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How is the state of Maine confronting the epidemic of substance use disorder?

The State of Maine’s annual Strategic Action Plan is designed to address the epidemic of substance use disorder (SUD) with evidence-based strategies that are targeted and tailored for maximum impact in Maine. Since Executive Order 2, issued two years ago, the Mills administration has taken the following steps:

  • Purchased and distributed 59,782 doses of naloxone through public health and harm reduction organizations (through December 2020), resulting in 1,231 opioid overdose reversals during 2020. 
  • Recruited and trained 534 recovery coaches.
  • Provided Medication Assisted Treatment (MAT) to over 500 inmates within the Department of Corrections, while they were incarcerated or linked to community providers upon release.
  • Provided MAT to over 250 individuals with a diagnosis of SUD in county jails.
  • Supported 22 emergency departments in standing up low barrier MAT through which over 500 patients received their first dose of medication in the hospital.
  • Increased the prescribing of buprenorphine for MAT by 43% in the past three years.
  • Increased the number of recovery residences from 101 to 120 in two years.
  • Increased Syringe Access Program sites from 7 to 12.
  • Increased Recovery Centers from 9 to 13 locations.
  • Enhanced prevention efforts, including the Department of Education making available to every school in Maine a pre-K through grade 12 social and emotional learning curriculum know as SEL4ME.
  • Served 295 individuals in Maine’s Adult Drug Courts, Co-Occuring Court and Veterans Courts in 2019, and increase of 11.3% over the previous year.

Non-pharmaceutical fentanyl and fentanyl analogs have caused a surge in overdose fatalities.

In Maine, drug deaths have been trending upwards since 2014 when the state first saw drug death toxicology reports containing non-pharmaceutical fentanyl and fentanyl analogs. Drug deaths had peaked in 2017 and began to fall in 2018. However, the COVID-19 pandemic has created instability in the drug supply, use-patterns, and the well-being of Mainers.

The chart below highlights the upward trend of overdose deaths by quarter since the fentanyl epidemic began in Maine. Overdose deaths are an indicator of deadly substances in the drug supply, and, with the outbreak of COVID-19, chaotic and unpredictable use patterns.

Source: Office of the Maine Attorney General, Maine Drug Death Report, 2020.

The chart below highlights the rise in non-pharmaceutical fentanyl fatalities beginning in 2014. The blue line shows that since 2016 deaths involving heroin and morphine have fallen. The navy line represents the total number of drug deaths. Since 2014, deaths due to non-pharmaceutical fentanyl (red line) closely mirror the total fatalities due to drugs.

Source: Office of the Maine Attorney General, Maine Drug Death Report, 2020.

Monthly fatal and nonfatal drug overdose report

The monthly overdose report, funded jointly by the Maine Office of the Attorney General and the Office of Behavioral Health, provides an overview of statistics regarding suspected and confirmed fatal and nonfatal drug overdoses in Maine during each month. Data for the report is collected at the Office of Chief Medical Examiner and as part of the Maine Naloxone Distribution Initiative. Year-to-date numbers will be updated with each new monthly report, as cases are finalized, and their overdose status is confirmed or ruled out. The totals are expected to shift as this evolution occurs. In addition, due to the smaller sample size in any given month, totals are expected to fluctuate due to the effects of random variation.

In Maine, harm reduction programs, such as naloxone distribution, save lives by allowing bystanders and public safety officials to reverse potentially fatal overdose events.

In July of 2019, the Maine Naloxone Distribution Initiative launched an overdose education, prevention and naloxone distribution project. Public health and harm reduction partners, known as Tier 1 Distributors, began distributing state-supplied naloxone rescue kits across Maine to clinicians, community partners, and end users. Naloxone is a medication to have on hand in case of an opioid emergency. It is designed to reverse the effects of opioids in the body.

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

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

There are many organizations distributing and administering naloxone in the State of Maine in an effort to mitigate the opioid overdose crisis. Law enforcement officers carry naloxone through a program administered by the Maine Office of the Attorney General to allow officers arriving first at the scene to begin to medically treat an overdose. EMS routinely carry naloxone to respond to opioid-related emergencies. As mentioned above, in 2019 with the creation of the Maine Naloxone Distribution Initiative, public health and harm reduction organizations began distributing state-supplied naloxone to clinical sites, community organizations, and end-users throughout the State of Maine.

Source: Office of the Maine Attorney General and OD MAP provides law enforcement data. Maine EMS provides EMS data. University of Maine, Margaret Chase Smith Policy Center provides Maine Naloxone Distribution Initiative data.

Maine is connecting an increasing number of individuals to treatment and recovery services.

Through the Maine Department of Corrections, the expansion of MaineCare treatment services, and the expansion of the drug court system more Mainers are being connected to essential substance use disorder treatment and recovery services.

Since 2015, enrollment and successful completion of substance-use programming has increased by men and women who are incarcerated. Examples of these programs include relapse prevention, living in balance, and medication-assisted treatment among others.

Source: Maine Department of Corrections, 2019 Year End MDOC Adult Data Report, 2020.

Since 2015, the number of MaineCare claims submitted for substance-use disorder treatment has increased. Opioids and alcohol represent a preponderance of the primary reason that individuals seek treatment. In 2019, cocaine and other stimulants emerged as a third major cause for individuals to seek treatment.

Source: Office of Behavioral Health, Substance use disorder treatment trends.

In Maine, drug treatment courts are special programs that utilize intensive judicial monitoring; specialized treatment, frequent and random drug testing, case management services, alongside other needed services including housing, employment, and health care. Clients are referred to the program by defense attorneys, district attorneys, judges, jail staff, family members, and themselves. Successful clients participate for a minimum of one year, at the end of which they will complete an agreed upon sentence. Any jail time is typically served prior to beginning the program.

Source: Maine Pre-Trial Services. Office of Behavioral Health.

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