Public health professionals struggle to bridge the divide between research and the implementation of evidence-based policy. With regard to the opioid epidemic, this divide is exceptionally clear. The opioid epidemic continues to prey on our most vulnerable populations, and yet there is persistent reluctance among the Legislature to accept much-needed policy changes.
At the heart of this public health crisis are policy barriers that hinder access to recovery supports and harm reduction services.
These services, such as syringe exchange programs, have been shown to reduce the incidence of drug poisoning, infection, risky injection practices and injection drug use itself; they benefit individuals struggling with substance use disorder and improve the health and safety of their surrounding communities.
In January, the Maine Coalition for Sensible Drug Policy released a report detailing 18 specific and comprehensive recommendations to address the opioid crisis. All thoroughly backed by public health research, these recommendations address primary prevention, harm reduction, recovery, treatment and anti-discrimination for people with substance use disorder. The coalition’s intensive report helped to inform a bill that recently passed through the Legislature but was held over for a lack of funding: LD 1689, An Act to Address the Opioid Crisis through Evidence-based Public Health Policy.
LD 1689 would have expanded access and funding for syringe exchange programs throughout the state, and decriminalized the possession of more than 11 hypodermic syringes. This legal restriction prevents syringe exchange programs from operating without certification under the Maine Center for Disease Control’s Hypodermic Apparatus Exchange Program.
Currently, there are only five active syringe exchanges operating under the state’s certified program, most of which are isolated to coastal areas. These five syringe exchanges do not provide adequate care to those in need, and they leave the majority of Mainers without access to their valuable services. The overdose mortality rate decreased in 2018. This is likely due in large part to Maine’s robust network of unsanctioned, peer-run exchanges.
As the bill made its way through the Legislature, vital measures to protect public health were removed, including the subsection that decriminalizes possession of more than 11 syringes. Not only did the Committee on Health and Human Services blatantly ignore the evidence of public health research, but they also allowed the doctrine of stigma to speak louder than life-saving policy implementation. The first regular session of the 129th Legislature adjourned on June 20, leaving LD 1689 without funding, waiting to be reassessed in January.
One month into her term as governor, Janet Mills signed an executive order to “Implement Immediate Responses to Maine’s Opioid Epidemic.” Failure to implement critical, life-saving policy is not aligned with the goal of “immediate” response. Bills that are grounded in solid population health research need to be prioritized. The Mills administration has taken important steps to combat the epidemic, such as expanding access to naloxone and enacting an overdose prevention Good Samaritan law. However, the potential impact of these steps is small in contrast to the drastic policy change that LD 1689 would have provided.
On July 15, Mills will hold the 2019 Opioid Summit in Augusta bringing together policy makers and keynote speaker and author Sam Quinones to discuss issues of recovery, law enforcement, and community support strategies. While the summit will undoubtedly garner input on solutions for the ongoing crisis, it also highlights the discrepancy between the narrative of the Mills administration and the lack of sufficient policy change. This summit presents an opportunity for Maine legislators and community members to fully embrace evidence-based, harm reduction policy implementation, and to effect meaningful change that is long overdue.
Louisa Munk is a public health student and graduate fellow for the Scholars Strategy Network, Maine Chapter at the University of Southern Maine. This column reflects her views and expertise and does not speak on behalf of the university. She is a member of the Maine chapter of the national Scholars Strategy Network, which brings together scholars across the country to address public challenges and their policy implications. Members’ columns appear in the BDN every other week.