Emergency department visits for suspected opioid overdoses increased by 34 percent in Maine from 2016 to 2017, during a time when drug overdose deaths in the state reached an all-time high.
At the same time, New Hampshire, Massachusetts and Rhode Island all reported decreases in emergency department visits for opioid overdoses, making Maine the only New England state to experience an increase, according to a U.S. Centers for Disease Control and Prevention report released this week. Statewide data was not available for the other two New England states, Vermont and Connecticut.
The CDC report measured the third quarter of 2016 through the third quarter of 2017, and was the first time the federal government has collected emergency department data on opioid overdoses.
Emergency visits jumped 35 percent overall in the 16 states tracked. The report also estimated the overall increase in 45 states to be 30 percent. The data is not yet available for the entire nation.
For the 16 states, there were about 120,000 opioid overdose visits to hospital emergency rooms over the 15 months. Wisconsin had the largest increase, 108 percent.
Although the report did not contain a state-by-state breakdown of emergency room opioid visits, the Maine Hospital Association estimated there were 1,500 to 2,000 visits in the period measured.
Maine’s drug overdose deaths continue to set records, with 418 reported in 2017. The state Attorney General’s Office has reported that a major factor is the presence in Maine of fentanyl mixed with heroin, making the drugs more powerful and more likely to cause an overdose.
The jump in opioid overdose emergency room visits is “consistent with what we’re seeing with the increase in overdose deaths,” said Bob Fowler, executive director of Milestone Recovery, which operates a detox center in Portland and a residential treatment program in Old Orchard Beach. “Without adequate prevention and treatment services, you will see an increased utilization of jails and emergency departments. It’s entirely predictable.”
Unlike the rest of New England, Maine has not yet implemented its expansion of Medicaid, which was approved by voters in November and would open up treatment to about 70,000 people. Gov. Paul LePage opposes Medicaid expansion and has been fighting with the Legislature over how to pay for Maine’s share of the costs.
A $4.8 million program launched by the LePage administration a year ago to help the uninsured gain access to treatment – the Opioid Health Home program – has only helped a handful of uninsured people, according to the Maine Department of Health and Human Services.
Meanwhile, the opioid crisis continues to worsen in Maine.
Gordon Smith, executive vice president of the Maine Medical Association, which represents doctors before the Legislature, said emergency department use is yet another sign that Maine’s response to the opioid crisis has been tepid.
“What is it going to take? How many more thousands are going to die? We’re clearly not doing enough, and what we are doing, we’re not doing it quickly enough,” Smith said.
Dr. John Southall, director of Mercy Hospital’s emergency department, said that department has seen a decline in opioid overdose cases over the past year.
“We saw our spike a little earlier, 18 months or two years ago,” Southall said. He said the expansion of the use of Narcan – an opioid overdose antidote – in the Greater Portland area has probably led to decreased numbers of overdose cases ending up in emergency rooms. Police, firefighters, paramedics and many residents now carry Narcan.
“It’s widespread in the community now in a way that it never was before,” Southall said.
Smith, at the medical association, said Portland may have more access to Narcan, but that may not be the case in more rural parts of Maine.
Southall said that during the past six months, any person who showed up at Mercy’s emergency department after overdosing was offered access to treatment programs, and could even make an appointment with a primary care doctor while they were still recovering at the hospital.
Katie Fullam Harris, senior vice president at MaineHealth, the parent company of Maine Medical Center, said MaineHealth has greatly expanded its primary care treatment programs for people struggling with opioids.
The “gold standard” to treat opioid addiction is medication-assisted treatment – such as Suboxone or methadone – combined with counseling.
“We’ve really come a long way. We are building the capacity for prevention and treatment to try to keep people out of the EDs,” Harris said.
But she said many people who have substance use disorder are uninsured, and trying to get the uninsured into a medication-assisted treatment program is difficult. Medicaid expansion would open up medication-assisted treatment to thousands of Mainers.
“Resources continue to be a problem for uninsured patients. It’s a significant barrier,” Harris said.
Smith said about 10,000 Mainers struggling with substance use disorder would gain access to treatment when Medicaid is expanded.
Dr. Anne Schuchat, acting director of the federal CDC, told reporters Tuesday that her agency is branching out to assess other aspects of the opioid crisis besides overdose deaths, and measuring emergency room visits is one of the ways to study the crisis in another way. Schuchat said they are hearing about many “innovative” strategies across the U.S. to provide help to people who need treatment.
“We think that the idea of initiating medically assisted treatment in the emergency department is an innovative and exciting strategy,” she said. “Another innovative approach is the idea of navigators. So (there would be) a person in the emergency department whose job it is to follow up with the person after they’re awake, after they’re home to make sure that they do get connected and potentially help link them with … medication-assisted treatment a few days out.”
Also this week, a report in the Journal of the American Medical Association found that, in the first long-term study of its kind, common over-the-counter painkillers were as effective, and in some cases more effective, than opioids in controlling chronic pain. And common painkillers don’t have side effects, such as leading people into opioid addiction, the study concluded.
Dr. Stephen Hull, a pain specialist at Mercy Hospital, said it’s the latest study of many to question whether opioids should be used for chronic pain. The CDC now recommends against it.
“American physicians, and the public, have come to believe that opioids should be the first-line medication for moderate to severe pain,” Hull said. “However, there are an increasing number of high-quality studies that are demonstrating, for a number of conditions, injuries and surgeries, (that) a combination of ibuprofen or naproxen and acetaminophen is as effective or more effective than an opioid in reducing pain.”
Dr. John Southall, director of Mercy Hospital’s Emergency Department, said that in the past six months, any patient who has shown up at the emergency department after overdosing has been given access to treatment programs. (Derek Davis/Portland Press Herald)