Maine experienced a larger jump in drug overdose deaths than all but five other states in the 12-month period ending Jan. 31, a stark statistic highlighting Maine’s slow progress combating the opioid crisis.

According to federal data released this week, the number of overdose deaths in Maine increased by 10.9 percent between January 2017 and January 2018. That is 65 percent higher than the national average of 6.6 percent and places Maine sixth in the nation – behind Nebraska, North Carolina, New Jersey, Indiana and West Virginia – in terms of the increase in the drug-related death toll last year.

The U.S. Centers for Disease Control and Prevention reported that 407 individuals died of drug-related overdoses in Maine during that period, up from 367 deaths in 2016. Those figures are likely conservative because they are based on mortality reports but also some preliminary data. The Maine Attorney General’s Office reported 418 and 376 overdose-related deaths, respectively, for the 2016 and 2017 calendar years.

Yet the federal data allows substance abuse experts and health professionals to track the overdose trends across states. And the picture painted of Maine is not a good one.

“The trend nationally is overdose deaths were not increasing as rapidly as they were and the last couple of months we can see a flattening” of the trend line, said Dr. Dora Anne Mills, vice president for clinical affairs at the University of New England and a former head of the Maine CDC. “Tragically, in Maine we can see the (rate) is increasing and we’re not seeing any slowing yet.”

Nationwide, the CDC reported that more than 72,000 people died of drug-related overdoses in 2017 – a jump of nearly 6,000 deaths over the previous 12-month period. A CDC graphic illustrating total deaths during 2017 shows the line starting to gradually decline in September/October of last year at the national level yet, in Maine, where many experts have said the state isn’t doing enough to combat the crisis, the line continued to climb until January 2018.

In fact, Maine was an outlier among its New England neighbors.

Rhode Island, Vermont and Massachusetts all saw overdose deaths decline by between 1.1 and 7.1 percent between January 2017 and January 2018. New Hampshire and Connecticut did experience another increase in deaths, but their respective rates of 2.2 percent and 7.6 percent were well below Maine’s 10.9 percent.

Last year, the Portland Press Herald/Maine Sunday Telegram published “Lost”, a 10-part series that examined the impact of the opioid crisis on the state. The series found that although many other states have been dealing with the same issue, the problem here has been made worse by a lack of resources and a lack of consensus on how best to combat the problem.

Dr. Jonathan Fellers, medical director of Maine Medical Center’s integrated medication-assisted treatment program, said he was not surprised to see the death rate continuing to climb in Maine even as other states have experienced declines.

“The trend has been for the past several years that it has been going up, and locally part of that has been a big increase in fentanyl in the marketplace,” Fellers said. “That seems to be driving the increase.”

Fentanyl is a powerful synthetic opioid developed as a pharmaceutical painkiller. As the national opioid crisis worsened, some illegal drug dealers and traffickers began combining – or cutting – heroin and other opioids with fentanyl because it is easier to manufacture in a lab and transport. But with the synthetic drug hundreds of times more powerful than heroin, addicts’ inadvertent use of opioids mixed with fentanyl has had incredibly deadly consequences.

Fentanyl surpassed heroin for the first time as the top cause of overdose-related deaths last year, killing an estimated 247 of the 418 people in 2017.

Fellers said Maine Med’s facilities are seeing more overdose patients coming in with only fentanyl in their systems, meaning the drug wasn’t even cut with heroin.

Fellers said it took longer for fentanyl to begin showing up in large amounts in Maine compared to New Hampshire, which was in the grips of an even worse overdose death epidemic than Maine several years ago. That could be one reason, among many, that Maine’s overdose rate continues to climb at a higher rate than New Hampshire’s, he said.

But substance abuse experts have repeatedly criticized the LePage administration and state lawmakers for failing to take bold steps – including providing millions of dollars in needed funding – to address the issue. However, a suite of bills passed this summer was viewed as a much-needed step.

While overdose deaths continue to rise in Maine, a spokeswoman from the Maine Department of Health and Human Services said recent initiatives appear to be having a positive effect.

Spokeswoman Emily Spencer said overdose deaths in Maine soared nearly 40 percent between 2015 and 2016, so the roughly 11 percent increase “definitely points to some substantial progress” in slowing the rate of growth.

In particular, Spencer attributed that progress to the recent emphasis on the “hub-and-spoke” model of care that integrates medication-assisted treatment – widely considered the most effective treatment for opioid addiction – with counseling, support and general health care services. The idea behind hub-and-spoke is individuals are more likely to succeed under a comprehensive approach that includes health and wellness, in addition medication-assisted treatment with methadone or Suboxone.

Lawmakers have been discussing for several years the hub-and-spoke model successfully used in Vermont and other states, but only allocated $6.6 million to the initiative this summer.

Several hospitals and health care systems, including Maine Med, had begun to implementing the hub-and-spoke system on their own, but part of the $6.6 million will help cover medication-assisted treatment for the uninsured, Additionally, Spencer said the state’s program to track prescriptions for opioid medications has led to a substantial decrease in prescriptions of the powerful painkillers that have become the entrance point to addiction for many people.

Another initiative to help the uninsured, known as “opioid health homes,” was allocated $4.8 million by the Legislature in 2017 to help 170 individuals access treatment, but had only helped five people as of February. However, Spencer said Thursday that the program is now up and running, and the homes are beginning to serve more individuals.

Asked about Maine’s slow progress compared to other New England states, Spencer said the recent initiatives passed by the Legislature and implemented by the LePage administration will take time to develop.

“What is important to understand is it will take several years before the treatment and prevention programs are able to dramatically reduce overdose deaths,” Spencer said. “So we are working very hard to make sure those programs take a holistic approach to these problems.”

Maine Med’s Fellers said other states have successfully reduced overdose numbers by expanding Medicaid coverage – which Gov. Paul LePage continues to block despite a voter-approved ballot initiative and court orders – and by addressing the stigma tied to drug addiction. But Fellers hopes the recent steps by lawmakers and the administration will prove successful.

“I’m really hoping we are going to have more funding going forward,” he said. “It’s going to help us to build our systems and help a lot more patients.”

Mills, the former Maine CDC director, said Maine needs to continue following the examples set in Vermont, Massachusetts, California and other states that have adopted comprehensive, “soup-to-nuts” approaches involving prevention, treatment and follow-up care. In addition to the hub-and-spoke model, Mills said states have also shown the importance of ensuring that those who enter jail with substance abuse disorders have access to continuing treatment after release.

She said Maine also needs to do a better job of tapping into federal dollars.

“There are federal funds that have been distributed to states to help fund these types of efforts, and Maine hasn’t fully utilized those funds,” Mills said.

Kevin Miller can be contacted at 791-6312 or at:

[email protected]

Twitter: KevinMillerPPH

filed under: