Nearly 100 people gathered in Bangor on Wednesday evening and decided preventing drug use should be the next priority the region pursues to address the opioid crisis. At the state level, they said the next priority should be bolstering funding for treatment.
The Bangor Daily News hosted the One Life Project: Public Priorities event at the Bangor Arts Exchange ballroom to get a sense of the most urgent and well-supported initiatives for tackling opioid addiction, involve the public in discussion about a key issue in advance of November’s election, and provide a chance for the gubernatorial candidates to listen to what matters to Maine people.
Independents Alan Caron and Terry Hayes, and Democrat Janet Mills participated in table discussions where attendees talked about nine regional initiatives and eight state initiatives, and then voted for their priorities. Republican Shawn Moody’s campaign manager, Lauren LePage, also participated.
Each attendee had three votes; they could cast all their votes for one initiative or spread them out. The Community Health Leadership Board, a collective of leaders of area health and social services organizations, will consider these priorities in deciding what to tackle next.
Here are the results of the voting for ideas to pursue in the Bangor region:
1. Develop a local approach to preventing youth drug use, and ensure focus and sustainable funding: 62 votes.
Young people who form positive bonds and feel supported are less likely to use substances. Schools and community organizations can play a role in developing these connections and addressing trauma. Investments in public pre-K and low-cost early childhood education can help children build resilience. More school nurses, public health nurses, social workers and counselors can form positive bonds with more children. Mentoring programs such as Big Brothers, Big Sisters can help with this, too. Schools can choose drug prevention curricula firmly rooted in research.
2. People need support beyond initial treatment: 53 votes.
The Bangor Area Recovery Network (BARN) and other peer recovery support programs should have the funding and support they need to ensure long-lasting success. Most people with a substance use disorder need long-term or repeated care to stop using completely and recover their lives. In addition to treatment and emotional support, people with substance use disorders often need jobs and more stable housing options. Their rental history may limit their housing choices, and available options are too frequently in neighborhoods where drug use occurs, making recovery more difficult. Community leaders could engage the Greater Bangor Apartment Owners and Managers Association and other housing advocates in expanding the availability of quality sober housing for those in recovery.
3. Expand access to treatment: 52 votes.
Health care organizations can encourage more of their providers to take the federally required training so they can prescribe Suboxone, and they can offer their practitioners general education on Suboxone and methadone. In addition, the emergency department is one important place to start treating someone with a substance use disorder. Local emergency departments should screen patients for opioid use disorder and prescribe Suboxone when appropriate. Patients who start treatment in the emergency room are more than twice as likely to stick with it as patients who receive only a referral. Bangor-area residents should also be able to look up easily which providers prescribe treatment medications and have openings.
4. Continue work to reduce stigma: 40 votes.
Many people, including medical providers, business owners and faith groups, may treat people with substance use disorders differently because of their condition. Continuing to showcase stories of people in recovery, publicizing research into what works to treat addiction, and helping businesses and other important entities navigate the issue are key. As long as stigma persists, people with substance use disorders won’t have access to the treatment, housing, jobs and community support that they need.
5. Work within the criminal justice system to get people with substance use disorders help: 29 votes.
The criminal justice system is on the frontlines of the opioid epidemic. Law enforcement officers should be able to connect those who have overdosed with treatment, not arrest them. County officials should work with the community on a plan that allows the Penobscot County Jail to continue inmates’ prescribed anti-addiction medications while behind bars, and connect them with treatment help upon their release. (The jail and Penobscot Community Health Care have already begun work with a Vivitrol program.) Courts should ensure that probation, bail and drug court conditions are based on medical assessments. Judges, attorneys, law enforcement officers and jail staff should have access to ongoing education about addiction.
6. Expand access to naloxone: 22 votes.
Naloxone, which can revive someone who has overdosed from opioid use, should be widely available. Training on administering naloxone should be available to anyone who wants it. Information on where to find naloxone should be compiled and widely circulated. Fundraising should continue to allow community organizations to give out naloxone for free. A local policy should dictate that anyone with a history of opioid use disorder leaving the hospital or a primary care office should have naloxone.
7. Integrate and improve care, so patients are more likely to get the help they need: 12 votes
Even when they don’t directly provide substance use disorder treatment, all health professionals are key partners in ensuring their patients’ safety and recovery. Medical professionals should follow the opioid prescription protocols developed by the Community Health Leadership Board. Primary care practices should employ or collaborate with behavioral health professionals, so patients have access to a full suite of treatment services in the same office. Primary care practices and emergency rooms should screen for substance use disorder, such as by using the Screening, Brief Intervention, and Referral to Treatment (SBIRT) tool. School-based counselors should be familiar with behavioral health and treatment options for youth. And treatment providers should encourage their patients to connect with recovery support groups, such as the Bangor Area Recovery Network (BARN).
8. Continue to reduce opioid prescribing: 9 votes.
Eighty percent of heroin users start off by misusing prescription opioids. Since easy access to opioid medications encourages their misuse, health care providers should continue to prescribe fewer of them and expand options for safe pain management. The need is especially urgent among dentists and specialty practices, such as surgeons and internists, and in some emergency rooms. In addition, Bangor-area communities can work to provide their residents with safe, easy disposal for excess opioid medications, and pharmacies can distribute instructions with opioid medications on their safe and proper disposal.
