Jim Carroll, former President Donald Trump’s drug czar, holds a package of Narcan in this October 2020 file photo. Credit: Linda Coan O'Kresik / BDN

The $130 million Maine is set to receive over the next 18 years as part of a settlement with opioid distributors isn’t nearly enough to compensate for an unrelenting epidemic that has struck Maine disproportionately and killed thousands of residents, according to the state’s director of opioid response.

But Friday’s announcement of the settlement that will direct funds to Maine towns, cities and school districts to cover costs related to opioid addiction marked the resolution of one part of a larger struggle to combat the opioid epidemic.

Maine has played an outsize role in that struggle not only because it has seen a disproportionate share of deaths. The state has also played a large part in bringing broader awareness to the dangers of opioid abuse that led to successful litigation against manufacturers and distributors, according to interviews with three substance use experts.

The settlement with Johnson & Johnson and others comes on the heels of a year in which Maine set a record of 636 overdose deaths, in a sign that the crisis has only worsened. Seventy-seven percent of those who died overdosed on fentanyl, a synthetic opioid that is 100 times more potent than heroin and is increasingly cut into a growing variety of illegal drugs.

Dozens of Maine cities and school districts have joined federal lawsuits against manufacturers like Purdue Pharma, the OxyContin maker owned by the Sackler family, and consulting firm McKinsey, which advised such companies on how to market their products.

Maine is set to receive another $20 million from Purdue as part of a nationwide settlement.

“The human cost is so horrific that it almost feels cheap to say, ‘Oh by the way, it’s costing the state a billion dollars a year,’” said Gordon Smith, Maine’s director of opioid response.

The settlement amounts to date pale in comparison to the funding Maine has received under the 1998 settlement that has so far directed more than $1 billion to the state from tobacco companies to pay for smoking prevention and cessation and other public health programs.

“By no means does it make us whole, but it’s new money that can be directed towards worthwhile projects like harm reduction, prevention, treatment and recovery support,” Smith said.

After Purdue began marketing OxyContin in 1996 as a prescription painkiller, its sales representatives targeted states such as Maine, Virginia, West Virginia and Kentucky with high concentrations of injury-prone, manual labor jobs, said Noah Nesin, an innovation adviser for Penobscot Community Health Care in Bangor and its former chief medical officer.

Such states were more rural and their medical providers had smaller professional networks, making them more vulnerable to promises from pharmaceutical companies that pledged to solve their patients’ chronic pain, Nesin said.

“It seemed like an answer to a problem that hadn’t been solved,” he said.

Maine was — and continues to be — one of the states with the highest prescription rates for opioids. The most recent data from the U.S. Centers for Disease Control and Prevention showed that Maine’s rate of opioid prescriptions per 100 people was 40.3 in 2020, the highest in New England.  

Law enforcement and other public officials sounded the alarm about opioid abuse as early as the 2000s, almost a decade before Maine reached its peak prescription rate of 93.1 prescriptions per 100 people in 2011.

Jay McCloskey, then the U.S. Attorney for Maine, was one of the first public officials to identify the threat that OxyContin posed in a February 2000 letter sent to Maine physicians, he later told the U.S. Senate Judiciary Committee.

“It is a very effective painkiller for people who have legitimate pain issues, but it is easily abused,” McCloskey said in an August 2000 press conference announcing the indictments of 11 people accused of illegally buying and selling OxyContin, according to Bangor Daily News archives.

Maine began tracking drug overdose deaths in 2002, when then-Attorney General Steve Rowe ordered researchers to collect data on overdoses dating back to 1997, said Marcella Sorg, a  medical anthropologist who compiles Maine’s drug overdose data and is the director of the Rural Drug and Alcohol Research program at University of Maine’s Margaret Chase Smith Center.

The state also began monitoring prescription drug data in 2004, Sorg said.

The crisis took root especially in rural communities in Down East Maine, where Michael Riggs, a former Washington County sheriff’s deputy, called it the “worst thing we’ve ever encountered” in 2003 U.S. Senate testimony.

But it was only around 2012 or 2013 that efforts from medical experts to draw awareness to how dire the opioid crisis had become began to resonate, Nesin said.

“We began to embrace the idea that prescribers were part of the foundational problem in the opioid crisis, and that it wasn’t just a handful of irresponsible prescribers, but a really broad pattern of prescribing that had triggered this opioid crisis,” Nesin said.

Nesin touted efforts like the expansion of medication-assisted treatment and the Maine Naloxone Distribution Initiative, which distributes the overdose-reversing medication, as factors in preventing more fatal overdoses, as well as the passage of a 2016 law  that restricts opioid prescriptions.

The COVID-19 pandemic and increasing presence of fentanyl in street drugs has led to more overdoses, but naloxone has helped reverse potentially fatal ones, Nesin said.

“Addiction is a disease of isolation, and as the pandemic exacerbates that isolation, people are more likely to use alone,” he said.

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Lia Russell

Lia Russell is a reporter on the city desk for the Bangor Daily News. Send tips to LRussell@bangordailynews.com.