Leaders from across the political spectrum are taking the state’s drug epidemic more seriously than ever before, and rightfully so. According to Maine Attorney General Janet Mills, more than five deaths per week in our state are attributable to heroin and other opioids.
Counties and municipalities are stretched beyond their breaking points. Consider this: According to Penobscot County Sheriff Troy Morton, the Penobscot County jail is built to hold 157 inmates but as recently as December was responsible for 290. All low-level offenders have been released. Calls for service to the Bangor Fire Department are up 41 percent since 2009, a jump that is largely attributable to the challenges of substance abuse and inadequate mental health care and housing.
In 2014, the Bangor City Council charged a group of health care professionals, law enforcement officials, business leaders, clergy and other interested community members with the responsibility of studying the complex questions of substance abuse, addiction and recovery. We asked the group to propose recommendations that could be implemented locally. The final recommendations, many of which are applicable on a broader scale, offer a roadmap forward.
The group was successful, in part, because it was insulated from politics. With no entrenched party interests, outside lobbying, or political scoreboard, experts in a variety of fields were able to share diverse points of views backed up by data, reason, thoughtfulness and professional experience.
What did the group learn?
First, reversing our drug crisis begins with prevention. Many people who become addicted to painkillers do so after receiving medications for routine medical procedures. Dr. Noah Nesin, Chief Medical Officer at Penobscot Community Health Care, recently reported that Penobscot County residents are prescribed on average 63 pain pills per year on a per-capita basis, which is extraordinarily high. The recommendation from the working group is to have a communitywide opioid prescribing protocol that would lower overall prescription levels and divert people into alternative treatment options. These protocols should include dentists, oral surgeons and anyone who routinely prescribes painkillers.
Best practices should also be adopted with methadone and Suboxone to ensure the lowest possible dosages of medication. These treatment options should be combined with more comprehensive counseling. Currently the ratio of people in treatment to counselors in the state of Maine is 150:1; the working group has recommended the ratio should be at least as low at 50:1.
Second, the group has recommended we open a community-based detox center. Emergency rooms and jails are not the most appropriate places to bring someone who is addicted, and doing so diverts resources from people who actually need to be there. Counties and municipalities simply do not have the resources to build detox centers, however, so support would have to come from the state and federal governments.
Third, sober housing should be constructed in communities throughout the region with “contracts of accountability” that stipulate that housing is contingent upon sober living. Residents who are in recovery and who want to get better must be supported with further counseling, life-training skills and guidance on health and well-being.
Fourth, a drug court should be re-established in Bangor to divert low-level drug users to treatment and counseling instead of jail. Criminal drug-seeking behavior and drug dealing should, of course, still be rigorously prosecuted, but the criminalization of addiction is partly why the jails are so full.
Fifth, the group has recommended we increase access to health services through MaineCare expansion. Simply put, if treatment and counseling cannot be afforded, they will not take place.
More broadly speaking, the group recognizes the need to reduce the adverse childhood experiences that frequently are correlated with high levels of substance abuse later in life by better supporting and nurturing the development of children from ages zero to five.
This overall roadmap includes actionable recommendations on prevention, education, treatment, enforcement and recovery. It will require the commitment of energy and resources to all five areas and abstaining from the emphasis of one area at the expense of another.
There is much to be proud of in Greater Bangor. But Brewer Mayor Bev Uhlenhake summed it up best at a recent event, saying, “We all must adopt this as our personal issue because this is the issue that threatens to undermine all the progress we have made.” The communities of Bangor and Brewer stand united and are ready to move forward using the recommendations provided to us by experts in the field. The full report, which contains additional recommendations beyond those discussed here, can be viewed on the City of Bangor website. It should be required reading throughout the state.
Ben Sprague is a Bangor City Councilor and a member of the Eastern Maine Medical Center Board of Trustees.