Maine, notorious in some circles for having given rise to a national epidemic of painkiller abuse and addiction, now officially tops the nation in the percentage of residents seeking treatment for addiction to prescription narcotics.
A recent report from the federal Substance Abuse and Mental Health Services Administration shows that since 1998, Mainers have consistently sought treatment for addiction to non-heroin opiates — such as the popular painkiller OxyContin — at rates significantly higher than in other states or in the nation as a whole.
State officials and others said Monday that the report reflects a reality they have acknowledged for years and underscores the need for continued collaboration between public and private agencies.
Released in December, the study shows that Maine has consistently topped other states in opiate treatment admissions. From just 28 Mainers per 100,000 total residents admitted for treatment in 1998, the rate has risen steadily to 386 admissions per 100,000 residents in 2008.
The national rate in 1998 was just nine per 100,000 and had risen to 45 per 100,000 in 2008.
New England states as a region have seen the highest rates of nonheroin opiate addiction admissions, with an admission rate of 131 individuals per 100,000 residents in 2008. Vermont and Rhode Island immediately trailed Maine that year, with 331 and 128 admissions per 100,000 residents, respectively.
Guy Cousins, director of the Maine Office of Substance Abuse, said Monday that Maine’s over-the-top ranking is not a surprise.
“We’ve been talking about this for quite a while,” he said. “This is a tide we have seen coming.”
Since the powerful synthetic opiate OxyContin hit the market in the early 2000s, the state has scrambled to counteract an epidemic of over-prescribing, abuse and addiction, Cousins said. The primary aim has been to reduce the widespread availability of illicit painkillers by educating doctors and others who prescribe powerful opiates and by encouraging the appropriate disposal of unused medications.
Maine’s online prescription drug monitoring program, established in 2004, tracks addictive prescriptions written by Maine physicians and other providers who are federally licensed to prescribe addictive medications. The system is designed to identify prescribers who write a lot of opiate orders as well as patients who may “doctor shop” or receive painkiller prescriptions from more than one prescriber.
About 35 percent of Maine’s 6,512 licensed prescribers participate in the voluntary program, Cousins said, although efforts are ongoing to increase that number.
State substance abuse officials also have partnered with law enforcement, private agencies and the medical community to promote local drug take-back programs that encourage consumers to get rid of unused drugs safely, as well as to promote alternatives to medication for managing chronic pain and other conditions.
The state also has supported the expansion of replacement-drug treatment services, including methadone clinics and the use of Suboxone, another opiate replacement drug, in local physician practices.
Despite this multipronged campaign, Cousins said, “at this point, prescription drugs are nearly as readily available as alcohol in Maine homes.”
Gordon Smith, executive vice president of the Maine Medical Association, said Monday that doctors are obligated to provide effective pain relief for their patients. But doctors also appreciate that there are ways to help patients other than by prescribing powerful opiates, he said.
The medical association is actively engaged in persuading physicians to take part in the state’s online prescription monitoring system, he said, but participation can be time-consuming and can feel intrusive to some prescribers.
The federal report comes as no surprise to Maine’s public safety community, said Roy McKinney, director of the Maine Drug Enforcement Agency.
“Opioids and narcotics are readily available in Maine,” he said.
The supply of illicit painkillers and other addictive medications is fueled by legitimate prescriptions written for patients whose drugs get diverted to other users from drug users and dealers who persuade well-meaning doctors to write prescriptions and from out-of-state dealers who smuggle drugs into the state knowing there is a steady demand here, McKinney said.
Last year, McKinney said, illicit prescription drugs accounted for 42 percent of drug arrests in Maine, compared to only 6 percent accounted for by heroin. Drug-seeking behaviors range from “doctor-shopping” to serious crimes including burglary, assault and homicide, McKinney said. McKinney said OxyContin was first identified as a serious public health threat in Washington County in 2000, heralding an epidemic of prescription drug abuse.
“Now, it has spread across the country,” he said.
Admissions and treatment data do not correlate directly with rates of abuse and addiction, but in conjunction with self-reported behavioral surveys, admissions data is used to estimate the demand for specific services.
Deb Dettor, coordinator of the Maine Alliance for Addiction Recovery, said growing rates of addiction reflect economic stress and other difficulties all across the country. Recent studies show that rates of prescription drug addiction have surpassed those of alcohol abuse, she said. But traditional treatment communities, including 12-step groups, have not changed to reflect the needs of people who are addicted to opiates, Dettor said.
It is essential that people seeking help for opiate addiction be provided a full range of services, Dettor said, including behavioral therapy and assistance with finding jobs and housing.
Cousins at the substance abuse office agrees. While much more needs to be done to prevent prescription abuse in Maine, he said, treatment and recovery programs also must be expanded throughout the state to provide a full range of recovery support.