AUGUSTA — Halfway through an interview in her office last week, newly elected Maine Gov. Janet Mills took down from a shelf a copy of the nonfiction book “Dreamland,” by Sam Quinones.
The book was worn. Mills has read it multiple times, even keeps notes in the margin. She calls it her “bible,” at least when it comes to the opioid epidemic.
In painstaking detail, Quinones lays out the origins of what has grown into the biggest public health crisis in modern times. How pharmaceutical companies flooded a small Ohio town (it easily could have been set in a Maine town) with highly addictive prescription opioids like OxyContin. How Mexican drug dealers saw a market for black tar heroin in the small and midsize U.S. cities. How those two phenomena converged.
In her first extended interview on the opioid crisis since she became governor, Mills, a Democrat, said she thinks of that book often and about the countless individuals and families here in Maine who have been swept into the deadly wake of opioids.
“These are people we want to come out from under the shadows,” she said. “We’re here to help them.”
Mills has made tackling the state’s opioid crisis a top priority in the early stages of her administration, and although she hasn’t laid out specific policy proposals, they are certain to differ greatly from those of her predecessor, Republican Paul LePage.
The biggest shift, though, could be in tone.
Where LePage favored a tough love, law enforcement-heavy approach, Mills’ words so far have been empathetic and treatment-centered.
Providers say they have been waiting a long time for an ally in the governor’s office.
“It’s like the clouds have parted. It’s a whole new day,” said Lisa Letourneau, a Portland-based public health advocate who treats patients with substance use disorder part time.
Bob Fowler, director of Milestone Recovery, which operates a detox facility in Portland and a residential treatment program in Old Orchard Beach, used almost the same words.
“We’re really feeling like a new day has dawned,” he said. “It’s palpable in the provider community, this sense that we have someone in leadership who understands this epidemic.”
‘REALLY JUST WANT TO TAKE ACTION’
Mills can afford to be aggressive. Both the House and Senate are controlled by Democrats and by big margins.
She already has made two major moves: She expanded Medicaid on her first day in office, giving low-income Mainers better access to treatment. LePage had stymied that effort. And last week she named former longtime Maine Medical Association executive vice president Gordon Smith as the state’s first-ever director of opioid response to coordinate efforts across all state agencies to fight the epidemic.
On Thursday, Maine Gov. Janet Mills announced the appointment of longtime Maine Medical Association executive vice president Gordon Smith to become the state’s first director of opioid response. He will coordinate efforts across state agencies to fight the epidemic.
Republican leaders have so far been restrained in criticizing any of Mills’ proposals, but they are prepared to raise concerns about how much some of them might cost.
“Addressing this is certainly a priority and I don’t think it’s a partisan issue,” said Rep. Kathleen Dillingham of Oxford, the House Republican leader. “But it can’t just be about throwing money at the problem.”
Mills said she already has been talking with her staff and Cabinet about what can be done through executive order or financial order and what can be done with legislation. She said she plans to release the first executive order in two weeks or so.
But she fully intends to leverage as many government resources as she can, saying that any cost to the state will be greater if Maine doesn’t invest now.
“I’ve been on two task forces involving legislators and public safety and the U.S. Attorney’s Office. … I’m just tired of talking about it,” she said. “I really just want to take action.”
AVAILABILITY OF NARCAN
Maine saw between 150 and 175 overdose deaths per year between 2002 and 2013, many attributed to prescription opioids. But things started to spike in 2014 and have exploded since, in large part because the state was unprepared.
The total for 2018 is still a few weeks from being released, but in 2017 there were 418 overdose deaths, more than twice as many as 2014, which was a record-setting year. Now heroin and the powerful synthetic opioid fentanyl have supplanted prescription drugs as the biggest killers.
Mills was the state’s attorney general while the crisis hit, but often there was little she could do.
By way of example, she referenced the drawn-out process to make the overdose-reversing drug Narcan available in pharmacies over the counter, a policy she endorsed.
The original legislation first passed in 2016, despite a veto from LePage. But the law languished while the Maine Pharmacy Board struggled to come up with rules. The bill then had to be rewritten and brought back before lawmakers a year later.
Yet even after it passed a second time, LePage – without any pushback from the pharmacy board – continued to hold up the bill until it was rewritten again to raise the minimum age from 18 to 21. The law finally went into effect in May 2018, more than two years after its original passage. Nearly 800 Mainers died from drug overdose in that time.
“It was obstreperous,” Mills said, a fancy word for out of control.
She couldn’t intervene there, but she did take matters into her own hands on Narcan in other ways. She used funds from her office to purchase thousands of doses, which she offered to local police departments.
