Maine on track to have fewer drug deaths in 2023

Maine is on pace to record its first year-over-year reduction in drug overdose deaths in five years, according to state data. Overdose deaths through October were down 11.7% from the same period in 2022.

Through October, Maine recorded 513 overdose deaths, down from 581 through the same period in 2022, according to state statistics released this month. Maine logged a record high 723 overdose deaths in 2022.

Gordon Smith, director of opioid response for the Mills administration, said they are “not declaring victory,” but said it seems like Maine is “on the right track” after many years of devastatingly high overdose deaths.

“There’s a lot of reason to be hopeful,” Smith said. “It’s gratifying to see the investments we have talked about, and the plans we have talked about for five years, beginning to show some results.”

Drug deaths, fueled by the opioid crisis, have ravaged the state and much of the nation for years, as the overprescribing of opioids that started about 20 years ago led to a surge in usage and deaths. People with substance use disorder often start with abusing pills, and then move to street drugs, such as heroin or fentanyl.

Overdose deaths have increased steadily since 2013, with 176 deaths that year ballooning to 417 by 2017.

In 2018, deaths declined to 354, but it was only a temporary reprieve.

Drug deaths have surged since, hitting a record 723 in 2022.

A myriad of factors have contributed, experts say, including more potent street drugs making overdoses more likely, and increased isolation caused by the pandemic.

The wave of drug deaths has overtaken an overall expansion of treatment programs and greater use of naloxone – a life-saving overdose reversal medication – in recent years. Naloxone reversals now number about 2,500 per year, up from about 1,500 annually in 2020. The pandemic’s early years also caused a temporary constriction of access to treatment at a time when people were struggling with loneliness, experts have said.

If the trend holds, Maine would finish 2023 with about 635 overdose deaths – still high, but substantially lower than last year.

Dr. Noah Nesin, medical director for research and innovation at Community Care Partnership of Maine, which provides substance use disorder treatment, said several factors may be leading to the decline in deaths – such as the expanded availability of naloxone and increased treatment options for patients – but Nesin cautioned that the improvements might not be lasting.

“It does look like something has shifted,” Nesin said. “We never assume that this trend will continue. We all just keep working to make things better.”

Nesin said providers have also learned how to more effectively treat opioid use disorder.

“The focus of treatment programs now is to have as low a barrier to entry as possible, and to make it accessible,” Nesin said.

For instance, there are now more choices for medication-assisted treatment that can better match patient needs. In some cases, patients may need a more consistent dose of buprenorphine, which curbs cravings, and so an extended-release version of the medication is now available. Some patients do better with buprenorphine-only prescriptions, while for others a combination of buprenorphine and naloxone – called Suboxone – is better, Nesin said.

Nesin said the supply of residential treatment, such as recovery homes, has “improved dramatically” in recent years, and most now have shed rules that prohibited storing treatment medication at sober homes and typically allow the medications on the premises.

Patients who previously would have been kicked out of residential treatment programs for relapsing and breaking rules are now typically allowed to remain in programs, another shift in treatment philosophy that is helping to keep people alive, Nesin said.

Smith said by next year, there will be 100 detox beds in many different parts of Maine, a dramatic increase compared to a low of about 20 beds during the pandemic. He said the Mills administration is spending about $40 million to $60 million per year on sustaining and improving the system to prevent and treat substance use disorder.

On Monday, the Maine Medical Association, which represents physicians before the Legislature, launched its “1,000 Lives for Maine Campaign,” which aims to save 1,000 lives in Maine over the next five years by expanding and improving treatment for substance use disorder.

“Our goal is expansion of access to lifesaving (opioid use disorder) care into every corner of Maine, and engage every part of the health care delivery system in this lifesaving work,” Dr. Erik Steele, immediate past president of the Maine Medical Association, said in a statement. “We want you to be able to walk into any emergency department, your doctor’s office, any hospital, and get this help.”