Drug addiction is a struggle, not only for people with addictions and their families, but for the community at large that deals with the consequences: death, crime, lost opportunity and overburdened social support services. The story of Garrett Brown shows these consequences in stark relief and highlights the shortcomings of how Maine has handled the addiction epidemic.
Earlier this year, lawmakers in Augusta came together to pass a $3.7 million plan to bolster treatment capacity and drug enforcement. Lawmakers continue to debate several other proposals to combat the drug epidemic.
There’s no silver bullet for stopping the epidemic in its tracks, but here are three strategies lawmakers have proposed.
Improve affordable access to medication-assisted treatment.
Although Maine has seen the number of people seeking treatment for heroin and opioid addiction climb steadily since 2010, it’s still uncommon for a Mainer suffering from opioid addiction to seek help, according to a 2015 report by the Office of Substance Abuse and Mental Health Services.
The treatment method generally considered most effective for dealing with addiction — methadone coupled with individual or group counseling — is out of reach for many afflicted with an opioid addiction.
One factor limiting access to methadone treatment is that the state has slashed the reimbursement rates MaineCare pays methadone clinics to cover their costs, Guy Cousins, the former director of Maine’s Office of Substance Abuse and Mental Health Services, told the Legislature’s Health and Human Services Committee on Jan. 28.
“The rate reduction created a number of different challenges for the opioid treatment programs that significantly altered and affected treatment services for the individuals who sought help for their opioid addiction,” Cousins said.
When Maine’s first methadone clinic opened in 1995, the reimbursement rate from MaineCare was $80 per week per patient. (Adjusted for inflation, this would equal $124.37 today.) This covered daily medication, monthly counseling, random drug screening, case management and administrative work.
According to research conducted by the National Institute on Drug Abuse, methadone treatment for addiction should cost about $143 per week. But MaineCare reimbursement for that same level of service has been cut to $60 per week per patient — one of the lowest rates in the nation.
As a result, clinics have fewer staffers who are handling more patients, Cousins said. The patient-to-counselor ratio before the rate cut was 50 to one; today, it is 150 to one. The reimbursement reduction, coupled with higher patient-to-counselor ratios, has led to a greater turnover at clinics, reducing their ability to provide the counseling needed.
Last August, a methadone clinic in Sanford that served about 100 patients closed its doors, citing low reimbursement from MaineCare.
A bill, LD 1473, sponsored by Sen. David Woodsome, R-North Waterboro, would raise the MaineCare reimbursement rate for methadone-assisted treatment from $60 to $80 per week per patient. The Department of Health and Human Services Committee on Wednesday unanimously approved a modified version of the bill — raising the rate to $72. The legislation awaits action in the House and Senate.
“We can make a difference in our addiction crisis and in people’s lives by funding effective treatment and ensuring that people have access to that treatment,” Woodsome told the committee in January.
Take advantage of naloxone to save lives.
In the first nine months of 2015, 174 Mainers died from drug overdoses, and the Maine attorney general’s office estimates the final death toll for 2015 to number between 230 and 250.
As the death toll from overdoses rises, lawmakers in Maine and across the country have pushed to put the overdose antidote naloxone into the hands of police officers and other first responders.
Paramedics across the state last year administered more than 1,500 doses of naloxone, up from 659 in 2012, according to Maine Emergency Medical Services, a unit of the Maine Department of Public Safety.
Last year, lawmakers pushed successfully to allow the family and friends of people at risk of an overdose to get a naloxone prescription so they can administer the antidote.
Now, lawmakers want to let pharmacists furnish naloxone over the counter. A bill, LD 1547, sponsored by Rep. Sara Gideon, D-Freeport, would grant the Maine boards of pharmacy and medicine the authority to establish procedures and protocols governing the furnishing of naloxone. Under Maine law, naloxone cannot be acquired without a prescription.
Gideon proposed the bill after representatives from CVS Health reached out to her about the need for legislation to allow pharmacists to dispense the life-saving medication without a doctor’s prescription. On Feb. 3, U.S. Sen. Angus King, I-Maine, sent a letter to CVS, responding to its announcement that naloxone would be available over the counter in Ohio pharmacies, asking the company to consider expanding this program to its 22 stores in Maine.
CVS already allows pharmacists in more than a dozen states, including Rhode Island and Massachusetts, to dispense naloxone without a prescription.
Let police ‘LEAD’ the way to recovery.
With drug-related deaths and arrests on the rise, police, mayors and health care professionals urged lawmakers last week to fund a program to divert drug offenders from jails and courts into treatment and recovery programs to break the cycle of addiction.
The proposal lawmakers are considering would create eight pilot projects across the state based on the law enforcement assisted diversion, or LEAD, program model in which people arrested on low-level drug offenses are given the chance to enter treatment for addiction instead of a jail cell.
A bill, LD 1488, sponsored by Rep. Mark Dion, D-Portland, would give $2 million in funding to these pilots. It also would require the communities in which they are located to track participants’ progress and report their findings to the Legislature.
“We are not advocating for ignoring criminal behaviors; however, we are advocating for removing the stigma associated with addiction and recognizing that people in active recovery are healthy productive citizens who have much to offer,” Brewer police Chief Perry Antone told the Judiciary Committee on Feb. 18.
Already, the LEAD program in Seattle, which started in 2011, has shown promise for reducing the likelihood that someone with an addiction will get trapped within the criminal-justice system. A University of Washington study released last year found that participants in Seattle’s LEAD program were 58 percent less likely to be arrested on a new offense and were 39 percent less likely to be charged with a felony compared with offenders not in the program.
In addition to diverting them into treatment and counseling, the Seattle LEAD program helps people with addictions locate housing, get job training and find health care.
Another approach Maine police departments are taking follows the lead of the Angel initiative in Gloucester, Massachusetts. Under this model, people who turn themselves in at a local police station and surrender their drugs and paraphernalia need not fear arrest, and police will work to place them in treatment.
The Scarborough Police Department in October launched Operation HOPE, modeled after the Angel initiative, which placed 120 Mainers in treatment programs in nine states between Oct. 1, 2015, and Feb. 18 — from here in Maine to as far away as California and Florida.
Nearly three-quarters of all participants receive treatment out of state because of a limited treatment capacity in Maine, Officer James Gill said.
It’s not clear yet whether the HOPE model used in Maine and other states, most of which are in their first year, have been effective at breaking the cycle of addiction. But Gill and other law enforcement officials recognize a new approach is needed to address the drug addiction epidemic.
“While we in law enforcement witness the toll heroin and opiate use takes on our communities, Operation HOPE has served to put the problem into the public eye and help foster a public dialogue about the situation,” Gill said. “Operation HOPE has helped demonstrate the full extent of Maine’s heroin and opiate epidemic, the desperation of people suffering from addiction and the lack of an effective response or strategy to deal with this crisis by government and political leaders.”
Correction: An earlier version of this report contained an error. It is James Gill, not John.