There’s an old Indian parable that bubbles up in my mind anytime I read about policy-makers’ attempts to deal with Maine’s addiction epidemic. The title is “Blind Men and An Elephant,” and there are many versions.
The one I keep recalling is the Jain version. Six blind men are asked to describe an elephant. Each accurately describes the part of the elephant directly in front of him, but none are able to grasp the entirety of the animal. The parable is intended as a study of the nature of truth.
The leg: Prescription pills
Recent Maine legislatures started by working with the leg of the beast, prescription pill abuse.
Among other changes, restrictions have been placed on prescribing practices under Maine’s Medicaid program, MaineCare, especially regarding synthetic opiates. Our state now scores five out of 10 on a policy report card from the Trust for America’s Health, which looks at 10 strategies for combating prescription pill abuse. Expanding MaineCare would have given us a six.
A score of five out of 10 is evidence lawmakers could learn from the 34 states that score higher.
Policymakers could also learn about the nature of this epidemic from their own actions — and how restrictions alone do not address addiction. Restrictions on prescribed painkillers have been anecdotally linked to a correlating rise in heroin use. Decreased access to synthetic opiates may have created a void that heroin middle-men all over the eastern United States have been all too happy to fill.
Could they increase competition again if Gov. Paul LePage gets his way? Suboxone is a synthetic opiate combined with an opiate blocker that can be misappropriated for abuse. In his current budget proposal, LePage seeks to replace methadone — doses of which never physically leave the clinic until ingested — with Suboxone that can be prescribed in monthly amounts. He should understand that some small percentage of that Suboxone would end up on the street, and no amount of urinalysis would stop the misappropriation.
A passage from a report prepared by the State of Maine Judicial Branch and presented to the 125th Legislature in 2012 reads:
“A relatively small but increasing number of drug court participants diagnosed with opiate dependence is being prescribed Suboxone, a partial agonist medication used as a form of opiate replacement therapy. Although considered a valuable treatment for many, the criminal justice system is experiencing its increased diversion and illicit use and drug courts are wary about permitting its use. This is an expensive medication and is currently covered by MaineCare for those participants with this coverage.”
I’d love to fill this paragraph with other relevant citations, but there are no blue letters to click on to land in confidential areas of my personal and professional life. Like too many Mainers, I have seen firsthand that surviving and recovering from opiate addiction is a messy process.
When addicts are ready for recovery, access to opiate replacement can be a lifesaver. Some do better with methadone and others, Suboxone. Legislating what medication people should receive will undoubtedly have unintended consequences.
The tail: Heroin, meth
In case potentially increasing the street supply of Suboxone isn’t enough, Lepage is also gung-ho about beefing up the Maine Drug Enforcement Agency to stem the flow of heroin and methamphetamine in Maine. His budget proposal is chock full of silver bullets. Given the rise in meth production in Maine, well documented in this BDN article by Christopher Burns, more enforcement as part of a larger, comprehensive effort makes sense. But a comprehensive effort is not part of LePage’s proposal.
Controlling the supply side of heroin, though, is different from meth, and anyone familiar with the game Whack-a-mole can understand why. The heroin trade is a federal problem. Poppy, the plant from which natural opiates are derived, is not grown, cultivated, or processed here. It flows endlessly over the southern border of the United States and arrives in a variety of ways from the Middle East.
A fascinating article in The Economist even links our foreign policy to flourishing opium and heroin production and suggests that shifts in the international heroin market directly correlate with shifts in where U.S. military and covert operation dollars land.
If LePage would like to do something about the heroin supply in Maine, he should relentlessly petition the federal government and our congressional delegation to do something about heroin importation. He should symbolically propose a monthly bill for the federal negligence. The costs are incurred in our families and communities, our courts, our corrections system, our schools, and in every corner of our Department of Health and Human services; excepting emotional, the costs are easily quantifiable.
Until the feds do something, Maine will arrest and jail out-of-state drug runner after drug runner, also at Maine taxpayer expense. As long as heroin continues to flow over the U.S. border, there will always be a drug mule ready to make a run up 95 for a quick buck — like the gentleman from Methuen, Massachusetts, just arrested in Skowhegan.
He’s facing up to 30 years on heroin-related charges. He’s sitting in a cell here in Maine and can’t post bail, so Mainers pick up the tab. Whack. Whack. Whack.
The trunk: Criminalization
With LD 113, Sen. Roger Katz, R-Augusta, is standing at the trunk. He and his supporters, quite admirably and compassionately, are looking the epidemic in the eye and seeing a sentient being. However, they should be cautious about assuming the being will react they way they want it to. LD 113 would change the charge for possessing or trafficking certain drugs from a felony to a misdemeanor.
They are right: a felony charge is basically a life sentence for simply possessing a substance to which one is addicted. Further, jail is not an appropriate setting for a forced intervention with an addict who crosses paths with the legal system. Jails are for incarceration; addicts need detoxification, rehabilitation and recovery services.
As co-sponsor Rep. Mark Dion, D-Portland, said in an interview with MPBN, “If a jail bed costs $135 a day, that can buy a lot of treatment for many addicts.”
The problem is I’ve known quite a few opiate addicts — all wonderful people stricken by a horrible condition. I just can’t picture any of them — while in the deepest throes of their addiction — walking out of district court after a misdemeanor wrist slap thinking, “Thank goodness I didn’t go to jail. I think I’ll check into rehab or find outpatient services.” I mean, it’s possible but not necessarily likely.
One young addict with whom I worked needed a few stays in county jail before he decided to try recovery. Usually by the time he landed in jail, he was spinning out of control. I would have preferred his interactions with the legal system resulted in landing in a treatment setting.
The harsh reality, though, is jail is all we have right now. When this young man was in jail, his loved ones were not worrying about him overdosing, and he was not dealing drugs in small amounts to youth in his community. After a few stays, he finally decided that he didn’t want to go back.
Proverbial rock bottoms can be hard to find. In the case of extreme narcotic addiction, rock bottoms are often prompted by forced involvement with some larger system, even repeated forced involvement.
I’ve heard members of Narcotics Anonymous refer to the phrase, “jails, institutions, and death.” They are acknowledging the most likely outcomes should they succumb to their disease. They say the words knowing stays in jails and hospitals can eventually lead to recovery, but death is death.
Ideally, there should be something on the list besides traditional jails, like drug courts and alternative jail programs, which could be expanded and linked to changes in classifications of charges. Legislators would do well to look at the efficacy of and access to these existing programs before instituting changes to laws that may result in missed opportunities to intervene and save lives.
Maine has five county drug courts and one family drug court. These programs are a first step in the right direction and already produce lower recidivism rates than traditional adjudication for drug-related offenses.
Kennebec County Sheriff Randall Liberty’s alternative drug program at Kennebec County Jail is another innovative effort. In place since 2010, the program addresses the totality of addiction: not just the actual chemical addiction, but also the behaviors and thinking that are a part of the disease. Every time I read or hear about the program, I am moved by its compassion and comprehensiveness.
At the heart of the motivation behind Liberty’s Criminogenic Addiction Recovery Academy (CARA) is the moral to this story: Finding real solutions to this epidemic will require caring enough to understand of the whole truth of it.
Trish Callahan is a mother and writer who lives in Augusta and does consulting work for a local nonprofit. Her next piece will outline potential solutions for addressing Maine’s drug epidemic.
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