DOVER-FOXCROFT, Maine — The dour economy and the high unemployment rate in Piscataquis and Washington counties have pushed the rural areas to the top of the state list for street sales of both prescription and illegal drugs, say law enforcement and medical officials.
Deaths and near-deaths from unintentional drug overdoses, either the misuse of prescription drugs or a combination of prescription drugs and illicit drugs, are of great concern in both counties.
Two Milo residents have died from drug overdoses and two other Piscataquis County residents narrowly escaped death from overdoses in recent weeks.
‘’We have a significant drug problem,’’ Dave Wilson, Piscataquis County’s drug recognition expert, said this week in an interview. Wilson, who is stationed in the Dover-Foxcroft Police Department, said he recently was able to bring the first conviction in the state of a motorist who was driving while under the influence of Spice, a synthetic drug often referred to as “fake pot.”.
‘’The drug problem is here, it’s here to stay, and it’s going to take a collaborative effort between citizens, law enforcement and the medical community to make a change,’’ Wilson said.
What is especially troubling in both counties is that the poor economy and lack of jobs have prompted some residents, including senior citizens, to sell some of their prescription drugs to bring in extra income.
When Wilson speaks before medical groups, participants are flabbergasted that undercover police have been able to purchase a variety of prescription drugs — including Percocet, Vicodin, Ritalin, methadone, and suboxone — on the streets, he said. ‘’They are easier to obtain than illicit drugs and they are paid for by the state,’’ he said.
The availability of these prescribed opiates is directly related to the fact that medical professionals are overprescribing them ‘’at an alarming rate,’’ said Washington County Sheriff Donnie Smith. The most prescriptions written for opiates in the state in 2010 were in Washington County, he said this week.
‘’If you have that amount of medication out in the public, there’s a lot of opportunity for diversion,’’ Smith said. ‘’’What I see, hands down, is we have overprescribing. In Washington County, only 19 percent of the providers participate in the state prescription monitoring program, so that tells you something.’’
That state monitoring program has been a great tool for providers in Mayo Regional Hospital’s emergency room, according to Dr. David McDermott, the Dover-Foxcroft hospital’s emergency room director. The online program offered by the Maine Office of Substance Abuse provides information on prescriptions for controlled substances filled at all Maine pharmacies. Medical providers and pharmacists who are registered with the database can obtain a patient’s prescription history for controlled substances over about a six-year period, according to McDermott.
If a patient walks into an emergency room citing pain and the providers have no history with the patient, the report provides valuable data, McDermott said. There have been patients citing pain who have told providers they have not taken any controlled substances. Yet the online data show that in the last six months, the patients may have gotten 15 different prescriptions for six different pain medicines from 12 different physicians that were filled in three different pharmacies and that some were paid for with cash and others were paid through insurance plans, he said.
‘’Those are all red flags for drug-seeking and drug-diverting behavior, and if we’re armed with that knowledge before we go in and talk with the patient, it helps us listen more carefully to the stories that they give us and it helps us be more cognizant of what we might be doing if we’re prescribing for them,’’ McDermott said.
The deaths from drug abuse are startling, McDermott said during a recent interview. Between six and 10 people, typically under the age of 40, die each year in his hospital’s emergency room as a consequence of abusing prescription drugs or overdosing on drugs that were not prescribed to them, he said. These people were not suicidal; they were using drugs recreationally and ended up dying, McDermott added. ‘’There’s a large number of people who think, ‘Well, if it’s a prescription drug it’s safe,’ and it’s a false sense of security they get from that,’’ McDermott said.
Wilson said that false security also involves new concoctions that mimic actual drugs. The problem is that these substances still have dangerous ingredients that are causing impairment, such as Spice, which mimics the effects of marijuana without the actual ingredients.
Guy Cousins, director of the Maine Office of Substance Abuse, said this week that the prescription drug abuse crisis is a community problem needing a community solution.
‘’We need to work diligently at educating people of the risks and dangers of nonmedical use of prescription drugs,’’ he said.
The state-initiated annual collection of unused and outdated prescription drugs is making a difference in reducing the amount of drugs on the streets, Cousins said, but more work is needed to educate medical providers about responsible narcotic and opioid prescribing practices.
