Dr. Ira Mandel holds up a poster during a community forum in Rockland on the opioid crisis, Feb. 5, 2016. Credit: Stephen Betts

ROCKLAND, Maine ― Five years ago, Camden native Jasmin Pike faced a now-or-never moment in confronting her battle with substance abuse.

With no insurance, her options were limited when beginning the long road to recovery in Knox County.

“There was no help for me. No help,” Pike said. “I don’t know what I would have done if my family hadn’t said, ‘you have one last chance,’ because there was nowhere to go.”

There were Narcotics Anonymous and Alcoholics Anonymous groups. But for individuals struggling with drug addiction and alcoholism, the county lacked other resources for recovery and a community-based support system.

During the past two years, that has been changing ― albeit slowly.

More doctors and clinics have started offering medication-assisted treatment for those struggling with opioid addiction.

— An information-only resource center has opened in Rockland.

— An intensive outpatient program is being offered through Maine Behavioral Healthcare.

— Later this month, a peer-run recovery center will hold its grand opening.

— By the end of May, the Midcoast Recovery Coalition hopes to open a transition house for men in recovery.

Strides have been made, but those working with individuals struggling with addiction in the small coastal county say much more must be done.

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Pike has been in long-term recovery for five years and has spent much of that time working in Knox County with people who are in recovery from — or are currently battling — substance-use disorder. She said the area needs more funding for treating addiction and more places for people to go when they are ready to begin recovery.

“We need to have more resources available,” Pike said. “I can’t even tell you the people who reach out to me that are ready for help and there is nowhere to go.”

High rates of addiction, limited resources

Knox County has a population of approximately 40,000 people. Its rate of substance abuse among residents is significantly higher than the rest of the state, according to a 2016 report compiled by the Maine Department of Health and Human Services.

In 2015, according to the report, Knox County saw more than 450 substance abuse related hospitalizations, such as opioid overdoses. Only Cumberland County, population 280,000, saw the same rate of hospitalizations because of substance abuse.

Additionally, 5 percent of babies born in Knox County are drug affected.

[Maine saw 418 overdose deaths in 2017, continuing a deadly trend]

Despite those numbers, Midcoast Recovery Coalition Executive Director Dr. Ira Mandel said the county’s track record for providing treatment and support has been poor.

“[Knox County needs] so many things. What we need is more people willing to do medication-assisted treatment, and we also need to educate the public about addiction because there is so much misunderstanding, ” Mandel said. “We can do a lot more than we are. We’re not doing very much.”

Until two years ago, aside from the methadone clinic in Rockland, Mandel was the only doctor in Knox County providing medication-assisted treatment, such as Suboxone, for people struggling with opioid addiction.

History of conflict

Rockland has a rocky history with methadone clinics with the now defunct Turning Tide clinic being shut down by the U.S. Drug Enforcement Agency and Maine DHHS following the 2012 arrest of the clinic’s founder for operating under the influence.

In 2013, the Rockland Metro Treatment Center opened in the former location of Turning Tide and has offered strictly medication-assisted treatment in the form of methadone. Mandel said the clinic has kept a low profile in the five years it has operated.

A treatment clinic called GROUPS: Recover Together opened a Rockland location in 2016 and offers patients Suboxone.

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Maine Behavioral Healthcare’s center in Rockland has “always been able to serve individuals with substance-abuse disorders,” said Debra Poulin, director of substance-use treatment and prevention programming for Maine Behavioral Healthcare.

Maine Behavioral Healthcare and the county’s only hospital, Pen Bay Medical Center in Rockport, are both owned and operated by MaineHealth, and work together to get patients struggling with addiction into the right path of treatment. There are two physicians in the Pen Bay system who can provide medication-assisted treatment for individuals coping with opioid addiction.

Two years ago, Maine Behavioral Healthcare started a program that focuses solely on substance-use disorder called EMBARK, which uses medication-assisted treatment along with counseling to treat addiction. The program currently treats about 100 people in Rockland, according to Poulin.

Through EMBARK, individuals can gain access to the level of treatment that they need, which at the highest level is an intensive outpatient program that meets three days a week for three hours.

