Substance abuse specialists in Maine are seeing a sharp increase in heroin addiction, even as progress is being made against the misuse of oxycodone and other prescription opiate painkillers.

The trend, which mirrors national figures, worries treatment experts because it coincides with the imposition of state-mandated limits on the use of the most effective treatment drugs.

“We have a public health emergency here,” said Ronni Katz, the substance abuse program coordinator for Portland, describing the spike in heroin use Wednesday.

Locally, the trend “is really startling,” said Mark Publicker, an addiction specialist with Mercy Hospital. Injected heroin, “from the standpoint of an addict, is a better drug,” than prescribed opiates, because it gets into the system quicker and is more intense than pills, he said.

The American Society of Addiction Medicine reports that misuse of prescription drugs has dropped about 15 percent nationally since 2010, while heroin use has doubled since 2007.

Publicker said he’s unaware of figures that document heroin use in Maine, but he’s seen a sharp rise in the number of patients reporting that it’s their drug of choice.

Stuart Gitlow, the acting president of the society, said progress has been made against the misuse of prescription drugs through public education efforts that highlighted the drugs’ highly addictive nature, together with an effort to get doctors to limit painkiller prescriptions and more closely monitor the patients using them,

While that curbed the availability of those drugs to abusers, heroin became a cheaper, more readily available alternative, he said, particularly in New England, where high-grade heroin can be found. He said the drug in southern New England, where he’s based, is so pure that some users start out snorting the heroin, avoiding the deterrent of self-injecting.

Publicker, however, said he’s been struck by how many young people he sees in Maine who are using heroin by injecting it. Their inexperience, he said, often leads to overdoses. He said he knows of four nonfatal heroin overdoses in the Portland area in the last two weeks.

Publicker worries that increased use of intravenous drugs will lead to a rise in HIV, hepatitis C and blood infection cases in the state.

“We’re really at risk of seeing something we haven’t seen before,” he said. “All of these are certainties, not hypotheticals.”

The state, he said, is focusing more of its substance abuse efforts at prevention, which he said is good, but that endeavor needs to be combined with treatment, for a comprehensive and effective response to rising rates of heroin addiction.

“It’s akin to providing fire prevention (advice) when the house is on fire,” he said. “It’s a good idea for the next fire, but it doesn’t do anything for the immediate problem.”

Publicker and Katz, the substance abuse coordinator for Portland, are both concerned about the impact of state-mandated treatment limitations scheduled to start on Jan. 1.

The state will impose a two-year cap on the use of buprenorphine and methadone, the two most effective drugs for treating heroin addiction. The limit will be applied retroactively, so some who rely on the treatment currently may be cut off immediately, Publicker said.

He said he’s joined a task force that has been formed to try to carve out an amendment to the limit that would allow treatment to be extended if a doctor certifies that a patient is making progress socially — such as getting a job or going back to school — and has remained crime-free.

But Publicker also noted that only those with insurance can get treatment, so a lot of heroin addicts are unlikely to get help.

Katz said the cutbacks at a time when heroin use is rising creates a frightening scenario.

“It’s going to get far worse,” she said. “This is just a preview. Fasten your seat belts.”

 

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