The Joint Task Force on Substance Abuse:

 

  Status Report

on Recommendations

January 2001

 

 

 

 

Introduction

 

In the spring of 1998, Governor Angus King joined the 119^th Legislature to appoint a joint task force to study substance abuse.  The task force, which met over the course of the summer held hearings, brought in experts, and reviewed reams of research documents.  They learned that substance abuse cost Maine approximately one billion dollars per year, $834 for every man, woman, and child in medical, criminal justice, child welfare costs, and lost work hours.  The task force outlined 42 recommendations for improvements in the way Maine addresses the statewide problem of alcohol and drug abuse.

 

Two years later, much progress has been made, but we still have a long way to go.  This report will outline progress made on the original recommendations, update trends in use and abuse of alcohol and drugs, and suggest further changes that are necessary in order to continue to work to decrease the effect substance abuse has on our state.

 

 

Current Trends

 

Data from the Office of Substance Abuse’s Treatment Data System (TDS) shows an increase in admissions to treatment for marijuana, heroin, and other opiates use over the last 5 years. Admissions for the abuse of opiates increased almost 500% between State Fiscal Year (SFY) 1995 and SFY 1999.  Admissions for alcoholism has decreased, possibly due to the fact that IV drug users are prioritized for admission for any program receiving funds from the Federal Block Grant.  Opiate addicts may be displacing alcoholics from treatment slots.

 

National Household Survey data from 2000 indicate an addiction rate of 7% among the state’s adult population.

 

Admissions data for persons under the age of 19 verifies that marijuana is a significant problem for our young people.  The majority of youth admissions to treatment (36.8%) for SFY 1999 are for a primary problem of marijuana with alcohol the second highest at 33.1%.  The third closest category is for youth who are affected by someone with an alcohol or drug problem at 23.5%.  There has been an increase in admissions due to abuse of prescription opiates, though the percentage remains fairly low (1.3%in 1999); however, the percentage continues to grow as preliminary numbers for SFY 2000 show 2.2% of adolescent admissions to treatment are for prescription opiate addiction. Heroin and cocaine usage appear to be on the rise among young people as well.

 

 

The Maine Youth Drug and Alcohol Use Survey (MYDAUS) was administered in 1995, 1996, 1998/99 and 2000 in Maine.  In reviewing trends across those administrations[1], past month alcohol use has dropped since the 1995 and 1996 administrations of the survey.  While this drop indicates a positive impact by prevention, and Maine remains similar to the national data[2], alcohol remains a significant issue for Maine youth with 80% of high school seniors drinking in the past year.   Past month use of marijuana has dropped in all grades except 6^th grade (it has remained consistent since 1996).  Maine 10^th and 12^th graders continue to have a higher rate of past month use of marijuana than the rest of the nation.

 

 

Seventh and Eighth graders have the highest incidence of past month inhalant use with 7% and 6% respectively.  Inhalant use drops in the higher grades.

 

No discernable change in past month use of Cocaine and LSD (and other psychedelics) was noted.  This survey does not track opiate use, which has been increasing in the young adult population.

 

Cigarette smoking showed a marked decrease in the 1998/99 and 2000 MYDAUS.  However, the historical gap between female and male usage has reversed.  In the 1998/99 survey, 1% more boys smoked than girls.  By 2000, for the first time ever, girls smoked more than boys.  Girls were 1.5% more likely to smoke than boys in 2000.

 

The Substance Abuse Treatment and Intervention Needs Assessment Project (STNAP) Integration Study shows that there are approximately 8,029 youth who need treatment in the State of Maine.  Of those, approximately 496 are school dropouts and an additional 703 are adolescent mothers.  According to the TDS, 1,437 youth received services in SFY 1999.  This indicates that only 18% of adolescents that needed treatment got it.

 

Through the STNAP studies of assessing treatment needs, the Office of Substance Abuse has garnered a great deal of information regarding the need of Maine citizens for intervention or treatment.  Currently, it is estimated that 82,918 adults in the State of Maine require treatment.  Of those requiring treatment, an estimated 1,830 are homeless persons; 4,141 are institutionalized; 560 are county jail inmates; and, 899 are state prison inmates[4].

 

 

Among these adults needing treatment, there are special population groups such as pregnant women, people who are injection drug users, adults charged with Operating Under the Influence, and adults with co-occurring conditions who require specialized treatment services.  The following are estimates of those special populations:

 

 

The TDS shows admissions of 10,256 for SFY 1999.  Based on the above estimate of treatment needs, 86% of those in need of treatment did not receive it.

