I read with interest your articles about the recent decline in Maine’s overdose deaths. This is good news, but to make further progress, we need to understand the reasons for the decline. In addition to the reasons you cite, I believe that law enforcement played a role.

Maine’s overdose deaths peaked at 417 in 2017 and declined 15 percent to 354 in 2018. The meaningful decreases have continued, with 74 deaths between January and March, down 14 percent from 86 deaths during the same period in 2018.

Your Aug. 8 story “As use of opioid antidote increases, drug overdose deaths decline” cited “a strong correlation between the two trends.” Your Aug. 2 story “Emergency hospital admissions for drug overdoses have declined in Maine since 2017” credits the increased availability of Suboxone to curb cravings for, and naloxone to block the effects of, opioids. Your July 15 story “Governor’s opioid summit brims with ideas for solutions to crisis” identified prevention, treatment, Medicaid expansion and easier access to naloxone. None of your articles, however, mentioned the role that law enforcement played in the decline.

The possibility that naloxone may be part of the explanation is understandable. Although our state does not comprehensively account for the amount of naloxone that has been made available or administered, there is no doubt that it became more widely available during the time of the fatal-overdose decline.

To the extent that naloxone administrations were tracked, they show that first responders went to the scenes of more suspected overdoses in 2018 (1,003), but administered naloxone less frequently (538 times), than in 2017 (761 and 573, respectively). It’s possible that they did not have to administer naloxone because someone else had already done so. But that is somewhat speculative because of resistance to collecting data in this area.

The U.S. Drug Enforcement Administration is trying to address that information gap. It has been making its Overdose Detection Mapping Application Program available in Maine. This mobile application allows first responders to quickly document, in real time, overdoses and associated facts such as naloxone administrations. Its statewide adoption would go a long way toward filling in the information gap and promoting better understanding of the trends.

Your Aug. 2 story also associated the decline in deaths and admissions with Medicaid expansion and increased access to substance abuse disorder treatment compared to two years ago. Whatever you think of the expansion of MaineCare starting in January, it doesn’t explain declines the year before.

Not mentioned in any of the articles was the possibility that law enforcement had a deterrent effect on users and dealers.

In December 2016, the Department of Justice announced its Strategy to Combat the Opioid Epidemic, which included stepped-up prosecutions of opioid cases and resulted in over 60 federal prosecutions in Maine.

For example, between 2014 and 2016, Erick Adams of Taftville, Connecticut, conspired to distribute heroin, cocaine and crack in Maine and illegally possessed a firearm. On May 16, 2018, he was sentenced to 25 years in prison.

Between 2015 and 2016, Jamie Akerson of Newport and Myron Crosby Jr. of Springfield, Massachusetts, conspired to distribute 8 kilograms of heroin in Maine. On Oct. 15, 2018, Akerson was sentenced to over 13 years in prison. On July 30, Crosby was sentenced to 14 years in prison.

Between 2015 and 2017, Andre Fields of Bronx, New York, conspired to distribute over a kilogram of heroin and crack in Maine. On May 21, he was sentenced to over 14 years in prison.

Between 2016 and 2017, Jordan Richard of New Vineyard conspired to distribute cocaine, heroin, fentanyl and oxycodone, and discharged a firearm in relation to that conspiracy. On Jan. 28, he was sentenced to over 13 years in prison.

On Aug. 30, 2017, Dejuan Rabb of Brooklyn, New York, distributed furanyl fentanyl and crack to a person working with law enforcement. On July 19, 2018, he was sentenced to nearly 12 years in prison.

In November 2017, Ariel Martinez of Lawrence, Massachusetts, was stopped in Brunswick with 19 grams of fentanyl. On July 25, he was sentenced to 12½ years in prison.

In July 2018, then-Attorney General Jeff Sessions came to Portland and announced that because of its ninth-highest-in-the-nation (per 100,000 population) overdose death rate, he’d chosen Maine to participate in a law enforcement surge against synthetic opioids. Operation Synthetic Opioid Surge is a program designed to reduce the supply of deadly synthetic opioids.

Since January, our office has worked with our state and local partners to bring an additional 34 S.O.S. cases.

These cases mean fewer dealers and less opioids in our community. They provide an incentive to those who can control their behavior. The combination of prevention, treatment and law enforcement offers our best chance of mitigating this crisis. Law enforcement is a part of that group effort. It should not be ignored.

 

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