Focus Area: Prevention

The Focus Area: Prevention dashboard contains information and metrics regarding Priority B of the State’s Opioid Response Strategic Action Plan which is to prevent the early use of addictive substances by children, youth, and young adults and Priority C which is to reduce the number of prescribed and illicitly obtained opioid. Metrics include the following:

• Prescription Drug Monitoring Program prescribing and patient trends
• DEA drug take back days prescription drugs collected
• State law enforcement drug arrests and drug seizures
• Linkages to the State Epidemiological Outcomes Workgroup prevention and prevalence dashboards
• Admissions to the Maine Department of Corrections for new sentences regarding a drug crime

At the end of each metric and in the information narratives below there are citations to the Strategy or sub-Strategy from the Opioid Response Strategic Action Plan that is addressed or measured.

The Maine Center for Disease Control and Prevention utilizes the Strategic Prevention Framework to design, execute, and appraise programs

The Strategic Prevention Framework is used to design, execute, and appraise programs and preventative interventions in communities. The process begins with Assessment to determine the community needs. It concludes with Evaluation to collect quantitative and qualitative data to confirm programming was effective or to make needed changes. At its center is sustainability and cultural competence to ensure substance use prevention efforts are as long-term and as relevant to their audiences as possible. 

To carry out this work using the Strategic Prevention framework, Maine CDC funds 20 local community partners who are working in communities to address primary and secondary prevention efforts. They form partnerships with their neighbors, educators, healthcare workers, law enforcement, local retailers and restaurant owners, and more, to come together to address community health issues. Learn more about what prevention work happens in your area by visiting their headquarters at You Are Prevention. (Strategy 6, 7, 8, 9, 10)

Part of the State of Maine’s primary prevention strategy is to reduce adverse childhood experiences (ACEs)

In an effort to minimize ACEs and support the people of Maine suffering from problematic substance use, the Office of Child and Family Services supports parents with substance use disorder in efforts to maintain custody of their children or achieving reunification whenever safely possible. During the 2022 fiscal year, 58% of all exits from State custody were to reunification while 24% were to adoption or permanency guardianship.

Source: Child Welfare Annual Report, Calendar Year 2022. Maine Department of Health and Human Services, Office of Child and Family Services.

Despite these efforts, problematic substance use persists as a significant factor in the lives and relationships of families involved with child welfare. Since the year 2000 the percentage of removals where substance use was identified as a risk factor has been trending upwards at both the State and national levels. Due to the disproportionate impacts of the opioid epidemic experienced in Maine, child removals due to substance use has ranged from 9% higher than the national level to 19% higher than the national level since the year 2000. In Maine, the rate of substance use as a risk factor at removal peaked at 53% in 2015 and has been trending downward since that time despite a continued upward trend at the national level. (Strategy 7)

Source: Child Welfare Annual Report, Calendar Year 2022. Maine Department of Health and Human Services, Office of Child and Family Services.

The law enforcement and criminal justice systems in Maine are dedicated to linking persons with problematic substance use to treatment and recovery services rather than incarceration.

The Overdose Prevention Through Intensive Outreach, Naloxone, and Safety (OPTIONS) initiative

In Maine, (OPTIONS) initiative embeds licensed behavioral health clinicians into one law enforcement department in each of the State’s 16 counties. The Liaisons de-escalate behavioral health crises, engage in postoverdose follow up visits, and refer persons in need, as well as affected others, to community- and state-based services to address problematic substance use. Law enforcement officers have made 2,698 referrals (58%) to Liaisons since October of 2021 when this data began being collected. (Strategy 7.g) Website: https://www.knowyouroptions.me

Source: University of Maine, Margaret Chase Smith Policy Center.

Maine’s Adult Drug Treatment Courts

Maine’s adult treatment courts are speciality dockets for eligible individuals whose involvement with the criminal justice system has been fueled by a serious substance use disorder. Individuals are admitted to an adult treatment court after entering into a plea agreement and accepting responsibility for their conduct. All entry into adult treatment courts is voluntary. Individuals admitted receive intensive judicial oversight, a multi-disciplinary treatment team, comprehensive treatment plans that can include medicated assisted treatment, case management, frequent drug testing, sanctions for noncompliance, and incentives for compliance.

Participants who successfully complete the program receive the successful completion sentence in their plea agreement. Participants who are expelled or withdraw from the program will receive the unsuccessful outcome sentence in their plea agreement. (Strategy 7.g)

Source: Maine Office of Behavioral Health

The State of Maine is working to improve the safety of opioid prescribing and is monitoring the prescribing of controlled substances to identify trends and to engage with outliers.

Through the Prescription Drug Monitoring Program and other initiatives the State of Maine is improving the safety of opioid prescribing as well as the prescribing of other controlled substances. Maine is promoting evidence-based guidelines for controlled substance prescribing and assisting providers with responsibly tapering patients from controlled substances. Metrics regarding prescribing trends and the ability to identify outliers are tracked through the Prescription Drug Monitoring Program. (Strategy 12a; 12b; 12c)

Further, to help reduce opioid misuse and opioid overdose in the state of Maine, the Prescription Drug Monitoring Program receives data regarding controlled substances from prescription dispensers that can be accessed by prescribing providers. Since 2015, the number of morphine milligram equivalents prescribed in Maine has decreased as has the number of patients prescribed opioids and the number of opioid prescriptions dispensed to patients.

This metric tracks the morphine milligram equivalents prescribed by providers, the number of patients receiving opioid prescriptions from their providers, and the number of opioid prescriptions dispensed in the State of Maine. The data is provided by the Office of Behavioral Health. The data is reported quarterly.

