Maine’s Heroin Crisis: Solution Not as Simple as Enforcement vs. Treatment

The past week has seen some much-needed wall to wall coverage of the heroin crisis across most major Maine media outlets.  The most recent headlines have been around the recent rash of overdoses over the course of a 24 hours period in Portland.  This isn’t the first time we’ve seen that story.  There have been previous clusters of overdoses in other Maine cities and communities.  But this is a scourge that doesn’t discriminate by geography or socioeconomics.  It can and does infiltrate communities big and small, poor and affluent.  This growing issue with heroin addiction and overdoses isn’t confined to any one state, as recent reports indicate that heroin deaths have quadrupled across the US between 2002 and 2013.

A Call to Action: It Isn’t As Simple as Treatment vs. Law Enforcement

Everyone agrees that this is a significant and deadly public health issue that we need to get our arms around, and fast.  Wednesday, Governor Paul LePage called for a summit of law enforcement and addiction experts to take on the issue.    Meanwhile, the public conversation has moved to discussing what the response should look like, revolving around a law enforcement vs. treatment debate.  From my perspective, this over-simplification sells ourselves short and sets us up for failure.  The reality is that it is far more complex than a binary set of choices, and I’m not sure pitting one against the other will really get us to where we need to be.

Now, it absolutely needs to be said that the state of access to substance abuse treatment options in Maine is completely inadequate.  For many Mainers, access to treatment is near impossible because they live too far away, or they don’t have transportation, or they don’t have the coverage or means to pay for services.  This is true of treatment for all substance abuse issues whether it is heroin, alcohol, marijuana, or prescription drugs.  This, of course, isn’t a new issue.  It has long been pointed out ever since I entered the substance abuse field a decade ago.  But the urgency of the issue has increased dramatically.

At the same time, there are also legitimate and rising public safety issues.  The cheap heroin that is in our state isn’t being produced in Maine, it is coming up from southern New England as well as the New York/Pennsylvania region.  That flow of drugs isn’t going to stop while we address our deficits in treatment.  The safety of our communities is a critical element.  This shouldn’t be a matter of law enforcement vs. treatment.  Instead, let’s move that part of the conversation towards how do we do a better job at improving both.

Learning From the Past

This won’t be the first drug abuse summit Governor LePage has called for during his time as Governor.  Back in 2011, he convened a summit that focused on the prescription drug abuse epidemic in Maine.  I was fortunate to be invited as one of the many Maine experts that came together to create a strategic approach to that issue.  It was a time when we were looking at similar headlines of prescription opiate overdoses and a more than doubling of pharmacy robberies.  At this summit it was recognized from the beginning that the approach that was needed was one that was multi-pronged.  It would need to be an approach that included law enforcement, prevention, intervention, treatment, recovery, the medical community, and even environmental protection officials.

What came out of that summit was a task force, led by then Attorney General William Schneider, that took on the task of developing the multi-pronged, comprehensive response to the prescription drug abuse crisis in Maine.   Out of that task force came improvements to the Prescription Monitoring Program, development of prevention and education resources, the expansion of the Diversion Alert program, and broadening drug disposal options in Maine.  Obviously, there is still much work to be done.  The point is when we embrace a comprehensive approach to these issues, looking at the spectrum of services including prevention, treatment, and recovery, we can make some real and measurable progress.  Most importantly, progress that improves the health, wellness, and quality of life of many Mainers.  Let us keep in mind that is really what is at stake here.

The Crucial Role of Prevention and Recovery Services

Part of the comprehensive approach to the heroin crisis needs to include prevention and recovery services.  We need to ask ourselves, how can we create communities with fewer risk factors that lead to substance abuse in the first place?  How can we increase the protective factors in communities that build resiliency amongst our youth and decrease the likelihood they will use drugs?  How can we build communities that promote and nurture wellness for people in recovery while setting them up for long-term success?  We also need to be able to address the short-term and the long-term.  We need to be nimble and agile enough to address the immediacy of the deaths and overdoses related to opiate abuse while also looking at approaches that address the long game.  Where do we want to be next week, but also, where do we want to be next year?

We absolutely have the knowledge, skill, and expertise in Maine to tackle this.  The media spotlight and the summit proposed by the Governor provides an excellent opportunity to bring together these forces and get some wheels into motion.  We must resist the temptation to boil it down to an over-simplified either/or menu of solutions.  We must be willing to engage in multiple strategies, involving multiple sectors, and involving folks working on the ground in the communities of Maine.  We must also be in this for the long haul and dedicate ourselves to maintaining momentum after the media spotlight turns to the next hot-button issue.  This is bigger than any one summit, it is bigger than any one task force.  Let’s get to work!




Scott M. Gagnon, MPP, PS-C

About Scott M. Gagnon, MPP, PS-C

Scott M. Gagnon, MPP, PS-C is a Certified Prevention Specialist and is the Director of Operations at AdCare Educational Institute of Maine, Inc. He currently serves on the Maine Substance Abuse Services Commission as well as the U.S. Substance Abuse and Mental Health Services, Center for Substance Abuse Prevention National Advisory Council. Scott volunteers as the Chair of the marijuana policy education and advocacy group, Smart Approaches to Marijuana Maine and is the current Board President of the Maine Council on Problem Gambling. Scott also serves as a Co-chair of the Prevention & Harm Reduction task force of the Maine Opiate Collaborative, the effort convened by U.S. Attorney Thomas E Delahanty, II to address Maine's growing opiate and addiction crisis. Scott is the recipient of the 2015 Maine Public Health Association's Ruth S. Shaper Memorial Award and 2015 Healthy Androscoggin Will Bartlett Award and is also the 2013 recipient of the Maine Alliance to Prevent Substance Abuse Prevention Award.