Maine s Opioid Crisis

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1 Maine s Opioid Crisis What are Opioids? Opium poppies are flowers found in dry, warm climates. After the petals fall, a seed pod can be found. Inside the pod is a milky sap. This is opium in its crudest form. There is a long, complex process to transform opium sap into heroin, an illegal drug. Prescription opioids are a class of drugs often used because they contain chemicals that relax the body and relieve pain. Some examples are oxycodone and morphine. Fentanyl, a synthetic opioid, also has medically approved uses for pain and anesthesia. However, it can also be illicitly manufactured and sold on the streets. It is typically significantly more powerful than heroin. What is the extent and impact of their misuse? The misuse of opioids has become widespread in the US, with 115 overdose deaths every day. In every community in Maine, residents are affected by misuse of opioids. Almost 75% of those who develop an addiction to opioids started by using a prescription pain reliever. All counties in Maine have felt the effects of misuse and opioid use disorders. Overdoses in 2017, by County Washington 3% Somerset 4% York 20% Remaining 8 Counties 11% Penobscot 16% Androscoggin 11% Cumberland 26% Kennebec 11% Knox 3% Source: Expanded Maine Drug Death Report for 2017, Margaret Chase Smith Policy Center spring/summer 2018 The number of deaths here has risen sharply over the last 5 years. In 2017, there were 418 drug-related deaths, of which 354 of them were due to opioid use. One in four of those deaths occurred in Cumberland County. In the first quarter of 2018, almost 2/3 of the deaths recorded were due to fentanyl or fentanyl analogues, a rising share of the cause of death. Fentanyl is a cheaper, more powerful alternative to heroin, and many users who believe they are taking heroin are actually using fentanyl. The demographics of overdose deaths in the state remained consistent from 2016 to Males outnumber females by a significant amount. For every 1 female overdose death, there were 2.5 male overdose deaths. The average age was 42 years old. Although deadly overdoses are less Graphic from Portland Press Herald common for women, they face particular challenges. According to a 2013 report from the Centers for Disease Control and Prevention, women are more likely than men to be prescribed prescription pain relievers, to be given higher doses, and to use them for longer periods of time. Many of these women are of childbearing age. The CDC found that from , on average 28% of women with private health insurance and 39% of women with Medicaid filled a prescription written by a healthcare provider for opioid medication. Use of opioid prescriptions during pregnancy can lead to the baby developing Neonatal Abstinence Syndrome (NAS), opioid withdrawal. The symptoms may include: rapid breathing, vomiting, tremors, and seizures. The effects can be long term. It was estimated that about 8% of all births in Maine had NAS in Tragedy may not always appear as an overdose. It may be an infection, which has potentially fatal perils. Dr. Rebecca Continued on Page 2

2 The Opportunity Alliance Community News and Notes The Opportunity Alliance 50 Lydia Lane South Portland, ME For more information or if you have an address correction call: or visit: Letter from the President, Michael J. Tarpinian Maine s opioid epidemic is a serious matter. The impact on our clients and neighborhoods is significant touching individuals to entire families and communities. As you will read in this newsletter, from our preventative work with youth and communities to our mental health and parenting programs, we are tackling the crisis on many fronts. TOA s programs and services are part of the solution but addressing the complex issues requires a coordinated community effort. We partner with other local agencies, municipalities, and diverse organizations to support individuals and to build more resilient communities. Thank you for your support in this vital work. Michael J. Tarpinian The Opportunity Alliance Board of Directors Dan Hunter - Chair Marc Doyon - Secretary Colette Twigg-Rowse - Treasurer Rebecca Bloch, MD Abusana Micky Bondo Anita Chandler Elizabeth Conrad Sarah Coupe Ann Courtney Jeanne Hulit Chris Jerome Anne LaFond Marie-Christine Simbizi Tom Smith Tim Soley Cynthia Tayman-Veroneau Jim Vachon Penelope Wheeler-Abbott Continued from Page 1 Maine s Opioid Crisis Bangor 30 Bloch, a TOA Board Director, Associate Medical Director of Maine Medical Center s (MMC) Biddeford 23 Lewiston 17 Emergency Department, and Medical Director Augusta 14 of Brighton First Care, weighs in on the issue. Sanford 12 In her work, she sees the impact of opioid use Cities with 10 or More Overdoses in 2017 disorder daily. She highlights the danger of injecting opioids as the effect is much stronger and can introduce bacteria into a person s system. These infections can lead to long, costly stints of hospitalization. According to Forbes in 2016, the average cost for an opioid related infection was about $107,000. About 5% of patients will die from the infection. What is being done to address the issues? City Total Portland 57 In this newsletter, we highlight some of The Opportunity Alliance (TOA) programs which are part of a community response to the crisis. TOA is committed to working with our partner agencies to strengthen our role in creating viable solutions to the range of issues which exist. There are two medical assisted treatments that are standards of care for treatment methadone and buprenorphine. However, the best path for long term recovery has not been determined and many partners are actively involved in creating pathways. 2 The Opportunity Alliance Community News & Notes spring/summer 2018

