March 24, 2018
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Maine is losing the war against opioids. Here are 10 steps to turn it around.

George Danby | BDN
George Danby | BDN
By Janet Mills, Special to the BDN

As 2017 fades into the history books, the year will be remembered for many things: polarizing political debates over tax reform, immigration, education funding and health care; exciting economic opportunities across the state; and the opening of the Katahdin Woods and Waters National Monument.

One phenomenon that stands out, however, is the stranglehold the opioid epidemic has established in our beautiful state.

My office sees this epidemic in every aspect of our work — from child protection and child support matters to medical examiner’s cases, prosecution of traffickers, murderers, health care crimes and pharmaceutical diversion by medical professionals.

The plain facts:

In 2017, 952 drug-affected infants were born in Maine, according to the Department of Health and Human Services. In the last decade, 7,708 babies were born affected by drugs, 1,024 in 2016 alone, representing approximately 8 percent of all live births in Maine.

At least one person a day dies of a drug overdose, increasingly from heroin and fentanyl.

Two-thirds of the 368 drugged-driving traffic stops in 2016 tested positive for opioids, according to the Maine Health and Environmental Testing Lab: Analysis Maine Rural Drug and Alcohol Research Program at the University of Maine.

In 2015 an estimated 15,000 people received treatment for substance-use disorder in Maine, while another 25,000 could not get treatment because of a lack of capacity or lack of insurance.

There is no silver bullet to this complex problem, which is not simply a public safety or law enforcement matter, but a full-blown public health crisis that leaves thousands of children without a parent, communities devastated, employers without a healthy workforce, and families torn apart.

Here are 10 things we can do:

— First, target the areas with a high number of overdoses, hospital admissions and drug-related crimes, and provide them with additional medical and economic resources — an opioid version of Pine Tree Zones.

— Second, rein in prescribing practices that encourage addiction and put opioids in the hands of people who misuse and divert them. A new law to monitor and limit opioid prescriptions, proposed by the governor and enacted in 2016, is a good beginning, but analyzing prescribing trends and providing better training for prescribers will further reduce overprescribing and diversion.

— Third, make naloxone, also known as Narcan, available to every family and agency that needs it. The Maine Board of Pharmacy drafted regulations for over-the-counter naloxone; these rules should be promulgated and adopted.

— Fourth, establish an opioid emergency line — a 2-1-1 line on steroids — to provide accurate information and emergency referrals 24 hours a day.

— Fifth, lift the state’s two-year limit on methadone treatment for Medicaid patients and raise Medicaid reimbursement rates for treatment, which are unrealistic and unsupported by research.

— Sixth, expand drug courts and provide medication-assisted treatment and supportive services to participants. Along with prosecuting those who poison our communities, we must also provide help to users in the most effective way.

— Seventh, provide treatment slots and supportive therapy across the state, along the lines of Vermont’s “hub and spokes” model, providing a “hub” of medication treatment to reduce chemical dependency and “spokes” of primary care, intensive outpatient services, and assistance with housing, employment, and so on. We cannot treat the physiological symptoms without knowing the cause and treating the whole person and his or her family.

— Eighth, make recovery coaches available on call at every emergency room and clinic, and medication-assisted treatment available for every person with substance-use disorder, reducing the revolving door of overdose, revival and addiction.

— Ninth, expand the number of detox slots, recovery residence beds and peer recovery centers, especially in underserved areas, making sure there is always a window of hope.

— Tenth, provide prevention programs in our schools and communities, focusing on self-esteem and decision-making skills, starting in early childhood, and identifying and addressing “adverse childhood experiences” that contribute to substance-use disorders later. The Substance Abuse and Mental Health Services Administration has a registry of effective programs, and the National Institutes of Health has a summary of “life-skills trainings.” Look at what Iceland has done with its community programs for all ages, along the lines of L.L. Bean’s “Take it Outside” focus, markedly reducing their incidences of substance-use disorder.

What we are doing now is not winning this war. We must do more than “just say no.” The solution requires compassion, community, a change in culture and our full commitment as a state.

One more overdose is one too many. One more family torn asunder is one too many. One more orphaned child is one too many.

Let’s make 2018 a new beginning.

Janet Mills is the Maine attorney general and a member of the Task Force to Address the Opioid Crisis in the State of Maine and the Maine Opiate Collaborative.

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