Whenever a patient of Milestone Recovery, past or present, dies from a drug overdose, staff typically logs into a critical incident system to report it.

One day this fall, Executive Director Tom Doherty went to log in but needed to update his password because it had expired after 90 days of inactivity.

It had been at least 90 days since someone died.

Service providers like Doherty aren’t taking victory laps, but there is a glimmer of optimism as 2024 sunsets that Maine might be reversing a deadly trend that has devastated the state for a decade.

Between January and October, there have been 403 drug overdose deaths, an average of 40 each month, according to state data. That’s down 21% from the same period in 2023 when 513 overdose deaths had been recorded, and it comes on the heels of a 16% decrease from 2022 to 2023.

If this year’s pace continues in November and December, Maine will end 2024 with fewer than 500 fatal overdoses for the first time since 2019.

Gordon Smith, Maine’s director of opioid response, said deaths aren’t always the best metric for success or failure, even though he understands that’s what generates the most attention.

“We could do everything right that we’re supposed to do, and our deaths could still go up,” he said.

And it’s clear there are some larger forces at work. Overdose deaths are down nationwide this year, although Maine’s decrease is more dramatic than the national decline.

Still, Smith said, the historic investments Maine has made in treatment, harm reduction and prevention might be paying off. Just last month, the state awarded $14 million to 43 projects through its share of opioid settlement funds and those funds will continue to flow to Maine for 17 more years.

Doherty said greater acceptance of harm reduction efforts has been a key factor. Harm reduction means everything from widespread distribution of the overdose-reversing drug naloxone and drug testing strips to the Good Samaritan law that allows anyone to call 911 following an overdose without fear of being arrested for drug possession crimes.

Milestone has two mobile outreach teams that spend their days traveling throughout greater Portland looking for people at greatest risk. Other agencies, including Maine Access Points, which focuses on harm reduction efforts in rural areas, have the same aim. The goal is to steer them toward treatment, even if that takes many attempts.

“Not everybody is going to clean up their mess on the same day,” said Angel Trotter, a Milestone outreach worker.

So, the goal becomes simpler: Just keep them alive.

‘Trying to get by’

Trotter and her outreach partner, Courtney Bass, spend most of their days working out of a Nissan NV3500 passenger van that’s filled with supplies and food.

One day this month, the two women also toted individualized Christmas stockings that had been stuffed by volunteers with candy and personal care items.

Their goal each day is to make contact with clients who are living on the street, most of whom are also dealing with substance use disorder — the most vulnerable to overdose.

“I’m not sure how long I would last living out behind the ballfield and having people not even looking at you or shouting, “Get a job,’” Doherty said.

Trotter and Bass said their work has gotten harder since Portland passed an ordinance prohibiting homeless encampments. Now, unhoused individuals who don’t end up at the shelter are scattered in bordering communities like South Portland and Westbrook.

With Bass behind the wheel and Trotter in the passenger seat on her laptop or phone, they start their route.

“Meeting people where they are at” is a common phrase, and that often means in parking lots of libraries or big box retail stores. Sometimes it’s just the side of the road.

Trotter has been an outreach worker for 18 months but said she, too, was living on the street not that long ago.

“It’s changed a lot,” she said.

Bass has been with Milestone for more than a decade. She said much of her job is making sure people have what they need to stay safe.

“You don’t think about these things when you’re running, you’re just trying to get by,” she said.

At one stop, a young man asked Trotter to look at a rash on his stomach that wasn’t going away. She asked if she could take a picture and send it to someone at the free clinic.

Back in the van, she places a call and tells a clinician she’s going to send the picture over to see if he needs to be treated right away.

They work closely with other service agencies, including Common Space, which operates a needle exchange program and other harm reduction initiatives. Executive Director Brian Townsend points to two factors contributing to the decline in overdose deaths: 1. A dramatic increase in available supplies for safe use and 2. Increased sophistication and knowledge of overdose response.

There is still resistance, he said, to harm reduction initiatives such as needle exchange programs. Townsend doesn’t begrudge anyone who has a strong emotional reaction, like complaining about discarded needles or the impact on emergency crews.

But he also tries to explain that harm reduction does not equate to enabling drug use.

“Our efforts are strictly to keep people safe, and keep them alive,” he said.

At their last stop, Trotter and Bass waited for nearly 20 minutes in a parking lot across from Lowe’s on Brighton Avenue, near the Portland-Westbrook line, for a client who was supposed to meet them. They didn’t show up the day before either.

Bass said if more than a couple of days go by without seeing a regular client, they start to worry a little.

“Then we go look,” she said.

‘Still way too many’

Maine isn’t alone in documenting fewer deaths. Fatal overdoses declined nationally by about 14% between June 2023 and June 2024, according to recent data published by the U.S. Centers for Disease Control and Prevention.

Some experts attribute some of it to the supply chain.

Fentanyl, the powerful synthetic opioid that supplanted heroin years ago as the go-to drug of many, has has become less potent as the country has started to crack down on cartels and other international suppliers. This fall, U.S. Drug Enforcement Administration head Anne Milgram announced that for the first time since 2021, her agency saw a decline in fentanyl potency.

Smith said Maine has likely seen some of that, too. In addition to fewer deaths, the number of non-fatal overdoses has decreased by 13% over the same period in 2023.

Still, fentanyl showed up in three of every four overdose deaths in Maine this year, often in combination with another substance, such as cocaine or methamphetamine, according to state data.

Smith also said officials have little control over the supply side of the crisis. Cartels and others have always found a way to stay a step ahead.

“I’d rather work on the demand side,” he said.

To that end, Maine has built a network of recovery coaches across the state that didn’t exist five years ago. Naloxone has become widespread in most communities. There are more than 1,000 recovery beds statewide.

The state has never had more people on methadone and Suboxone, the two primary forms of medication-assisted treatment. And more and more are opting to use Sublocade, which is a one-month injection that blocks opioid receptors and effectively makes it impossible to get high.

In Portland, Milestone has doubled its number of detox beds. Combined with other beds around the city, there are 5 times as many as before the pandemic.

“It used to sort of be like Willy Wonka and the golden ticket,” Doherty said.

There are always challenges. Experts say tracking other substances that might get mixed with fentanyl or methamphetamine or cocaine is key. Some newer mixers are resistant to naloxone. It’s one of the reasons agencies like Milestone and Common Space distribute testing strips. Longer-term residential treatment, which is expensive, is still in short supply and often faces local resistance.

Townsend said that independent of the state’s investments, the conversation about opioid use and overdose has evolved so that it’s OK to talk about. Mostly.

“Stigma remains one of our biggest issues,” he said. “That has not shifted all the way, but it has shifted in the right direction.”

While there is more hope, experts aren’t declaring any victories. “It’s still way too many (overdose deaths) in a state our size,” Smith said.

Doherty agrees and is always quick to temper his optimism.

Not long after he logged into the critical incident system with his new password, the agency saw two overdose deaths back-to-back.

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