Discussion of L.D. 1711 – Resolve: To Save Lives by Establishing a Homeless Opioid Users Service Engagement Pilot Project within the Department of Health and Human Services – was tabled twice in Augusta before an initial committee vote last month in favor of the bill. As the measure awaits further House and Senate action, the 50 identified lives and their acute needs are also on hold. This proposed pilot project is a lifeline and a declaration that people deserve better.

This pilot project’s acronym is HOUSE. There’s a poignant reason for this choice. A lack of affordable, accessible and safe housing in Portland is correlated with and may even be contributing to the opioid crisis. MaineCare changes have resulted in a significant drop in the number of adults eligible for health insurance, which means that their access to and coverage of treatment has been terminated. In Westbrook, one of Maine’s largest recovery centers closed, and emergency rooms are where many people go to see about withdrawal management/detox now. The shelters are overflowing and undersupported. Most of the substance-use treatment centers that involve housing are self-pay or accept only MaineCare or private insurance. It’s not enough, and it’s not working.

This pilot project would address the basic and immediate needs of a person struggling with homelessness and addiction: safe housing and treatment. The HOUSE program would provide medication-assisted treatment and rapid housing to concurrently address the person’s individual needs. Instead of talking in numbers about the rate of opioid-related overdoses, deaths, use of naloxone and emergency response-related services, our community would be treating each client with respect, dignity and the comprehensive support they need to start and then stabilize their recovery. The opposite of addiction is not just sobriety – it is connection. Homelessness and addiction are both isolating and traumatic experiences for all those involved. People need safety and support to start and sustain the healing that comes with addiction recovery.

The pairing of the housing-first model with evidence-based substance use treatment is a recipe for success. In Portland and across Maine, there are effective substance treatment programs that include housing, but they are few and far between, require insurance and most often run a waiting list. Addiction and waiting lists don’t make much sense when there’s an opioid epidemic occurring.

There’s a dollar amount to each overdose – the cost for people to access and utilize the hospital and emergency department for a safe place to be at night and the only substance abuse-related care available to them. Safe, sober housing paired with substance use treatment might also reduce the potential for the diversion, trade or sale of the treatment medications on our streets.

There is a clear need for lower-barrier housing options, as evidenced by the demand for the services provided by Preble Street, Oxford Street and Milestone. There need to be more low-barrier treatment options coupled with safe housing. The HOUSE pilot project will fit nicely in that continuum, because addiction is on a continuum.

This pilot project acknowledges the need for homeless individuals to gain concurrent access to rapid housing and low-barrier medication-assisted treatment and related treatment. These clients will likely be identified by their consistent and chronic use of the emergency department and crisis response workers, criminal justice system, use of the shelter and identified relationships with community providers. Our community providers know who these people already are, so let’s help them now.

That this pilot project could choose a number like 50 as a starting point tells me that the need for such services is much greater. I could probably pick out that many people who are in need and deserving of this program in an hour, during a drive through downtown Portland.

This is not just a health care or an economic crisis – it’s a social welfare and community crisis, touching on poverty, lack of rural access to services and disconnection and isolation. These people need and deserve to have their basic needs met. To expect a person to successfully undergo substance use treatment while they’re homeless and barely surviving is unrealistic. Many people are labeled as “noncompliant” or not ready for treatment just because they couldn’t afford to lose their bed at the shelter to get to a treatment appointment, or didn’t have a bus pass or a place to stay in preparation for attending treatment the next day. These barriers might be removed if they had permanent housing that is connected to their treatment.

Programs like this exist, but there are waitlists. Let’s not wait any longer to make this pilot project a reality. These people deserve a home, but for now at least they can get the HOUSE.

— Special to the Press Herald

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