatment, to provide more recovery resources, and we’ve seen the administration just stymie it in every direction.”

McCreight, the Harpswell lawmaker who chaired the opioid task force, said no new legislation is likely on the drug crisis before next year, when a newly elected Legislature is seated.

She said the task force, now disbanded, focused on the three pillars of prevention, treatment and law enforcement, and made recommendations to the various legislative committees of jurisdiction. Those panels voted out a number of bills, but many that were passed on the floor of the Legislature ended with vetoes from LePage.

“Everything that passed in special session was because of an override of the veto,” McCreight said. “But because we didn’t get everything, we are missing some important pieces of that comprehensive approach. Piecemeal isn’t going to give us the results that we need to really address the epidemic.”

She said one of the best results of the task force is that it helped lawmakers and others involved gain a better understanding of substance use disorders, and that’s changing attitudes and helping build support.

“If people understand the brain mechanics, they understand we are talking about a disease process, or certainly a biosocial, psychological issue – and it’s not a moral failing,” she said.

Vachon, the Republican legislator, agrees that education and building understanding are key to gaining the political support needed to advance the programs that will make the biggest difference in Maine. She is now trying to organize an “opioid tour” to help politicians in Maine get a better and deeper understanding of the depth of the crisis and its complexity.

She offers an example of one young man in recovery who spent time meeting with lawmakers, including some key Republican leaders, and she credits him with changing hearts and minds.

“With medicated-assisted therapy, people can get back to work and get their life back on track, and if you look at this young man you can see that,” Vachon said. “A lot of times, people think of people with substance use disorders as junkies in the alley, and it’s way more than that.”

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