As was reported by the Bangor Daily News, a week ago the Maine Opiate Collaborative unveiled its final report on the recommendations it was making to fight the opiate crisis in Maine. The Maine Opiate Collaborative consists of three task forces, law enforcement, treatment, and prevention, that were convened by U.S. Attorney Thomas Delahanty after the opiate summits convened by Senator King and Governor LePage. Friday, May 6th’s unveiling event saw each of the task forces present their recommendations, interspersed with addresses from the Maine Attorney General Janet Mills, Public Safety Commissioner John Morris, and the US Attorney himself. It was an inspiring event that set forth an ambitious course to address this public health crisis.
Along with my friend and colleague William Paterson from the University of New England, I have been serving as one of the Co Chairs of the Prevention and Harm Reduction Task Force of the Collaborative. Since we were assembled last October, we set an aggressive meeting schedule, coming together every two weeks to research, discuss, and deliberate what we would put forth for recommendations. Our task force consisted of around a dozen prevention, harm reduction, and recovery services experts from around Maine. It was an immensely talented group. An immense amount of credit and thanks have to go to Gordon Smith at the Maine Medical Association and Dan Perry, Assistant U.S. Attorney, for coordinating the efforts of all three task forces, and keeping us on track.
One other common trait we all shared was that we are all very action oriented. From the beginning, we agreed that whatever we come up with, this wasn’t going to be a plan that just sat on a shelf. We want to see this through and see everything implemented. Some ideas will be easier to implement others. Some may need to wait for a different political climate in a couple of years. But one way or another, all of this needs to happen and if it does, we will make a huge difference, through prevention, in significantly reducing the numbers and percentages of youth and adults who develop opiate addictions.
You can review the full Prevention and Harm Reduction Task Force recommendations, along with the recommendations of the Law Enforcement and Treatment Task forces at the Maine Medical Association’s website. For the purposes of this article, I would like to highlight three recommendations I would like to see prioritized for implementation. To be clear, I want to see everything in our report implemented, but if we could only pick a few to start, I would want these in the mix.
Objective 1: Increase understanding of harms and decrease stigma surrounding opiate and heroin use disorder
Strategy: Educate the general public about the opiate/heroin problem in Maine.
Giving credit where credit is due, the public conversation around addiction, in the context of the opiate crisis, has been remarkably constructive. I’ve seen demonstrable progress in rising above derogatory language when speaking about people with substance use disorders. That said, we still have a long way to go to decrease the stigma of substance use disorders and to deal with this disease with the same attention and compassion we pay to heart disease and cancer. We need to get to the place where the substance use disorder patient is getting casseroles and cards like the cancer patient, and not shame and stigma.
One way we can get there is to continue to fund statewide educational campaigns to continue to educate the public on addiction and specifically this opiate epidemic. We propose that campaign to be a multi-media campaign utilizing traditional media along with social media. The goals of the campaign are as follows:
- De-stigmatize substance use disorders;
- Increase understanding of risks and harms specific to opiate and heroin use;
- Increase understanding of substance use disorders and their prevalence; and
- Increase knowledge of harm reduction, treatment and recovery resources.
- Create awareness of importance of primary prevention in addressing Maine’s substance use problems.
Along with education, we need to continue to examine the language we use when talking about substance use disorders. My colleague Alison Jones Webb previously provided an article on these pages talking about this very thing. We can make great progress on this front if we all think about the language we use when talking about this issue. We no longer should be using terms like “addict”, or “substance abuse”. To be sure, this is something we in the field also need to confront. Many of us have or currently receive funding from funders such as the Maine Office of Substance Abuse and Mental Health Services, or federal Substance Abuse and Mental Health Services Administration. I serve on the Substance Abuse Services Commission. Now, it would take changes in statute to change the names of these state and federal departments. But we can help lay the groundwork for those changes by talking about substance use disorders in stead of substance abuse.
Objective 3: Reduce unnecessary access to legal opiates.
Strategy: Expand and support efforts promoting safe storage and disposal of opiates.
