Drug addiction specialists and advocates for treatment programs are criticizing the Legislature for, once again, failing to take any major steps to address Maine’s opioid crisis despite record-setting death tolls caused by overdoses in the state.
But lawmakers and some advocates said they hope a few key opioid-related measures can be salvaged from the political fires consuming the State House when the Legislature returns for an extended veto day or a special session later this spring.
Partisan disagreements over Medicaid expansion and tax cuts derailed work in the final days of the 2018 legislative session, leaving several bills related to the opiate crisis as well as more than 120 others stranded in the budget-writing committee. Although a last-minute maneuver kept those bills alive at least temporarily, it’s unclear whether lawmakers will be able to agree to fund those smaller initiatives unless they can resolve the bigger, partisan issues.
If not, this would be the second year in a row that lawmakers have largely failed to act in the face of a drug crisis that killed 418 Mainers last year, double the number of overdose fatalities in 2014.
“I am feeling very frustrated because we have put in a lot of hours and a lot of work looking at the opioid crisis in Maine,” said Malory Shaughnessy, executive director of the Alliance for Addiction and Mental Health Services and a member of a state task force that recommended dozens of actions to the Legislature. “Now they are all caught up in the political process, and people are dying every day.”
One of the major recommendations that emerged from last year’s Task Force to Address the Opioid Crisis enjoys widespread, bipartisan support.
The bill, L.D. 1430, seeks to replicate Vermont’s successful “hub-and-spoke” system that integrates medication-assisted treatment – widely considered the most effective treatment for opioid addiction – with counseling, support and general health care services, The idea behind “hub-and-spoke” is individuals are more likely to succeed under a comprehensive approach that includes health and wellness in addition medication-assisted treatment with methadone or Suboxone.
The bill passed both chambers unanimously but is stalled in the Appropriations and Financial Affairs Committee awaiting funding. A $68 million spending package endorsed by committee Democrats and Senate Republicans includes $6.7 million to establish a hub-and-spoke system in Maine, but the agreement fell apart after House Republicans objected to other contents of the package.
“There was huge, bipartisan support for that bill and now it is just sitting there,” Shaughnessy said, calling the delays “a disservice to the people of Maine.”
Committee co-chairman Rep. Drew Gattine, D-Westbrook, said he was also frustrated with the lack of progress on opioids. A bill that Gattine proposed to provide treatment and housing to homeless addicts – a major problem in Portland – also passed both chambers but is stuck “on the table” in his own committee.
“I’m very worried,” Gattine replied when asked about the prospects of the “hub-and-spoke” or other opioid-related measures receiving funding this year. “I think we need to continue to work and find common ground on those things that we can do. And if we don’t, then we need to come back in January” to address them.
Maine’s death toll from drug overdoses has set a record several years in a row as the state and the nation have struggled to deal with the heroin and prescription opiates crisis. While the number of opioid prescriptions has fallen significantly in Maine, thanks to a 2016 law placing restrictions on doctors and patients, emergency rooms in Maine continue to see a surge in suspected overdose cases.
In many ways, the current State House stalemate is a continuation of the tensions – with Democrats and Senate Republicans on one side, and House Republicans plus Gov. Paul LePage on the other – that caused last year’s three-day government shutdown. This year, Democrats are pushing for funding to begin implementing Medicaid expansion, while Republicans’ insist that lawmakers cut state taxes to conform with the recent federal tax cuts from Congress.
More than 120 bills passed by both chambers will soon die in the Appropriations Committee unless lawmakers agree to fund them. Other opioid-related bills “on the table” in Appropriations would provide funding for needle exchange programs, emergency housing and treatment for women with children, and “pre-diversion” programs that divert addicts in the criminal justice system toward treatment programs instead of jail.
Like Shaughnessy, advocate Kenney Miller had hoped for some “real action” this session in response to the carefully crafted, bipartisan recommendations from the opioid task force. Instead, they’ve watched bill after bill get caught up in the broader negotiations among Appropriations Committee members and legislative leaders.
“I don’t think they are treating this issue like the crisis that it is. We shouldn’t be bargaining about these bills” said Miller, executive director of the Health Equity Alliance, which runs a needle exchange program and distributes kits for naloxone, the overdose reversal drug, to at-risk individuals. “The cost of inaction is another 418-plus lives over 2018. We can’t afford to continue to watch this death toll climb and not do anything about it.”
Lawmakers have passed several minor opioid-related measures that did not have a price tag.
For instance, the Legislature passed a bill making clear that Mainers under age 21 should be able to obtain naloxone without a prescription. The Maine Board of Pharmacy is currently finalizing rules – two years in the making – that would have only allowed pharmacists to dispense naloxone, or Narcan, to adults 21 or older without a prescription. The 21-and-over age limit was a compromise intended to win the support of the LePage administration, which has stalled the rules.
But organizations involved in treating the growing number of people with opioid addictions plan to continue pressuring lawmakers for whenever they return.
“Our legislators have a unique chance to stand with Maine’s people in the response to the opioid epidemic and stop playing politics with the lives of our people,” Courtney Allen, chapter leader for Young People in Recovery and co-founder of the James’ Place recovery residence in Augusta, said in a statement. “They must pass and fund the recommendations of the opioid task force this year.
Gattine said there are other bills that could receive funding, but acknowledged that “it’s hard to separate those questions from the overall picture in regard to spending.” He and other Democrats blamed House Republicans – and particularly House Minority Leader Rep. Kenneth Fredette – for scuttling the $68 million spending package, but also suggested the LePage administration has not prioritized dealing with the crisis.
“As a Legislature, I don’t think we have done enough, but a number of the things that we have done have been ignored or not implemented by the LePage administration,” Gattine said.
As an example, Gattine pointed to the $5 million earmarked by the Legislature last year to provide treatment for up to 400 Mainers. As of February, only about 50 people had been served and less than $60,000 of the $5 million spent by the Maine Department of Health and Human Services.
Fredette, R-Newport, said he also has been frustrated by the Legislature’s lack of action on the opioid crisis. Fredette said he spoke with Gattine’s co-chair on the Appropriations Committee, Republican Sen. Jim Hamper of Oxford, about his concerns that the $6.7 million for hub-and-spoke model wasn’t enough to address the crisis.
“Because I didn’t see more in there, I actually went to Jim Hamper … and said, ‘Jim, we really need to be looking at what are some other options for spending on possible solutions to this opioid crisis,’” said Fredette, who is seeking his party’s nomination for governor. “My belief is some of these things are going to be in the final package. And that only happened in the last three or four days.”