Prescriptions for the powerful pain medications that helped hook so many people on opioids are down in Maine, as are the number of fatal drug overdoses.

That’s good news. But there remains plenty of evidence that the drug crisis is changing, bringing new challenges to policy makers, health care providers, law enforcement and families. Many of those Mainers will be at Gov. Janet Mills’ opioid summit on Monday in Augusta; they should address these new challenges.

Drug overdose deaths fell 14 percent year over year in the first quarter of 2019, continuing a decline that began in 2018. That means a dozen fewer families lost a loved one — no small victory for the many people who have been fighting up hill against this crisis.

It appears the largest factor in decline, state officials say, is the wide availability now of naloxone. The overdose-reversing drug was inexplicably criticized by Gov. Paul LePage, but has been embraced as the lifesaver it is by Mills, first as attorney general and now as governor.

Naloxone saves lives, and can be the first step in recovery. But if people require naloxone, it means they are still regularly using dangerous drugs. So while the number of overdoses may have dropped, that doesn’t necessarily mean people are getting the treatment they need to lead full, productive lives.

What’s more, within the overdose numbers there are signs that the focus on opioids is shifting habits. Most deaths were caused by two or more drugs, and cocaine was a factor in 31 percent of overdose deaths in the first quarter of 2019, up from 25 percent at the same time in 2018. Officials say methamphetamine use is on the rise as well.

That mirrors what is happening nationwide, as stimulants are increasingly found in overdose victims.It is not so different than shifts experienced over the last two decades in Maine, where bath salts and synthetic marijuana caused problems at different times alongside prescription drugs and street opioids.

It shows that what we have isn’t so much an opioid crisis but an addiction crisis, with people grabbing whatever is potent and available.

So while Maine works to increase the availability of treatments for opioid use disorder, such as methadone and Suboxone, the state will have to contend with a growing number of people struggling with addiction to substances that can’t be helped with those medications. Other treatment options will need to be available.

Just like the focus on naloxone and medication-assisted treatment was part of a opioid-centric response, so too were the efforts to decrease prescriptions, pushed heavily by LePage.

There was good reason — the overprescribing of painkillers fueled the drug epidemic, giving people an easy introduction to addictive opioids.

Fewer prescriptions will mean fewer pain medications lying around to be diverted to illicit use — and thus fewer people who will ultimately lose their lives, one way or the other, to addiction. That route to addiction, at least, won’t be as common.

But that does nothing for the thousands of Mainers already addicted to opioids. And as prescription drugs are cut off as a path to addiction, other routes — cheap heroin and fentanyl, as well as stimulants — come up to take its place.

Only in the last year or so has Maine taken substantial steps toward solving the drug crisis, and those efforts must continue.

But the crisis is changing. The state’s response will have to change with it.


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