The case for universal prevention as a solution to the heroin crisis

This article was inspired, in part, by a recent presentation by the great Dr. Dennis Embry at the recent 2015 National Prevention Network Conference.

As you might imagine, working in the field of substance abuse, I have been a part of a few discussions with colleagues about this heroin/opiate crisis our state faces.  In a few instances now, this common parable has come up in the conversations.  I’ve heard it in a few different iterations, but basically it is a parable about a river.

The parable goes: there are some people fishing in a river and they notice someone floating down the river, drowning, so they jump in and rescue the person.  Then they notice another person so they go in and rescue that person, then another.  They decide they will put a net at the end of the river to catch people to keep them from going over the falls and drowning.

This is our heroin and opiate problem.  And our net is full of people sized holes and failing far too many Mainers.  The political back and forth about how to solve this problem is mired in how to fix the net.  Is it law enforcement?  Treatment?  How do we plug up the holes?  And we absolutely need to do this work and is the charge of the law enforcement and treatment work groups of the U.S. Attorney’s Opiate Collaborative.  However, in the parable of the river, there is that one voice that comes along and asks, “Shouldn’t we figure out how people are falling into the river in the first place?”  That is prevention and recovery.  Building a fence to keep people from falling into the river or those who’ve escaped the river from falling back in.  But we even can’t stop there.

Substance use is a social issue, and like other social issues, it doesn’t go away when the news cameras and newspaper headlines stop covering it.  This isn’t going to be a situation where these three task forces are going to come up with a plan, implement it, solve the problem and then we all move on.  We have to be in this for the long haul.  Not two years, not five years, not ten.  What is heroin and opiates today was cocaine and crack in the 80s, will be [insert new synthetic drug] ten years from now.  We need a fundamental and systematic shift in how we address substance use disorders, yes, in terms of treatment but also in terms of prevention.

We eradicated polio through prevention, through a program of vaccination and public education.  This is what we need for behavioral health.  We have the research and science.  We know how to build protective factors and reduce risk factors, starting at early ages.  What we haven’t done yet is actually invest and implement prevention universally.  We’ve been doing it in pockets and in a reactionary way with very meager resources.

I can hear the question some readers may be asking.  How would we pay for that?  Let’s look at a program such as the Good Behavior Game.  This simple yet effective program costs less than $300 to implement in an elementary classroom.  It is a program that teaches kids self-regulation, self-control, and collaboration at a very early age.  It is an evidence-based program listed on the Substance Abuse and Mental Health Services’ National Registry of Evidence-Based Programs and Practices.  Multiple studies have followed those who were exposed to the program and found substantial reductions in tobacco and substance use and increases in academic performance along with increased mental health.

Imagine the positive outcomes we would see if we implemented this program in every first grade classroom in the United States, while providing universal parent support programs in primary care settings.  With this established prevention science we could “vaccinate” our children by building those protective factors and dramatically reduce the number of Mainers developing a substance use disorder.

Here is the thing, we are all paying for the costs of substance use in Maine, and the price tag is steep.  The last Cost of Substance Abuse to Maine report from 2010 put that annual price tag at $1.4 Billion.  That is $1,057 for every resident of Maine and a 56% increase from 2005.  One can assume the cost in 2015 has escalated even more.

Beyond the immense benefit to our communities and society, universal prevention would see a substantial savings in healthcare costs, lowered morbidity, higher worker productivity, lower criminal justice and law enforcement costs, among other costs.  Universal prevention would pay for itself and then some. We wouldn’t have to buy any more nets.


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.