3 Our Role in the Response to The Opioid Use Disorder Problem We believe in treating the whole person. We use that belief in our approach on how to help our clients in prevention and treatment work. Our Behavioral Health Home (BHH) provides care management for clients who have mental illness often with co-occurring substance use disorders. We create a partnership between us and local primary care and specialty practices. This allows us to help the client manage all of the different services that they may need. We promote recovery by engaging our client as well as family and other natural supports in the plan. The Women s Project focuses on women affected by substance use disorders who are pregnant and/or have children 5 years and younger. We offer individualized recovery service plan and goal setting, mental health and trauma screening, and referrals to resources and supports available. We have a residential facility dedicated to helping those with substance use disorders. Clients are referred to us from providers or case managers. Our trained staff create care plans for our clients and help them work towards their goals, such as beginning the recovery process. We currently offer parenting education through Nurturing Parenting, Circle of Security, Strong Fathers, and Parent Effectiveness in Resolving Conflict with Teens (PERC) classes. These curricula cover a wide range of topics that strengthen parents understanding of child development, how to name and manage feelings, how to effectively manage behavior and how to enhance a child s self-worth. Many of the families in our classes are either in recovery or have family members in recovery, and the topic of the impact of substance use disorder frequently comes up in discussions and real life scenarios in class. Addiction is complex, but we know that early use of any substance increases the risk of an opioid use disorder. Our Public Health Program partners with schools, law enforcement, parents, and youth across Cumberland County on how we all can keep youth safe. We focus on reducing access to drugs and alcohol, educating community members how they can support youth to make healthy decisions, and shifting the consequences associated with substance use from punitive to restorative. The Maine Youth Action Network (MYAN) is part of Maine Prevention Services a comprehensive statewide initiative funded by the Maine CDC to lower rates of youth substance use. MYAN provides leadership development programming to middle and high school students and their adult allies in order to increase young people s resilience. We work to build young people s strengths and social supports as part of our programming. MYAN and our eight local partners across Maine support dozens of groups of young people all over the state to take action and inform policy on issues important to their lives, including bullying and harassment, mental health, and youth substance use issues that we know are connected. In 2016, several nonprofit and public sector partners committed to creating the Greater Portland Addiction Collaborative, GPAC. Per GPAC, through this effort, its members aim to contribute to the long-term health and wellbeing of the Greater Portland community through an integrated and comprehensive treatment model specifically focused on uninsured persons battling heroin or opioid addiction. Under this new approach, the potential improvement in clinical outcomes, financial and operational performance of several organizations will drive resource allocation, continuous improvement, and delivery redesign that will result in fewer overdoses and untimely deaths. GPAC has been working through how to tackle this complex and rapidly growing issue in our communities. PUT SOMETHING HERE? spring/summer 2018 The Opportunity Alliance Community News & Notes 3

4 A Tale of Recovery: The Power of Hope Bethany*, 34 and mother of 4, greeted me with a warm smile as I entered her home for the interview. I met Bethany through The Women s Project, a program that focuses on mothers of young children in recovery from substance use disorder. I knew her tale of recovery was filled with dark and even scary twists and turns. The tale was riveting; I listened to it, on the edge of my seat, continuing to question how she would get out of it, but she always did. As I learned, her tale also has the threads of love and hope. Bethany is a native Mainer who grew up in a home with her mother, father, and two younger sisters. The home was filled with abuses of many kinds physical, emotional, and sexual. At age 5, her father was incarcerated for sexual The Women s Project Case management services for women 18 and older who are pregnant or parenting a child 5 or younger and affected by substance use disorder. Our services are available in Androscoggin, Cumberland, Kennebec, Lincoln, Oxford, Sagadahoc, and York Counties. Must be a MaineCare member. abusing her. Her mother, a nurse, coped with the violence against her and the sexual abuse by drinking. She was hurt at work and did not return to nursing. She began driving taxis. Through that new lifestyle of late nights, Bethany was exposed to many things including some of her mother s new friends. Bethany grieved the loss of one of these friends and a cousin to gun violence. Through it all, she knew she wanted a better life for herself. At 14, she was turned over to State care by her mother. She was sent to a boarding school in another part of Maine. She graduated and left for college in Florida. She returned to Maine the summer following her first year and became pregnant. She transferred to an online option and stayed in Maine. She had the baby and completed her schooling. *name has been changed to protect her identity. Even though she was living in shelters and in the streets, she stayed away from drugs. She met her future husband a short time later and her whole life changed. The couple married and had a baby together. His family had successful retail shops in Maine, so she worked for the family business. They worked long hours as they began a life together. They even opened their own shop. Life was good for her and she felt like she had it all. That however took a turn. While she was working long hours in their business, she had a feeling something wasn t right. Her marriage fell apart and he left her on the streets with nothing. He kept the kids from her. She was now alone no job, no family, nothing. She slid into serious depression. She still held onto her dream of a better life, so she found a job preparing taxes. She would work all day then retreat to the streets at night. Her casual drinking accelerated into consistent drinking. Bethany said, if you drink enough, you are numb to the cold temperatures. She spent months doing this. Then she began using painkillers to numb herself. At one point, she did seek help. She wanted to get better. She showed up at the doors of a facility here in southern Maine after work. However, she was turned away because she was told, you didn t fit the criteria. She felt like she hit rock bottom, but she still couldn t get help. So now she felt completely rejected. Her hope was fading, but never fully gone. She felt like if she made and/or saved money that may help. She switched from painkillers to heroin. As she explained to me, heroin is far easier to get and much cheaper. To earn additional money, she began driving for crack dealers. Once caught up in that circle, she began accepting crack as payment for driving instead of cash. She still needed the money, so she started selling it. While watching everything that was going on around her, she kept trying to get better. She said that she knew she didn t want to be another statistic. During this time, she moved in with her boyfriend. He was emotionally abusive, but that was all she knew. Unexpectedly, she became pregnant. Bethany s eyes began 4 The Opportunity Alliance Community News & Notes spring/summer 2018