It was a stark departure from LePage, who at one point said all Narcan does is give users a false sense of security.
Mills said Narcan should be available everywhere. Saving a life is not controversial.
Treatment providers said even though the crisis isn’t in the news every day, it hasn’t waned.
“We’re still in the thick of it,” Letourneau said. “We really haven’t gotten at those who are dying. We need to learn more about them. If 418 people died of the flu last year, we’d know a hell of a lot about those people.”
EMULATE SUCCESSFUL MODELS
Mills is still working out specific proposals but offered some hints last week. She wants to establish a more robust hotline. She wants to create a network of recovery coaches. She wants to expand treatment in jails and prisons. And she wants to focus on treatment models that have proved successful. She mentioned as a model the Addiction Recovery Center at Brunswick’s Mid-Coast Hospital, which operates an intensive outpatient program.
Leah Bauer, the center’s medical director, said she was flattered her program is held up as a model.
“We still have a long way to go with the general population,” Bauer said. “But the more we educate about the science and neurobiology of addiction, the better. We’re really hopeful with Janet Mills as governor, that we’ll see even more of a shift.”
The center has a location in Damariscotta, as well, and recently partnered with hospital emergency rooms there and in Brunswick. The goal there is to connect people with substance abuse disorder who arrive in emergency rooms with immediate services.
Dillingham, the Republican House leader, said her party believes addressing the crisis is a priority, too.
“We want to work collaboratively with Governor Mills on this,” she said, again cautioning against overspending.
Democrats wanted to work with LePage, too, but that often didn’t happen.
REIMBURSEMENT RATES IN FOCUS
As other states have responded to the opioid crisis, some have started to see results, at least in slowing the death count.
A report from the U.S. Centers for Disease Control and Prevention released in December found that two New England states, New Hampshire and Massachusetts, saw decreases in overdose deaths from 2016 to 2017. Maine, though, saw a 20 percent increase.
Because Mills and her allies feel Maine has lagged behind other states in responding to the opioid crisis, there could be a flurry of policy changes.
Those will add up.
Mills said she couldn’t go into specifics but she’s hopeful that Maine might get a share of settlement money from lawsuits against pharmaceutical companies who used deceptive practices to market opioids, which helped create the crisis.
With Medicaid expansion now on line, tens of thousands of Mainers are now covered, and many will no doubt seek treatment.
Fowler, with Milestone Recovery, said having more people covered is good, but it could come with consequences to providers.
That’s because Medicaid reimbursement rates for many services haven’t been raised in years. He said his organization gets $213 in reimbursement per Medicaid patient per night. If a patient has private insurance, the payment to Milestone is $600 or more. The actual cost to provide services is $324.
Fowler said if organizations like his only take Medicaid patients, or primarily Medicaid patients, the finances simply won’t work.
Reimbursement rates for medication-assisted treatment like Suboxone also are lower than the cost for many providers.
‘WE KNOW WHAT WORKS’
Mills is not likely to be as focused on law enforcement as LePage, but she is a former prosecutor and has supported tough penalties for drug traffickers.
Sagadahoc County Sheriff Joel Merry, who has served on statewide opioid task forces, said the feeling in the law enforcement community has shifted away from locking up everyone who’s caught with a drug.
“I think we’ve always realized that traffickers, stopping that, is our duty and responsibility and we take that seriously, but some folks are addicted and that drives them to the point of selling to support their habit. So, is there another way?” he said. “We can’t be filling our jails with people who are sick.”
Merry said he hasn’t heard any concerns that Mills will be soft on drug dealers.
Mills said if LePage was truly committed to holding drug dealers accountable, he would have signed a financial order to fill vacant prosecutor positions in the Attorney General’s Office, which she once led. That’s on her to-do list as well.
She also said that if the focus during the last several years has been on law enforcement, she doesn’t see any problem with focusing now on treatment and prevention.
“I really want to take a closer look at what other states are doing,” she said. “We know what works.”
Mills remembers reading a long story in The Washington Post in 2015 about an affluent family in Falmouth who lost a son to overdose.
“That was an eye-opener,” she said. “I remember thinking maybe things will stop.”
But they didn’t.
Then she remembers reading the 2017 Portland Press Herald series “Lost,” about the opioid crisis, and thinking that might change things.
But the crisis persists.
Mills said stigma remains the biggest barrier.
So while she waits to propose specific policy initiatives, Mills plans to continue talking directly to people suffering from substance use disorder.
“They need to know: We see you, we hear you,” she said. “You are not alone.”
Eric Russell can be contacted at 791-6344 or at:
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