 

Treatment Improvement

 

As a field, substance abuse treatment has made remarkable advances in recent years.  Research has given us a better understanding of the etiology of the disease of addiction and led to improvements in treatment techniques.  The State of Maine Office of Substance Abuse has undertaken a number of activities in order to assure every client receives the best available treatment.  It is critical that we continue to support improving the quality of addiction medicine to assure that our funds are being spent to provide effective services, particularly for those populations that require specialized services.  Recent research has focused on the development of medications to reduce craving for opiate and cocaine addicts, as well as comparisons of psychotherapy techniques to determine which treatments are most effective for which client groups. 

 

The Office of Substance Abuse, charged with transferring research into practice, has instituted several initiatives in order to move the treatment system into providing more effective services.

 

·         The Office of Substance Abuse has expanded its involvement with provider agencies by performing technical assistance site visits to all contracted agencies in the state.  The visits offer information exchange and technical assistance for the agency, as well as provide the Office of Substance Abuse with an enriched perspective of the state of practice at the treatment facility and the development needs of staff.

·         Creating a System Welcoming to Clients with Co-Occurring Disorders of Mental Illness and Addiction is a new Department of Mental Health, Mental Retardation and Substance Abuse initiative established to examine the barriers to both substance abuse and mental health services in the state. With the Office of Substance Abuse playing the lead role, an advisory board has been established to begin the work to develop a plan for improving standards of care and developing practice guidelines and training curricula. 

 

·         In response to the recent increase in use of heroin and synthetic opiates, particularly in the Cumberland, Penobscot and Washington County areas, a daylong conference was presented in early October bringing national experts in opiate research and treatment to Bangor.  Approximately 160 professionals including clinicians, law enforcement and medical and school personnel attended the presentation.  The Office will continue to provide training and consultation to providers and communities dealing with this difficult problem.

 

·         The Office of Substance Abuse has joined with the Bureau of Health to study and respond to the impact of Hepatitis C on substance abusing, particularly injection drug using, clients.  A needs assessment has already been completed and activity is currently underway to develop a response plan through education and awareness programs to the communities. 

 

·         Core licensing protocols are being developed within the Department of Mental Health, Mental Retardation, and Substance Abuse Services to reduce redundancy, and bring emphasis to improved standards of care.  The Core Standards require annual trainings of all staff in key areas.  The new licensing standards will more closely mirror the American Society of Addiction Medicine (ASAM) levels of care and practice standards.

 

Prevention Improvement

 

Research has begun to demonstrate what works in preventing risky behavior, as well as what doesn’t.  We now know that prevention of early initiation of alcohol and drug use, as well as other dangerous behavior, requires a sustained, community wide effort.  It should come as no surprise that open parental communication combined with clearly communicated and strictly enforced rules regarding use act as effective prevention of substance use by children.  Mentoring by other adults or by older adolescents can alleviate the lack of parental involvement. 

 

Research is also demonstrating that community norms play a large role in early initiation of tobacco, alcohol, and drug use.  So called environmental strategies that focus on combining increased enforcement of existing statutes, developing parent and community networks, and providing positive alternatives have shown promise in reducing youth alcohol and drug use.

 

Improvement in the prevention services has been promoted through several initiatives.  “Best practice” forums meet monthly and are now able to serve the entire state.  The forums promote:

 

·         Staying current with the latest prevention research

·         Peer review to improve prevention programming

·         Networking and collaboration

·         Professional development

 

 

In addition to the Best Practice Forums, the Office of Substance Abuse now has the ability to post relevant information on a prevention e-mail group.  As opportunities are found by prevention specialists, they can be posted electronically to the field, which adds another mechanism for updating providers.

 

The principles of effectiveness, as mandated by the United States Department of Education, have been adopted and are required of prevention contracts.  The four principles of effectiveness require that:

 

·         All contracts base their programming on local, objective data;

·         Programs write measurable goals and objectives based on the need demonstrated in their community;

·         Researched and evaluated programs or promising practices be adopted to meet those goals;

·         Programs be evaluated.

 

Training and technical assistance workshops have been conducted around the state to acquaint school and community prevention providers with these principles of effectiveness.  If programs are unsuccessful in meeting their goals and objectives, they are provided with information on programs that have demonstrated effectiveness.

 

In the near future, the Office of Substance Abuse would also like to bring credentialing of prevention providers to Maine.  Currently, there are no standards or course work required of practitioners on the science of prevention.  The Office of Substance Abuse is currently gathering information from other states about their prevention curriculums so that discussions can begin on how to build the infrastructure needed to ensure people that provide prevention services to the children in Maine are well qualified.

 

 

Progress on Task Force Recommendations

 

 

Recommendation 1:  Expand resources to fund substance abuse initiatives by: reallocating state general fund revenues; making changes in state tax policy; applying for federal grants; building municipal support; and obtaining private sector grants. 

