AUGUSTA — While federal and New England state officials discussed strategies for combating the opioid crisis at a statewide summit Monday, Mainers shared personal stories of family and friends dying of drug overdoses and their own struggles with substance use disorder.

About 1,000 people attended the “Turning the Tide” opioid summit at the Augusta Civic Center, an event organized by Gov. Janet Mills’ administration. It was the largest event of its kind in Maine since the opioid crisis accelerated about five years ago. Maine experienced a record 418 drug overdose deaths in 2017, declining to 354 deaths in 2018, but the deaths are still historically high.

Attending Monday were Sam Quinones, a Los Angeles-based investigative journalist and author of the book “Dreamland”; Michael Botticelli, former White House director of National Drug Control Policy during the Obama administration; and Dr. Patrice Harris, president of the American Medical Association and others.

Mills, who has made alleviating the opioid crisis one of her top priorities since her term began in January, said that it’s important to hear ideas from many sources.

“Everyone has ideas, and if you bring them all together, you may hear something different than anything we ever thought of here,” Mills said. “We know there’s no silver bullet. There’s no one solution.”

Mills has adopted a 10-point plan for the opioid crisis, heavily focused on prevention, increased access to treatment, eliminating a two-year cap on medication-assisted treatment for Suboxone and methadone, easier access to opioid antidote naloxone, and connecting people who need help to treatment. Expanding Medicaid, which began on her first day in office in January, opened access to medication-assisted treatment for thousands of Mainers.

Mills said in looking at what other states have done, she’s intrigued by how Rhode Island has brought medication-assisted treatment into its prison system, and also provided follow-up treatment to those re-entering society after they finish their prison sentence. A study showed that prisoners were 61 percent less likely to have a drug overdose after being released from prison in Rhode Island compared to prisoners who were released prior to the treatment program being available.

Sam Quinones signs a copy of his book “Dreamland” before his presentation Monday at the governor’s opioid conference in Augusta. Andy Molloy/Kennebec Journal

Quinones, in his 2015 book, focused on how the opioid crisis ravaged Portsmouth, Ohio, a town of 20,000. He tracked how Portsmouth was overwhelmed with pills, starting in the late 1990s. Quinones said the opioid crisis is a nationwide problem, but by taking a deep look into one town in Ohio, he was able to explain the many factors that contributed to the crisis.

He said the opioid manufacturers, starting in the 1990s, successfully marketed the opioids as a non-addictive way to alleviate pain, despite scant evidence that they were effective and not addictive.

The American people bought into the ploy, Quinones said.

“We want things quick and easy. If you’re hurting, it’s like bringing yourself to a car mechanic,” Quinones said. “Doc, fix me up.”

But pain is complicated, and treating it is not easy, as society later discovered, he said.

Under the LePage administration, Maine was one of the first states in the country to approve a strict opioid prescribing law, limiting dosages and length of prescriptions. Maine’s opioid prescribing has fallen 41.5 percent since 2013, according to IQVIA, a consulting and research firm, and experts have said part of the substantial decline stems from the law.

Patients are much more likely to overdose when they have a high-dose prescription.

Susan Bernardini, 49, of Bangor, said she was prescribed opioids for a broken ankle in 2009. She became dependent on the opioids, and her life spiraled downward for about a decade. She said she’s been sober now for about six months from alcohol and nearly a year from opioids.

Bernardini said if the prescribing law had been in place a decade ago, she likely wouldn’t have abused opioids

“I lost my nursing license, and I’ve had years of stigma,” she said. “The whole epidemic is outrageous.”

Harris, president of the AMA, said states have to be careful not to approve laws that encroach onto the doctor-patient relationship, and make opioids so hard to obtain that some patients “suffer needlessly.”

Maine’s law does carve out exceptions for cancer pain, palliative care and others.

Dr. Noah Nesin, chief medical officer of Penobscot Community Health Center, said there’s  no evidence that opioids are effective in controlling chronic pain, and research on certain types of chronic pain, such as back pain, points to opioids being harmful to patients.

Harris said that while treating pain is not as simple as handing out painkillers, she noted that the solutions have to be accessible to most patients.

“We shouldn’t be overly reliant on what I would call ‘middle-class solutions,'” Harris said. For instance, physical therapy is often done during working hours when many can’t get the time off to attend, and even for those who have insurance, the co-pays are often expensive, putting the therapy out of reach for many patients.

Harris said she’s not against physical therapy, but it’s an example of how the health care system needs to work at reducing barriers to treatment. Harris said in Virginia, programs provide transportation to opioid treatment, eliminating one common barrier.

“There are areas of hope across the country,” Harris said. “And Maine is doing some great things.”

 

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