Summary/Abstract

Choopers Guide response to Paul LePage's committee selection for the Drug Summit to address Maine's opioid epidemic.

Content

Chooper' Guide Editors Note:

This brief commentary is being written in response to Paul LePage's supply reduction strategy for the opioid epidemic in Maine as evidenced by the expert committee invited to participate in  August 26, 2015 Drug Summit. See article published in Portland Herald on August 18, 2015 below

We were very disappointed in the Govenor's committee selection for the upcoming drug summit. The committee is seeded primarily with Law Enforcement professionals and has no addiction medicine physicians and only one addiction clinician and recovery advocate. In reality, treatment has a 4.5% representation. This is not only unacceptable but highly uninformed. Two of the individuals listed here with Hospital affiliations cannot be considered experts as they function in administrative roles. So it seems to be the same approach which unfortunately got us to where we are now.

A law enforcement approach in Maine will have little impact on supply as the multiple sources supplying Maine are all out of State. The drugs dealers on our corners are low level "dope slingers" and are quickly replaceable. Incidentally, many of these dealers are also addicts just selling enough to support their habits. Federal, State and local governments have waged a futile battle against drugs for over forty years to no avail. The Drug War has failed and we need to cast pride aside. We need to learn from our mistakes and look to states and other countries who have shifted the paradigm and focused on demand rather than supply reduction as a way to humanely and effectively address this epidemic. Portugal is an excellent example where incidence rates have dropped dramatically as a result of a demand reduction approach.

This is, like any business, a matter of supply and demand. It is simple economics. The less demand, the less profit and therefore the less incentive and therefore less supply. Treatment lowers demand as the target market diminishes and disrupts the price-purity index where price increases and purity decreases. Treatment also saves lives and money. Recent studies indicate that for every dollar spent society will realize up to a twelve dollar return. This is an ROI that Wall Street would pursue.

A Few Suggestions

• Maine needs to focus on expanding access to treatment with an emphasis on medication assisted treatment as it is the Gold standard for opioid addiction. Opioid addiction in many case is analogous to type I diabetes. It requires medication to achieve initial stabilization and an optimal outcome.
  
• Maine needs to evaluate the role of law enforcement and adopt law enforcement assisted diversion practices (LEAD) which stress treatment rather than incarceration.
  
• Maine needs to adopt harm reduction as one of the principal pillars in its drug strategy and allocate funding to harm reduction best practices which are not only highly cost effective but positively impact health and mortality rates amongst intravenous drug users. We can significantly reduce the transmission of blood borne diseases by providing funding for syringe exchange programs and immediately reduce overdose mortality rates by making naloxone affordable and easily available. These practices are recommended by NIDA, the CDC, the World Health Organization and the United Nations.
  
• Maine needs to change its understanding of addiction and realize that it is a chronic disease with a complex biopsychosocial etiology and that afficted individuals have the same right to compassionate, nondiscriminatory healthcare as any other person afficted with a chronic disease.
• Maine need to borrow best practices for ongoing support for individuals in recovery and encourage the establishment of community resources (Recovery Community Organizations)  that provide ongoing support for addicts ad help strengthen communities. It is a chronic disease that has been erroroneusly treated with an acute care model. A eighty five percent relapse rate after thirty days from completion of inpatient/residential would strongly suggest that our treatment practices are misguided.
  
• Maine citizens need to understand that addiction is not an act of volitional misconduct but rather the result of an individual who made a poor early life choice with an underdeveloped pre-frontal cortex who then had their brain hijacked by the drug.  An old saying which summarizes the addictive process is - first the person takes the drug, then the drug takes the drug, then the drug takes the person.
• We all need to be "perfectly clear" that addiction is a chronic healthcare problem. It is  not a moral or criminal justice issue and as such stigma and discrimination need to be eradicated with social inclusion as the primary objective.
  
• Maine needs to play better with its neighboring states regarding law enforcement strategic and tactical planning understanding that only through effective collaboration and accurate intelligence can the major trafficking networks be dismantled.
• Maine needs to promote recovery, encourage advocacy and involve consumers in policy development.
  

Law enforcement officials will outnumber treatment experts more than 3-to-1 at an Aug. 26 drug summit convened by Gov. Paul LePage in response to the state’s ongoing drug crisis.

The governor’s office on Tuesday released a list of the 22 people who have been invited to join LePage at the summit.

The list is heavy with law enforcement and legal professionals, and light on those representing the treatment community, mirroring LePage’s focus on law enforcement to get illegal drugs off the street.

