Gov. Janet Mills focused a substantial portion of her State of the Budget speech on the opioid crisis, unveiling new initiatives to try to save lives less than two weeks after the state reported that 2022 had been Maine’s deadliest year ever for drug overdose deaths.

Her speech Tuesday included pledges to use millions of dollars in new spending to address the crisis. The governor devoted more than 10 minutes of her hourlong address to the problem. “The scourge of addiction continues to reach into every corner of our state,” she said.

The emphasis stood in stark contrast to the annual speech to lawmakers delivered by Mills one year ago, when she drew criticism for including only a brief mention of the opioid epidemic.

The governor’s focus was welcomed by advocates. But some in the treatment and recovery community are still not convinced that Mills’ latest plan is robust enough to reduce the wave of drug overdose deaths that have devastated Maine. And some of her words were criticized as adding to the stigma of addiction.

Dr. Noah Nesin, innovation adviser for Penobscot Community Health Care in Bangor, said Mills’ speech was important.

“It’s a signal to the Legislature and others in government that this is something we are really going to press for this year,” Nesin said.

But Nesin also said one of the most persistent barriers to access to treatment has nothing to do with state spending, but rather resistance by some primary care providers who are reluctant to treat substance use disorder.

Courtney Gary-Allen, organizing director for the Maine Recovery Advocacy Project, which lobbies on behalf of the recovery community, said she has mixed feelings about the speech. Gary-Allen said so much more needs to be done, and she sees the measures touted by Mills as only incremental steps.

“We are building access, but the problem remains that the people don’t have access to what they need to address their substance use,” said Gary-Allen, who also is an Augusta city councilor.

The 716 lives lost in 2022 far surpass the previous record of 631 overdose deaths in 2021, and deaths have climbed steadily during the past decade. While experts say access to treatment, overdose-reversing medication and other help has improved in recent years, the devastating impacts of the opioid crisis continue to ravage families in Maine.

SUPPORT VS. STIGMA

Gary-Allen is herself in recovery and lost custody of her children for nearly a year in 2015 because of her drug use. She said parts of Mills’ speech that highlighted the problem of broken families caused by parental drug use were stigmatizing.

In her speech, Mills said “Maine’s drug epidemic is a grave threat to the safety of our children” and cited two real-life examples of children harmed by being accidentally exposed to fentanyl by parents.

“The way (Mills) talked about parents who use drugs was so deeply harmful,” Gary-Allen said. “I listened to it and thought, ‘Oh, that’s how she feels about me.’ All of those things that happened doesn’t make me a bad person.”

Gary-Allen said her parents had substance use disorder and that she had a difficult childhood. She had her first of two children at age 14 and later developed substance use disorder herself. Her children were removed from her in 2015 and placed into the foster care system because of her cocaine and heroin use. She said she was able to get them back after successfully completing a Family Recovery Court program and has since rebuilt her life. She earned a bachelor’s degree and is now pursuing a master’s degree, has gotten married and was elected to the Augusta City Council.

While criticizing some of the governor’s words, Gary-Allen also believes Mills is trying to do the right thing in addressing the opioid crisis, especially when compared to her predecessor, former Gov. Paul LePage.

“Gov. Mills has been an ally on this issue time and time again,” Gary-Allen said.  “I believe she deeply cares about the lives of Mainers with substance use issues.”

One area where Mills’ record contrasts sharply with LePage’s is the availability of naloxone, a medication that reverses overdoses that could otherwise be fatal. LePage was against the wide use of naloxone, while Mills has embraced the strategy.

During the speech, Mills announced a 25% increase in the supply of naloxone, with an emphasis on boosting supply in rural areas.

Gordon Smith, the opioid response director for the Mills administration, said in an interview with the Press Herald that there are still some issues with inadequate supply in rural Maine, and saturating the market will help save lives. Since 2020, the state supply of naloxone – known by its brand name, Narcan – already has more than doubled.

“Naloxone is a miracle drug if we get it there in time,” Smith said.

EXPANDING TREATMENT

Mills also announced a $2 million investment to help treatment centers complete renovations and expansions, a move aimed at increasing the supply of both detox beds and long-term treatment. Paired with a previous $3 million investment in residential treatment, the state is adding nearly 250 beds for residential treatment programs.

Nesin said residential treatment, while expensive, will likely be a growing need because more people have severe substance use disorder and need more comprehensive treatment than an outpatient setting can provide.

“We don’t have enough residential treatment, but the state has recognized this and prioritized it,” Nesin said.

But Gary-Allen said an additional $2 million, while important, is “not even close” to the investment needed compared to the demand.

“It’s a political ploy,” Gary-Allen said. “It’s an attempt to appease the people on the front lines.”

Gary-Allen said her group has counted only 26 accessible detox beds in Maine, meaning detox beds that do not require admission to a hospital.

Mills also touted boosting a state program that partners a social worker with police and fire departments to help connect people with substance use disorder. The state is investing an additional $1.5 million annually to double the program from 16 social workers to 32.

“This is real work on the ground,” Smith said. He said the gold standard is to follow up with people who survive overdoses “and then connect them to harm reduction or a pathway to recovery.”

Lauren Dembski-Martin, social services navigator for the Scarborough Police Department, said demand for treatment is high, and that the state’s program is valuable in helping to find resources for people struggling with substance use who come into contact with police. Doubling the program will help expand its reach, she said.

“You can never have too many resources, especially when we are talking about the opioid epidemic, substance use disorder and recovery,” Dembski-Martin said.

The Mills administration already has improved access to outpatient treatment by doubling Medicaid reimbursement rates for medication-assisted treatment, Smith said. Also, expanding Medicaid provided access to a lower-income population that didn’t have insurance and was previously shut out of treatment. Now 25,000 people in the Medicaid expansion population have taken advantage of substance use treatment programs.

“The access is improving all the time,” Smith said. “I’m more optimistic about that than I ever have been.”

Nesin said the state has done an admirable job of improving access to outpatient treatment, but now the goal is to change the culture of primary care doctors to prescribe Suboxone and other medications that can help patients manage their addiction and begin long-term recovery. Previous barriers to prescribing Suboxone by the federal government have been eliminated, and with improved reimbursement rates, Nesin said there’s no longer any excuses for doctors to not prescribe the medicine when it’s needed.

CHILD WELFARE

Mills’ initiatives on the child welfare front include a $1.3 million investment being used to hire eight substance use disorder specialists who will work with child welfare caseworkers. Also, the Mills administration is launching a $250,000 pilot program to hire recovery coaches who will help families struggling with substance use disorder.

Smith said both groups will provide much-needed assistance to caseworkers who are trying to help families.

“We are going to be hiring individuals who have lost their children but successfully gotten their children back – people who had previous serious substance use disorder – and get them to coach families struggling with this issue right now,” Smith said.

Gary-Allen said while she was upset about the way Mills referred to parents who have used drugs, she is excited about the policy implications of bringing in specialists to help coach parents into recovery.

“The fact that we want to support parents in getting their children back is great,” Gary-Allen said.

But she said it will take a comprehensive, sustained effort to make it work.

“The reason why I was able to get through that system and have my children back in my life is because I had access to housing, treatment, education and community support,” Gary-Allen said. “And people didn’t shame me for using drugs.”

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