5 to water as she discussed her pregnancy with her third child. She knew she had to stop using. She knew she needed help. As she said, I knew I had to get sober. I had a reason. Her love of her children poured out of her. I could feel it. She sought help. Because the hours of the clinic conflicted with her work hours, 9 to noon, she used heroin in the beginning of the pregnancy as she feared stopping completely would do more damage to her and the baby. After tax season, she got into the clinic during the open hours and began her recovery. During her pregnancy, the emotional abuse intensified. She would be left out on the streets in the middle of the night with just the clothes she was wearing. Alone and desperate, she sought out who and what she knew. A few of those times led to using crack. But she kept going to the clinic as she so desperately wanted to be sober. She entered a program for pregnant women. From there, she was connected to The Women s Project which she s been a part of for 4 years. Her baby was born with mild withdrawal symptoms. She started a life with her boyfriend and baby. Her other two children had been visiting with the mom and the oldest now lived with her full time. She saw her second child frequently. She and her boyfriend had a second child together. Again, due to the few times of crack use, the baby was born with mild withdrawal symptoms. About a year later, she left her boyfriend for the final time. She and her children moved into a motel room. She began to do some work for the owners. She was determined to give her children a better life. She said that her drive to get back to the life where she had it all was what kept her going. During this time, one of her children was diagnosed with cancer. She focused on caring for her sick child and stayed sober. She didn t use. She didn t relapse. She did the best she could bringing her oldest child to school while caring for the toddler and baby. Fast forward to today. The adorable child who greeted me with a smile and asking me to color with them is now doing ok. Her cancer is in maintenance, meaning it is not spreading. She recently recovered from a long stint with fungal pneumonia. Bethany is working for the same motel owners that took her under their wing. She works at another motel the family owns. She finally was able to get an apartment and has a car now. She has stayed sober for 4 years. She has been thrown more curveballs and more reasons not be sober than I can even express. Yet she s not relapsed. She gives some of the credit to her case manager with our program. She said that our case managers check in with her, but also understand her and want to help. They have provided support and referrals when needed. Having someone that she can trust and who wants to her to succeed has been crucial. I asked her what advice she d give other moms who may be facing the same battles. She said, It gets hard, but it goes up. No matter how bad it is, your kids are worth it. It ll always get better. Her advice was about finding your reason. Find a reason to want a better life. As she told me, Everyone has a goal. She has clung to her kernel of hope all these years. Addiction is powerful, but so is hope. It is truly inspiring. spring/summer 2018 The Opportunity Alliance Community News & Notes 5

6 Nonprofit Org. U.S. Postage Paid Permit No. 39 Portland, ME 50 Lydia Lane South Portland, ME Statewide Resources The Opiate Helpline, operated by Maine, is an information and referral line available 24/7. The call specialists offer you or someone you know information about treatment options and services that can help. If you need additional, immediate assistance, the specialist can transfer you to the Maine Crisis Line. Maine Crisis Line is a statewide mental health line, available 24/7 at If you or someone you know is experiencing a mental health crisis, the crisis call specialists will listen and refer you to additional resources if necessary. Mobile Crisis Response is a team of crisis workers who can provide face to face assessments for those experiencing a mental health crisis, available 24/7. The teams can be reached via the Maine Crisis Line. A short term stabilization unit is a facility that a person in a mental health crisis can be referred to. If the person meets the criteria, the person would be in a facility with trained professionals to help stabilize them. SCAN to donate Opiate Helpline by Maine Maine Crisis Line Mobile Crisis Response Short Term Stabilization Unit NOW *download free QR code reader app Visit us online, like us on Facebook, follow us on Twitter.