AUGUSTA — A day after U.S. Sen. Angus King convened a roundtable discussion about the “public health and safety crisis” of opioid abuse in Maine, local, state and federal officials will gather Wednesday in Augusta for a similar summit convened by Republican Gov. Paul LePage.
While King’s forum featured the federal director of national drug control policy, as well as treatment experts, people in recovery, their families and law enforcement officials, Wednesday’s session — which is closed to the public and media — will be hosted by Maine Commissioner of Public Safety John Morris.
It will include 20 law enforcement leaders, heads of state departments and hospital administrators. Five spoke to the Bangor Daily News about what they would like to see emerge from Wednesday’s meeting.
Their statements highlight the divide between advocates for a tough-love approach that emphasizes interdiction and using the legal system to hold addicted people accountable for their actions versus a model, which involves family members, reduces the fear of arrest for those who could be in position to help someone who is overdosing and places emphasis on addiction treatment.
Roy McKinney, director of the Maine Drug Enforcement Agency, said Tuesday he will speak current drug enforcement efforts in Maine, which focus not only on heroin but other drugs he said “really challenge our resources,” including crack cocaine and methamphetamine. He then hopes the conversation turns toward how existing resources could be better reallocated to battle opiate trafficking — primarily heroin but also prescription opiates, including fentanyl, often used to dilute heroin, and fentanyl analogues.
A sheriff’s view
Sagadahoc County Sheriff Joel Merry, a Democrat who serves as president of the Maine Sheriffs Association and chairman of the Maine Board of Corrections, said many of his peers in law enforcement support a “three-pronged” approach that combines treatment, prevention and enforcement.
“If you’re going to have discussions of the ‘Seattle model’ and the ‘Gloucester model,’ those involve law enforcement and treatment,” he said of efforts undertaken by two cities to combat drug abuse. Gloucester, Mass., focuses its drug abuse program on treatment instead of jail time, and a pilot program in a Seattle neighborhood provides meals, drug treatment and stable housing for “low-level” drug offenders as an alternative to the criminal justice system in an effort to reduce recidivism.
“I do believe the conversation has evolved to the point that we’re hearing more and more about the need for treatment and prevention,” Merry continued.
Merry, who took part in the 2011 summit held by then-Attorney General William Schneider to address a prescription drug abuse epidemic, said a number of initiatives resulting from that meeting reduced prescription opiate abuse, but in so doing at least in part triggered the rise of heroin.
“Shame on us,” he said. “We squeezed the balloon. We cut back on the prescription drug abuse but we didn’t take care of the demand side — the demand for opiates — and heroin became the path of least resistance.”
Merry said he looks forward to hearing from treatment providers about what specific barriers they anticipate in the battle. He said the state must prepare for additional treatment of addiction in jails if they step up enforcement.
“Jail’s a terrible place to be treating people for substance abuse, particularly when they’re shut off from the pipeline and they go through withdrawal,” Merry said. “It’s not safe for them. But then again, we can’t become a treatment center. We’re not going to dispense methadone within the confines of a correctional institution.”
Cumberland County District Attorney Stephanie Anderson said any discussion of treatment needs to address people who enter programs for reasons such as staying out of jail or remaining in public housing. She also called for stricter definitions of treatment, arguing that methadone clinics treat symptoms, not the disease.
“There’s always been an attempt to strike a balance between treatment and enforcement, but … we throw around a lot of treatment in the state of Maine and very little of it is robust enough to do the job. A lot of it goes to people who don’t want it and who don’t want to change their lives,” Anderson said.
Anderson advocated for stricter oversight, including focusing on physicians who “hand out opiates at the drop of a hat.” They don’t ask questions (such as), ‘Do you have any problems with narcotics or substance abuse?’ … This whole thing — pain, pain, pain. Well you know what? Pain is a part of life.”
“Let’s ask a couple of hard questions,” Anderson said. “What do we do when the police officer encounters a person overdosing from heroin and they’ve already been (revived) twice in the past week? … There’s certainly an intellectual argument that says, ‘OK, three strikes and you’re out’ — you get NARCAN three times and we’re not doing it again. The truth of the matter is nobody wants to see that person die of an overdose and stand by and not do anything, but at that point I think you say, ‘You need to be charged.’”
Maine Department of Health and Human Services Commissioner Mary Mayhew labeled the summit an opportunity to share her department’s statistics, including “information about the history of substance abuse in Maine, including the number of people who have sought treatment, demographics of those who seek treatment, the impact that substance abuse has on child welfare, the amount of funding dedicated to treatment and other important facts,” she said in a prepared statement.
She also called for more accountability in treatment services.
“We must set the bar high and invest in quality treatment that can be measured and is supported by the evidence to promote recovery, as well as continue our effort to strengthen primary care and integrate physical and behavioral health,” she said.
Maine Attorney General Janet Mills, a Democrat who openly has sparred with LePage, said Tuesday she hopes leaders hold “a brainstorming session.”
Mills said any discussion of using existing resources to combat Maine’s drug abuse problem must take into account two treatment facilities that recently closed because emergency room physicians tell her they can’t find treatment centers with room to care for addicts who land in the ER.
“They have no choice but to return to the street or wherever they came from,” she said. “It’s clear from the meetings I’ve been to that many addicts lack health insurance coverage and we know that thousands of people who were in treatment came off the MaineCare rolls a year and a half ago. We need to fill that gap.”
Mills said the suggestion to make better use of the state’s resources became more difficult with the recent closure of treatment programs in Westbrook and Sanford.
“We cannot arrest our way out of this problem,” Mills said. “The longer we sit and do little, the more people are dying. It seems every day someone in Maine is dying of an overdose. And drugs are getting more and more potent.”