At our summit last week, Marci Sorg from the University of Maine went through the data we have around the overdose deaths that come through the chief medical examiner’s office. One piece of data she talked about was that far more often than not, if an individual is overdosing on prescription opiates, they were not pills that were prescribed to the person who overdosed. They were obtained from someone else who had the prescription, in many cases likely taking them without permission. This is the very reason programs like the Medicine Take Back Initiative and medicine drop boxes were created. To reduce the stores of expired, unused, and unwanted medicines in Maine homes. Far and away the largest source of prescription drugs that are misused by youth are obtained from some kind of social connection, usually a parent or grandparent.
To date, the twice annual medicine take backs have largely been funded and supported by the US Drug Enforcement Administration. There was a very brief period where DEA suspended its involvement in the program, during which the Maine Sheriff’s Association picked up the program in Maine. Meanwhile, several communities across Maine have installed permanent drop boxes, often at police departments, where citizens can drop off their expired and unwanted medicines. While these programs have grown, there are still areas of Maine that aren’t adequately covered, and there is always the chance the DEA withdraws from supporting the program again, as federal budgets ebb and flow.
This is why one of our recommendations is for legislation to be introduced to create a statewide product stewardship program to fund the disposal of expired, unused, and unwanted medicines, including prescription opiates. There is already a successful county-level model for this in Alameda County, California. The way it works is that any pharmaceutical company that wants to sell their products in Alameda County, needs to create and submit a product stewardship plan. As an example, the pharmaceutical company Elelixis developed and submitted this safe drug disposal program plan. Elelixis is operating a mail-back program for any patients in Alameda who were prescribed their drug, Cometriq, and have unused or unwanted quantities they wish to dispose of. Essentially, Alameda is making the pharmaceutical companies take responsibility (read: pay) for the disposal of the products they are marketing and selling in that county. Pharmaceutical companies are way over due to contribute to addressing an epidemic that they are complicit in fueling. It’s time for them to take responsibility in Maine as well.
Goal 2: Strengthen and enhance Maine’s public health infrastructure to prevent and reduce opiate use disorders and overdose deaths.
Objective 1: Enhance the state’s capacity to implement a comprehensive approach to prevent and reduce opiate use disorders.
Strategy: Create a high level position (e.g. Commissioner of Substance Use Reduction) to coordinate a comprehensive approach across state and local government to the drug problem in Maine.
The final recommendation I will highlight for this article is our recommendation to create a high-level position within state government responsible to coordinate all efforts across the various government departments and offices that are impacted by addiction. You will be hard pressed to find a department in state government not addressing addiction or the opiate crisis in some way. The Department of Labor has to look at issues related to addiction and employees. Public Safety obviously has to deal with the criminal and safety elements. The Department of Education has this issue on their radar. This high level position we are recommending would be able to create the opportunities for communication amongst these various departments and to align efforts.
One way this would be accomplished is by convening an interagency committee. The federal government has such a committee called the Interagency Coordinating Committee on the Prevention of Underage Drinking. This committee brings together various federal government departments and agencies to guide policy and program development with respect to underage drinking. In our report, we recommend the creation of a state-level Interagency Coordinating Committee on the Prevention of Substance Use Disorders. If you are someone who is concerned with an effective and efficient state government, this is a proposal you should support. This enhanced communication and collaboration would ensure that efforts don’t work against each other, and increase opportunities to maximize efficient use of precious and scarce resources.
These are just three of the Prevention and Harm Reduction Task Force recommendations, but they are three I think are very doable in the short-term, and that would make measurable impacts on this addiction crisis. In the end, the full plan, including those from the Treatment and Law Enforcement teams must be fully funded and implemented. If we fully implement this plan, we will turn the tide on this. It is going to require resources and funding. It is going to require leadership. Perhaps most of all, it is going to require persistence, patience, and resolve. This addiction crisis didn’t happen over night, it has been building for years. It is going to take years to address it. If we continue to come together and stay on this, we WILL make a difference and we will save lives.
The time is now to get this done!