9. Address provider recruitment, shortages, retention and burnout: 5 votes.
Graduates from local social work, medical, nursing, dental, pharmacy and law enforcement training programs need to be prepared for careers working with people who have substance use disorders, and they should receive appropriate training while in school. Community leaders should engage educators from the University of Maine, Eastern Maine Community College, Husson University and Beal College to ensure that happens. In addition, the first responders who encounter overdoses on a daily basis need access to counseling and other support to reduce burnout.
Here are the results of the voting for the state policy ideas:
1. Bolster funding for treatment: 70 votes.
Increase funding for medication-assisted treatment and other programs, such as counseling, residential care and detoxification, to better serve people who lack insurance or the means to pay. Medication-assisted treatment, which includes Suboxone and methadone often in combination with counseling and behavioral therapies, has been shown to decrease opioid use, opioid-related overdose deaths, criminal activity and the transmission of infectious diseases. In addition, treating opioid-dependent pregnant women with medication helps their babies by reducing the symptoms of neonatal abstinence syndrome. Currently, Maine law generally limits Medicaid to covering two years of methadone and Suboxone treatment, and Maine’s Medicaid program pays among the lowest reimbursement rates in the nation for methadone. In addition, reimbursement for a range of substance use disorder and mental health treatments have remained at the same level for more than a decade. Medicaid expansion under the Affordable Care Act has been approved by voters and courts, but not implemented.
2. Ensure people in recovery have safe housing: 45 votes.
Recovery residences are where people live together to support one another in their recovery. While having a stable, safe place to live can help prevent relapse, there is currently no state certification process for recovery housing, which has created recovery homes of inconsistent quality.
3. Develop and fund diversion programs to connect people with treatment and recovery services instead of putting them in jail: 40 votes.
A significant proportion of people who are incarcerated have substance use disorders: about 53 percent in state prisons and 68 percent in jails, according to the Substance Abuse and Mental Health Services Administration. Diversion programs usually aim to connect low-level drug offenders with case managers who can get them treatment rather than processing them through the criminal justice system.
4. Help jails treat inmates: 21 votes.
Treating inmates would involve developing and funding services in jails to address mental health and substance use disorders, including medication-assisted treatment, and connecting inmates with treatment in the community upon their release. It would also involve the creation of a permanent advisory board to help facilities keep up with best practices on treatment and programming. People lose Medicaid coverage when they are incarcerated, leaving Maine counties and the state to pick up health care costs. As a result there is virtually no medication-assisted treatment in Maine jails and prisons, though it has been successfully used in other states and has lowered reoffense rates. It is also important to connect people with treatment in the community upon their release as studies have shown that people who are newly released have a greater risk of overdosing.
5. Develop a strategy to prevent drug use: 18 votes.
There is currently no dedicated state funding for substance use prevention in Maine. Current funds are passed down from the federal government, and levels vary year to year. Municipalities can benefit from having more professionals focused on prevention efforts. Those efforts should include training for teachers and school administrators on youth substance trends and helpful substance use policies, and ensuring schools and communities use drug prevention programs research has shown to be effective. There are a number of well-studied drug prevention programs listed by the Substance Abuse and Mental Health Services Administration and the registry Blueprints for Healthy Youth Development. They range in cost from $17 per participant in the first year to $173 and usually aim to bolster young people’s emotional development and feelings of connectedness.
6. Reduce diversion of opioids: 13 votes.
Diversion, which is when legally prescribed drugs are used for illicit purposes, contributes to the opioid epidemic. About 80 percent of people who use heroin first misused prescription opioids, according to the National Institute on Drug Abuse. A state law has already forced prescribers to limit opioid doses, but the state can do more to increase and promote prescription drug take-back days, alternative drug disposal options, and drug-collection boxes at police stations and other locations. It can also require pharmacies to give patients information on how to dispose of excess medication.
7. Improve access to information about which treatment services are available and where: 8 votes (a tie).
It’s often challenging to find out where treatment is currently available, making it more difficult for people to get help quickly. It’s possible an online tool could show real-time data on available treatment options, waitlists and provider capacity. The tool could also have information on costs, eligibility and what is required of participants.
7. Fund and expand the use of specialty courts across the state that connect people to treatment and other services: 8 votes (a tie).
At drug court — and others, such as co-occurring disorders court and veterans court — people have to adhere to specific conditions that may include substance use disorder treatment, mental health and trauma counseling, random drug testing, and work or education requirements. They have to pay all fines, restitution, child support and taxes. If they fail to follow the rules, they may be terminated from the program, or the court may impose new sanctions. People who complete drug court have been found to have lower reoffense rates, saving taxpayers money in the long run.
To vote, people placed stickers on poster papers for each idea. They were also encouraged to write comments on the poster papers, to add their ideas or reactions. Here are eight of them, which have been edited:
— Have businesses post stickers saying “naloxone available here,” similar to the approach with automatic external defibrillator devices.
— Bring in more youth to Boys and Girls Club.
— We need access to treatment in emergency departments.
— Expanding access to treatment in emergency departments would require significant training and additional dedicated resources to make sure it is done well.
— The state should use its bargaining power to purchase low-cost naloxone.
— The state should fund health centers in Maine to provide integrated care inside jails.
— Medicaid should cover people in prison and jail.
— Put tamper-proof prescription take-back boxes at more locations, such as at city hall, hospitals, pharmacies, fire departments and police departments.
Maine Focus is a journalism and community engagement initiative at the Bangor Daily News. Questions? Write to firstname.lastname@example.org.