PORTLAND, Maine — An expert on the state’s increasing problem with opioids said the problem is complex, and worse in Portland than the rest of the state.
“I’m urging you not to try and simplify it, because it is not simple,” Marcella Sorg told the Mayor’s Subcommittee on Substance Abuse on July 16.
A research associate professor at the University of Maine Margaret Chase Smith Policy Center in Orono, Sorg has been reviewing overdose data provided by the state Office of the Chief Medical Examiner since 1997.
A broad picture shows the increase in overdose deaths is dramatic, but not as severe as imagined, Sorg, who has a doctorate in forensic anthropology, said.
“If you think we have a problem, Maine is not as bad as you think,” she said, noting West Virginia, with a similar population and demographics, has a far larger problem.
Yet the city and Cumberland County are harder hit than the rest of the state in the proportion of overdose deaths in the last five years.
“We really haven’t had Portland- or Cumberland County-specific data,” Mayor Michael Brennan said. And Sorg cautioned against using overdose deaths to fully measure the addiction problems and how to combat them.
“It is just the tip of the iceberg,” she said. “Whether (an overdose) ends up in a death depends on so many different things.”
It is an expanding iceberg, according to state data.
The number of overdose deaths in Maine increased 18 percent from 176 in 2013 to 208 in 2014. When Sorg began compiling data, 34 overdose deaths were reported.
Overall, the deaths recorded are of varied ages, with 38 to 40 the average age.
Cumberland County contains 21 percent of the state’s population, according to the 2010 U.S. Census. Based on where the deaths occurred, Sorg’s data through 2014 shows the city and county recorded 21 percent of the state overdose deaths and 22 percent of overdose deaths due to at least one pharmaceutical opioid, such as oxycodone or methadone.
When measuring deaths caused by illicit drugs including heroin or cocaine, the percentage increased to 33 percent, Sorg said.
Measured in terms of deaths per 100,000, the area rate is 16.3 for the city and county, versus 13.73 in the state from 2012 through 2014. Averages measured from 2009 to 2011 put the ratios much closer, at about 13 per 100,000 in the state and region.
“If I were to use just Portland,” Sorg said, “we’d be in worse shape.”
Statewide crime statistics released July 21 by the state Department of Public Safety revealed a 15 percent decrease in crime overall, with the exception of arrests for drug offenses, which increased by 200 to 5,800.
Portland police reported the number of overdose calls for the first six months of 2015 increased by one from the same period in 2014, but the 155 recorded calls are a 15 percent increase from the first half of 2013.
Exact causes of overdose deaths can be hard to determine, Sorg said, because medical examiners record traces of almost everything found in the bloodstream.
“We almost never see a death with one drug. You are not going to get a ‘smoking gun’ with the drugs,” she said.
Increasingly in the mix is fentanyl, an opioid that had been mixed with heroin, but is now frequently sold on its own to unsuspecting users. Overdose deaths with fentanyl as a sole or contributing cause have gone from around 10 in 2009 to more than 40 alone, and more than 50 in combination, last year.
“It is not pharmaceutical fentanyl, it is being made in clandestine labs,” Sorg said.
The increase in overdose death alone will not help the city obtain grants to fight addiction problems, Sorg said.
“We have a problem doing anything meaningful with these statistical numbers,” she said. “I strongly recommend you present this whole context.”
She suggested a broader approach, including getting as much information as possible from people enrolled in the city needle exchange, more attention to gang activities, and access to Narcolex, which blocks and reverses the effects of opioids in the body.
“You need a package that includes strong law enforcement, strong public health programs that include harm reduction, because we do know that works, and an emphasis on the need for treatment,” Sorg said. “We still have a societal problem where drug abusers are seen as throwaway people.”