Maine has some of the bleakest statistics in the nation when it comes to the opioid crisis. Two years ago, the state ranked in the top 10 in opioid-related deaths per capita.
Newly elected Gov. Janet Mills has vowed to change that, beginning with the creation of a new state director to coordinate what she says will be a comprehensive approach to the problem. She made the announcement last week, after being sworn into office.
“Our administration will create the director of opiate response, a person who will marshal the collective power and resources of this state to stem the tide of this epidemic,” she said.
She has yet to say exactly what this new director will do, but she has said it should help address a problem that has proven daunting.
One of Maine’s most prominent specialists in addiction medicine can recite a long list of policy initiatives he’d like to see implemented.
“We’d like to see an expansion of education for professional education about addiction, repealing the state’s two-year limitation on methadone treatment, treatment for Mainers who are incarcerated,” says Dr. Mark Publicker, who has been practicing for more than three decades.
The former president of the Northern New England Society of Addiction Medicine, Publicker has been critical of the LePage administration’s response to the opioid crisis, which focused heavily on law enforcement but not so much on treatment and prevention.
“We need somebody to coordinate all of the agencies, to help the governor set policies and help implement them,” he says.
Others in the treatment community say a director could bring a cohesive approach to the crisis.
“One of the things that’s been confounding about the opioid crisis and this public health crisis we’re experiencing is that it’s very, very complex,” says Bob Fowler, executive director of Milestone Recovery in Portland.
Fowler says that’s because the crisis touches so many different aspects of society, from law enforcement and public health to child welfare. The response from different governmental agencies can vary, or even conflict with one another.
Fowler says a legislative task force he served on put the problem into focus.
“It was clear that the whole system is quite fractured,” he says.
Publicker offers a specific example of how during the LePage administration, the state instituted a two-year limit on methadone and Suboxone treatments for Medicaid recipients in part, he says, to reign in the program’s pharmacy budget.
But he says it came at an additional cost to other agencies that would have to deal with patients who no longer had access to addiction medication.
Publicker says there other examples of state agencies working at cross-purposes.
“The silos are enormous,” he says.
For the last eight years, the LePage administration has focused so heavily on law enforcement that former Gov. Paul LePage once threatened to take extreme measures to disrupt the drug trade.
“If we can’t develop a comprehensive plan with existing resources, I will use the National Guard,” he said.
But even some top law enforcement officials believe a more balanced approach is required.
“I think most police chiefs in this state have said from the beginning that we cannot arrest our way out of this problem,” says Ed Tolan, the director of Maine Chiefs of Police,
Tolan says his organization isn’t worried about whether Mills will put the same emphasis on law enforcement as her predecessor. And he agrees with treatment advocates that the state needs someone to coordinate its opioid strategy.
“We’re all trying to do great things as departments. But I think sometimes we’re both incorporating the same ideas, or we’re falling short on cooperation between departments,” he says.
Maine would not be the first state to install an opiate director or board. Several of the hardest hit states, including Vermont, Ohio and New Hampshire, have already taken one step or the other.
In New Hampshire, which ranked 2nd in deaths per capita in 2016, the state’s so-called drug czar was part of a response that last year earned praise from U.S. Surgeon General Jerome Adams during a forum in Concord.
“There’s nowhere in the country that can say they’ve come as far as New Hampshire from where they were, in terms of responding to this epidemic,” he said.
The Granite State arguably had farther to go compared to some of its counterparts. The state ranks highest in median income, but ranked near the bottom of the country in the availability of treatment programs.
But that began to change as the crisis intensified to a point that it ranked as the biggest problem facing the state in a poll taken late in 2017, toppling traditional issues such as jobs and health care.
The opioid crisis has not yet risen to that level in Maine, at least according to issue polls conducted here. But Mills says it’s a priority, and it has been since her victory in November.
“We already have a lot of work being done, quite frankly. Since the election I’ve had somebody out there scouting the territories and finding out what’s working, what’s not working perhaps as well as it should,” she says.
As attorney general, Mills’ office was responsible for reporting the grim statistics of opioid-related deaths — there were 185 in the first half of last year.
Since becoming Mills has vowed to increase the availability of the overdose reversal drug Narcan, access to medication-assisted treatment and on-call recovery coaches in emergency rooms to begin the treatment process immediately after someone is revived from an overdose.
It’s not clear when Mills will announce her choice to fill the new director of opiate response position, but the state’s financial commitment to Mills’ policy initiatives could end up being as important as the person she picks to oversee them.