Among those invited: Department of Public Safety Commissioner John Morris, U.S. Attorney Thomas Delahanty, Chief Maine Supreme Judicial Court Justice Leigh Saufley, Attorney General Janet Mills, Portland Police Chief Michael Sauschuck, Cumberland County District Attorney Stephanie Anderson and Department of Health and Human Services Commissioner Mary Mayhew.

The treatment side will be represented by Acadia Hospital President Daniel Coffey, Maine General Medical Center’s chief medical officer, Dr. Steve Diaz, and Bruce Campbell, chairman of the Bangor Area Recovery Network. The time and location of the summit have yet to be determined.

LePage said his recent call to action came after he learned of 14 heroin overdoses in Portland during a 24-hour period earlier this month.

“We must identify how to best utilize the scarce resources available to combat Maine’s heroin crisis,” LePage said in a statement. “I am very impressed by the group of individuals who will be at the table, and I anticipate an exchange of information that will help us find solutions to improve the health and safety of all Mainers.”

A FATAL DRUG PROBLEM

Adrienne Bennett, the governor’s spokeswoman, said the goal of the summit is to identify meaningful steps the state can take with limited resources available. She said follow-up meetings are likely but might not include the entire group.

In a news release identifying summit participants, the governor’s office said those who attend “will discuss public safety strategies” to address the state’s drug epidemic, but Bennett said treatment will not be ignored.

Maine’s drug addiction problem has become increasingly severe in recent years.

Last year, 57 people died from heroin overdoses in Maine, an increase of 68 percent over 2013, when 34 people died.

The number of Mainers seeking treatment for heroin addiction also has increased, from 1,115 in 2010 to 3,463 last year, according to the Maine Office of Substance Abuse.

Nationally, the number of people addicted to heroin has more than doubled in a decade, from 214,000 in 2002 to 517,000 in 2013, according to a study released this year by the Substance Abuse and Mental Health Services Administration.

“Heroin has hit Maine hard and now we’re starting to see an evolution of heroin,” Morris, the public safety commissioner, said in a statement. “Initially, we were seeing heroin and fentanyl mixed together, but we are now finding many more cases of fentanyl alone. It’s a lot cheaper to produce than heroin. We must identify specific problem areas and seek solutions before we lose more lives.”

Fentanyl is a prescription opioid painkiller that is sometimes diverted for illicit use or mixed with heroin by dealers to produce a powerful compound.

ACLU DISAPPOINTED BY PANEL

The American Civil Liberties Union of Maine expressed disappointed that the summit is so heavily weighted toward law enforcement.

“How can there be a fully informed conversation about addiction at a summit where law enforcement agents and prosecutors outnumber medical professionals three to one?” asked Oamshri Amarasingham, policy counsel for the ACLU of Maine. “If the governor actually wanted to protect the health and safety of all Mainers, he would include more people who know about public health. Instead, his stubborn refusal to recognize the importance of treatment and recovery in combating addiction puts Mainers at risk.”

House Speaker Mark Eves, a Democrat from North Berwick and a family therapist who has worked with addicts, said he hopes the summit participants treat the state’s drug crisis as a “health care crisis, not simply a matter for law enforcement.

“I urge this group to focus on the ways substance abuse treatment tools can work together with law enforcement efforts to fix the problem,” Eves said. “There are models in other places like Gloucester, Massachusetts, and Seattle that have proven to work.

“In treating at-risk families across the state, I’ve seen firsthand that the battle with addiction won’t be won in a jail cell. The state must take a comprehensive approach.”

APPROACHES ELSEWHERE

In Gloucester, addicts can now go to the police station and get an escort to a treatment facility without fear of being charged, even if they are in possession of drugs. The town’s police chief, Leonard Campanello, said his department is committed to going after demand.

Seattle has implemented a similar program, called Law Enforcement Assisted Diversion, that has reduced criminal recidivism rates by up to 60 percent for mostly low-level drug dealers and users.

LePage, though, has made cutting off the supply his priority.

Under his watch, the state has added Maine Drug Enforcement Agency personnel and drug prosecutors, and LePage would like to add more enforcement resources.

Last week, he said he would activate the Maine National Guard if necessary and he included Brig. Gen. Gerald Bolduc of the Maine National Guard as a participant for the upcoming summit.

The governor has consistently said Maine has plenty of money for treatment. Bennett said Tuesday that state General Fund spending on substance abuse has increased from $22.5 million in fiscal year 2011 to $30 million in the current fiscal year.

Nevertheless, LePage has had pointed words for addicts in the past, most notably during a May 29 news conference.

“I’m looking to go after the traffickers. I don’t care about the users,” he said. “We’ll get them in clinical therapy and that can be dealt with – if they chose to.”