The EMBARK intensive outpatient program used to only be available in Damariscotta through a partnership with Mid Coast Hospital’s Addiction Resource Center. But six months ago, Maine Behavioral Healthcare started offering an intensive outpatient program in Rockland for individuals who could not make it to Damariscotta.

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Poulin said EMBARK plans to add an evening intensive outpatient program for people who need treatment but cannot attend a daytime program because of work.

Lack of insurance is not a barrier to getting treatment through EMBARK, Poulin said. Instead, staff will work to find opportunities to connect patients with funding.

“We will not turn people away from opioid treatment,” Poulin said.

Community policing

Rockland police Deputy Chief Chris Young said the department works with Maine Behavioral Healthcare if they encounter an individual struggling with addiction who is in crisis. But if there is an underlying criminal case with the individual, Young said that must be resolved before treatment can be sought.

Several officers with the department are trained in crisis intervention, Young said, though funding is preventing more officers from getting the training.

“We are trying to address this from a community standpoint,” Young said. “Independently none of us have the resources to address this.”

While the number of medication-assisted treatment options has risen in the area, Mandel said there is a lack of collaboration and community organization around addiction.

“Knox County is really dysfunctional,” Mandel said. “No one is talking to each other. We should be meeting and saying, ‘What are you experiencing, what are you running up against, what problems are you having … how can we all work together?’”

New opportunities for support

The Midcoast Recovery Coalition is currently working to change the dialogue in Knox County about addiction and recovery.

The coalition, which formed in 2016, will be opening an office on Main Street to give itself a visible presence in the community. Individuals trying to get into recovery will be able to stop in to find out what resources are available and get referrals.

The coalition has also started hosting a series of lectures around the topic of addiction to try and educate the public and give those in Knox County an idea of what strategies have worked elsewhere to fight addiction within communities.

[Pace of drug-affected baby births in Maine finally slows]

On April 10, the Lincoln County Recovery Collaborative spoke to a packed room at the Rockland Public Library about how they brought individuals from a variety of backgrounds and professions together to help weaken the grip of addiction in Lincoln County. The group is made up of law enforcement, health care providers, community groups like the YMCA, and residents who wanted to help their neighbors who were struggling.

“What we’re trying to do is treat the environment,” Mandel said, adding that a healthy, supportive and educated community is paramount in helping individuals struggling with addiction.

The Midcoast Recovery Coalition is currently working on opening a transitional living house on Brewster Street in Rockland for men in recovery from addiction. With help from an anonymous donor, the coalition was able to purchase the eight bedroom house and closed on the property April 13.

The home, called The Friends House, is slated to open by the end of May, Mandel said. The house will serve as a safe place for men to live and focus on their recovery. The city has approved the residence for four unrelated adults, Mandel said, though the coalition is working with Rockland to increase the number of residents in the future.

On the other side of town, at Maine Behavioral Healthcare, a peer-run recovery center will hold its grand opening April 25. The drop-in center is for individuals struggling with mental health disorders, including substance-use disorder.

The center will be open Monday through Friday and will feature a host of programming and activities selected by the individuals who use the center through a peer-run advisory council.

“It’s a safe place to hang out,” said Pike, who is working at the center as a peer support specialist.

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The center requires no insurance or payment for participation. Maine Behavioral Healthcare has two similar centers in Sanford and Biddeford. They chose to open a center in Rockland because of the lack of similar programming in the area, according to Randy Morrison, Maine Behavioral Healthcare’s director of peer services.

“In my vision, it’s really a hub. No insurance is needed. No charge to participate in activities. It’s not a clinical setting, so there are no hoops to jump through. It’s really just a community space,” Morrison said.

While treatment options have grown in Knox County, recovery advocates say the work is far from done on creating an environment that is supportive of those struggling with substance-use disorder.

“There is no one size fits all. There is no one solution. But I do agree that [in Knox County] it’s very fragmented right now,” Pike said. “I think we should be uplifting. I want to make recovery cool.”

To find help near you for addiction, call 211 or visit 211maine.org.

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