For at least the fourth time this year, the Portland Press Herald editorializes that the only solution to the opioid crisis is harm reduction and treatment, to the exclusion of law enforcement.

In your Oct. 19, editorial, “It Shouldn’t be Surprising that Fatal Drug Overdoses Keep Increasing,” the Editorial Board said “too many people still go to jail for nothing more than their addiction.” In your Sep. 10 editorial “Advocate’s Death is a Tragic Reminder,” you describe the War on Drugs as a “losing cause.” (You said much the same thing in “Drug Crisis Rages On in the Background,” July 19, and in “Maine’s Opioid Epidemic is far From Over,” Jan. 26).

Doctors have been waging a war on cancer for about 50 years. Yet, at 599,108 deaths in 2017, cancer remains the second leading cause of death in the United States after heart disease. You don’t call it a losing cause.

I was sorry to read the Maine Drug Death Report for 2019. It showed that the downward trend from a peak of 417 deaths in 2017, to 354 in 2018, was reversed by the 380 deaths last year, a 7 percent increase. The just-released, mid-year report is even more concerning. It reports 258 overdose deaths. At that pace, Maine’s death rate for 2020 will be an unprecedented 516.

The isolation and inactivity of the pandemic and associated social distancing likely have contributed to depression and drug abuse, while also limiting the delivery of services. But the precipitous increase in deaths began in the second quarter of last year, so that dynamic doesn’t explain it. The governor didn’t order social distancing until mid-March.

As before, most of the 2019 deaths (318 or 84 percent) were caused by opioids, and most of those by illicit, non-pharmaceutical, synthetic opioids like fentanyl. Fentanyl is incredibly potent. A few milligrams can kill. It caused 259 of the 2019 deaths. That’s 81 percent of the opioid deaths and 68 percent of all overdose deaths in 2019. Illicit fentanyl is not manufactured in Maine. The vast majority of it comes from abroad, and it is getting to remote places. The Drug and Alcohol Dependence Journal just reported that between July of 2019 and March of 2020, rare fentanyl analogs were detected more often in Penobscot than any other county in the nation.

Other notable data points in the 2019 report include a 22 percent increase in the number of deaths caused by cocaine (from 90 to 110), a 81% increase in those caused by methamphetamine (from 26 to 47), a 128 percent increase in the number of deaths caused by buprenorphine (from 14 to 32), a 31% increase in the number of deaths caused by methadone (from 19 to 25), and a 13.4 percent increase in the number of autopsies which detected the presence of naloxone (from 97 to 110).

The treatment drug buprenorphine caused 3.9 percent of deaths in 2018, 8 percent in 2019, and 7 percent of the deaths during the first half of 2020. Methadone, which has been killing Mainers for over 20 years, caused 5.3 percent of deaths in 2018, 7 percent in 2019, and 5.8 percent during the first half of 2020. Naloxone was detected in 27 percent of autopsies in 2018, and 29 percent in 2019.

Your reaction to this information is that we need more Medicine-Assisted Treatment, more harm reduction including needle exchanges, and more naloxone.

Last year was the first year of MaineCare expansion. It didn’t save more lives. Neither did more naloxone.

Although there still is no comprehensive accounting, there is no doubt that our state has been flooded with naloxone for the past two years. The increased number of autopsies detecting naloxone is some confirmation.

Experts agree that MAT can’t succeed on its own. Addicts must make a commitment to sobriety. They must take their medicine as prescribed. They must avoid using illicit drugs.

Law enforcement helps by making deadly illegal drugs less available. Law enforcement focuses on dealers, not users. It clarifies what we do and don’t value. It acts as an incentive for those who can, to control their behavior. For those who can’t control their behavior, law enforcement can impose a measure of control that may facilitate their recovery.

Law enforcement is not the only component of the response to the opioid crisis. But it is an essential one.

— Special to the Press Herald