Recognizing the ‘’fairly big’’ problem with drugs, in particular the misuse of prescription drugs in Piscataquis County, Mayo formed a task force and invited law enforcement to participate. The sessions have been eye-openers, according to McDermott. He said Maine Drug Enforcement Agency officials advised providers that a current trend is for people to drive to Florida, where they can obtain controlled pain substances from that state’s many pain management clinics, and then they return home and sell the drugs on the street.
Mayo’s providers also have come to recognize that some of the medications on the street have been diverted from prescriptions they wrote for what they believed was legitimate pain, according to McDermott. The task force was started to help providers better understand the problem.
The biggest fruit from this local effort has been the “diversion alerts” that are patterned after a similar effort in Waterville, McDermott said. The MDEA provides prescribers a monthly report with information about every person in the area who has been charged with a drug-related offense.
Because of patient confidentiality, doctors are not allowed to talk about specific cases to police, but the creation of the task force has opened the door for police to call providers and let them know when they find prescriptions written to patients that have been diverted into the community, according to McDermott.
That effort is working well, according to Lt. Robert Young of the Piscataquis County Sheriff’s Department. When county officers find someone is abusing a prescription drug by snorting it or selling it, the providers are notified. ‘’I think it’s a good step in trying to get a handle on the prescription drug problem,’’ he said.
Through this give and take, providers also learn of the hot spots for drug activity, one of which is in the Milo region, according to McDermott and police.
‘’I think that the Milo area just seems to be saturated. [The drug problem is] very prevalent in the Milo area,’’ Young said. Prescription drug misuse tops the list of substance abuse issues in that area, he added.
Society has got to figure out why young people feel compelled to experiment with dangerous drugs, said Young, who believes culture and family life play a role in the problem. In the Milo area in particular, police deal with parents and grandparents of the same family who are involved in drugs, he said. ‘’You see that drug abuse being learned or passed off through generations. It’s very common you see that connection. Breaking that is hard.’’
Milo Police Chief Kenny Williams agrees. He also believes that the drug problem in his community stems from a combination of issues, but low incomes and the lack of jobs are high on the list. He believes some residents shop for doctors in order to get drugs to sell on the street to supplement their incomes.
His department has been working closely with the MDEA to help curb the illegal activity. In addition, he said a federal drug enforcement agent has expressed an interest in working in the Milo area.
‘’Prescription drugs overall is our biggest problem, but there are other drugs, like cocaine and that kind of stuff, that is also in all areas of the county and state,’’ Williams said. An offshoot of the drug problem is the other crimes it brings with it, such as robberies and burglaries, he said.
Those problems also plague Washington County, according to Sheriff Smith. He said there have been four home invasions since September and most were drug-related. Emphazing the role overprescribing has on the drug problem, Smith said that in one of the home invasions, the resident had been prescribed enough Dilaudid, a hydromorphone, in one month that it would have fetched about $24,000 on the street.
‘’We’re chasing our tails most of the time. It’s a vicious circle. You could put a drug dealer out of business in Washington and Piscataquis counties or any county today, and three or four more would take their place by tomorrow,’’ Smith said.
‘’I think substance abuse education should be taught in schools K through college,’’ Smith said.
By the time law enforcement becomes involved, a crime has already been committed, but the substance abuse came first.
In any given day, Smith said about 50 inmates in his jail are there for some type of substance-related crime. When mental health funding is reduced, the jail population increases, he said. Officers in his county also see people self-medicating since they can’t afford treatment. ‘’‘Wherever you see a rural poor community, you see a very high volume of prescription drug abuse,” Smith said.
‘’Putting these drug cases together is like a jigsaw puzzle,’’ Young said. ‘’You take pieces of information that you have, and oftentimes a single piece of information doesn’t give you any legal footwork to do anything. But as people provide the information they know law enforcement can put those pieces together and make a case out of it.’’
‘’If we had in Piscataquis County 10 gang-related shootings every year, we would as a community be very worried about that and probably would change our approach to that,’’ McDermott said. ‘’Our research allocation for law enforcement would change and the priorities of the communities would change. It would fundamentally alter how we view the security and comfort of our community. And yet we have six to 10 people a year dying of inadvertent overdoses of prescription drugs. I just don’t see that that’s raised the alarm bells in the community.’’