Source: Maine Prescription Drug Monitoring Program Annual Report 2021.

Electronic prescribing of opioids enhances the ability for the State to prevent misuse.

As of August 1, 2017, providers in Maine are required to prescribe any opiate medication by electronic means. This measure enhances the ability of the State to electronically track prescriptions of opiate medications and avert potential misuse and diversion. The data is provided by the Office of Behavioral Health. The data is reported annually.

Source: Maine Prescription Drug Monitoring Program Annual Report 2021.

Benzodiazepines and stimulants are increasing as cointoxicants involved in overdose deaths alone or in combination with other drugs and alcohol.

Long-term use of benzodiazepines can cause physical dependence, addiction, and overdose death. Benzodiazepines used alongside pharmaceutical and non-pharmaceutical opioids increases the risk of respiratory suppression as well as nonfatal and fatal overdoses.

Stimulants elevate heart rate, blood pressure, and breathing and can cause paranoia and anxiety. Excessive use and non-medical use of stimulants can be dangerous and deadly damaging the respiratory, cardiovascular, and central nervous systems causing irregular heartbeat, heart failure and seizures among other side effects.

This metric tracks the number of patients receiving benzodiazepines and stimulants from their providers and the number of benzodiazepine and stimulant prescriptions dispensed in the State of Maine. The data is provided by the Office of Behavioral Health. The data is reported quarterly.

Source: Maine Prescription Drug Monitoring Program.

Source: Maine Prescription Drug Monitoring Program Annual Report 2021.

Maine’s Prescription Drug Monitoring Program provides alerts to clinicians to reduce the risk of overdose

The Prescription Drug Monitoring Program is one tool that improves the safety of prescribing controlled substance through the generation of automated alerts to clinicians under circumstances where attention may be warranted to increased risk for problematic substance misuse or overdose. Clinicians are alerted when prescriptions of opioid medications exceeds 100 morphine milligram equivalents per day, when a patient has with five of more controlled substance prescriptions for different providers or when controlled substance prescriptions for a patient are dispensed at five or more pharmacies within 30 days, and when a patient has concurrent prescriptions for opiate and a benzodiazepine medications. (Strategy 12.a; 12.c; 12.f)

Source: Maine Prescription Drug Monitoring Program Annual Report 2021.

The State of Maine supports DEA National Prescription Drug Take Back Day which address the misuse of controlled prescription drugs.

The Drug Enforcement Agency’s National Prescription Drug Take Back Day addresses a crucial public safety and public health issue. According to the 2018 National Survey on Drug Use and Health (NSDUH), 9.9 million Americans misused controlled prescription drugs. The study highlighted that the majority of misused prescription drugs were obtained from family members or friends, often from a home medicine cabinet.

Mainers play an important role in preventing the diversion of prescription drug for misuse. From its inception in 2010, Maine ranked #1 in the United States per capita for the total pounds of medication collected during the Maine Prescription Drug Take Back Day. In total, Mainers have turned in 534,992 pounds of prescription drugs that had the potential to be misused by family and friends.

This metric tracks the pounds of prescription drugs taken into custody by the DEA during Take Back Day. The data is compiled by the Federal Drug Enforcement Agency. It is reported semi-annually. For national data regarding the DEA’s Prescription Drug Take Back Days visit DEA Diversion’s website. (Strategy 12.d)

Law enforcement prevents problematic drug use and overdose by making illegal drugs less available and by aggressively prosecuting drug traffickers.

The Maine Drug Enforcement Agency (MDEA)

The MDEA addresses the drug epidemic in the state by making deadly illegal drugs, such as fentanyl and fentanyl analogs less available. They also focus their investigative efforts on removing drug traffickers and dealers from our communities. (Strategy #13.a)

This metric tracks the grams of drugs seized by MDEA, the pharmaceutical dosage units of drugs seized by MDEA, and the drug related arrests made by MDEA by substance. This metric is an indicator of the illicit substances found in Maine by law enforcement officers as well as the quantity of illicit substances and traffickers of illicit substances removed from Maine’s drug trade by MDEA. MDEA data is reported annually. For full reports visit the Maine Drug Enforcement Agency Website’s News and Events Page.

Source: Maine Drug Enforcement Agency.

Source: Maine Drug Enforcement Agency.

Source: Maine Drug Enforcement Agency.

Source: Maine Drug Enforcement Agency.

The Maine State Bureau of Identification (SBI)

SBI collects and maintains criminal history information throughout the State including drug related arrests. These metrics tracks the number of drug arrests by substance and the number of opioid arrests by county. It does not include federal charges or dispositions. It includes data for all participating local, county, and statewide law enforcement agencies in Maine. These data do not include federal law enforcement arrests or seizures that take place in Maine. This data is reported monthly. (Strategy #13.a; 13.b)

Source: New England High Intensity Drug Trafficking Areas (NE-HIDTA).

The Maine Department of Corrections (MDOC)

MDOC, which operates six adult facilities throughout Maine aims to reduce the likelihood that juvenile and adult offenders will re-offend, by providing practices and identifying individuals who could benefit from programs and services which are evidence-based and which hold offenders accountable.

This metric tracks the number of residents admitted to the MDOC for new sentences with a primary sentence for a drug crime. The preponderance of primary sentences are for furnishing drugs. Only 3% of men and 4% of women incarcerated during 2022 were charged with the primary offense of drug possession. This metric is an indicator of individuals incarcerated for drug-related crime. This data is reported annually. (Strategy #13.a)

Source: Maine Department of Corrections. Annual Report on Substance Use, 2021.