 

The $4.75 million appropriated from the tobacco funds substantially expands the resource base of the Office of Substance Abuse. This allows the Office of Substance Abuse to address approximately 24% of the unmet need reported in the task force report. We will address specific spending later in this report.

 

No effort has yet been made to increase alcohol taxes, though tobacco taxes have been increased significantly.  General funds from alcohol tax collection have not been reallocated.

 

The Office of Substance Abuse has applied for several federal grants including a joint application with a treatment provider, Day One, for expansion of treatment capacity for juveniles in the criminal justice system, and a prevention grant aimed at including youth in developing prevention activities, both of which were awarded.  The Office of National Drug Control Policy has awarded two prevention grants to Maine providers.  In addition, the Center for Substance Abuse Treatment (CSAT) has funded the development of a Differential Substance Abuse Treatment model for adult offenders, and training with national experts on the treatment of opiate addiction. 

 

DMHMRSAS has a department-wide effort to partner with the Bingham Foundation in a joint funding project that would target innovative programs aimed at creating system change. One of the initiatives this partnership will fund is innovative treatment for people suffering from both mental illness and substance abuse disorders.

 

The Office of Substance Abuse will continue to seek federal funding where appropriate.  In 2001, the Office of Substance Abuse will begin work on developing partnerships with business and communities across the state in order to increase the business community’s participation in prevention efforts.

 

Recommendation 2:  Implement mechanisms to ensure that the Office of Substance Abuse is appropriately positioned in state government and that substance abuse issues receive an appropriate level of attention in both the Executive and Legislative branches. 

 

Legislation has been submitted for the upcoming 2001 legislative session.  This change in legislation would place the Office in a direct reporting relationship to the Commissioner.

 

Recommendation 3:  Continue to bring together representatives of the Legislature’s seven key policy committees into the Joint Select Committee on Substance Abuse so they can address substance abuse issues in a coordinated manner.

 

As the Select Committee was not legislatively mandated beyond the life of the task force report, the Office is planning to involve legislators in other ways. This status report will update legislators regarding the progress of the implementation of the task force recommendations.    In addition, four new legislative members have been added to the Substance Abuse Services Commission in order to keep information flowing to the legislature as requested.

Recommendation 4:  Support the development of an independent consumer initiative in Maine to play an active role in discussion and resolution of substance abuse issues.

 

In 1999, the Maine Association of Substance Abuse Programs was awarded a subcontract from a federal grant to the New England School of Addiction Studies headquartered here in Maine.  The grant is to train a grassroots group of recovering individuals and family members to work to reduce the stigma of substance abuse.  This group, Maine Association for Addiction Recovery (MAAR), has cosponsored several public forums and training opportunities in Maine, as well as represented the state at regional activities.  The state will use tobacco funds to continue to offer support to this group, which has approximately 300 members state wide, when federal funding runs out in September, 2001.

 

In September 2001, MAAR will sponsor the Treatment Works activities across the state. They will play a role in helping to host the New England Institute of Addiction Studies Summer School scheduled to be held in Brunswick, Maine, in June 2001.

 

 

 

 

Recommendation 5:  Assess which substance abuse services are needed in each region of Maine.  Provide funding, in proportion to population and geography, to support all components of the continuum of care in each region.

 

 The Office of Substance Abuse has conducted an extensive needs assessment that encompasses six different studies (STNAP, previously cited) funded by the federal Center for Substance Abuse Treatment (CSAT).  The Office of Substance Abuse is in phase two of this process, which looks at special populations and makes recommendations for system expansion or realignment. These studies in addition to the task force report have been used to make allocation decisions regarding funding and geographic distribution of programs.  The studies are public documents and available to anyone who requests them.  The largest study, a household survey, estimates that Maine treats approximately 14% of the people that need treatment annually.

 

Recommendation 6:  Increase access to and availability of substance abuse screening tools and assessments for youth.  Establish a long-term treatment facility for adolescents, as well as alternative services for youth that are geographically accessible.  Increase the availability of transitional housing for youth.

 

Maine has expanded capacity for assessment and treatment of youth that are involved in the criminal justice population in the past three years. Intensive outpatient services have grown statewide as well, in anticipation of an increased Medicaid rate.  The Office of Substance Abuse is working with one provider, Day One, to develop transitional housing options for young people.  Without additional funding, there are no plans to expand residential treatment, though the need for this type of program still exists.  Some outpatient services for adolescents will be funded through the tobacco settlement allocation.  While Maine is making great progress in meeting the needs of youth in the criminal justice population, the household survey estimates that we serve only 18% of adolescents in need of treatment annually.

 

Recommendation 7:  Recruit and retain appropriate and adequate staffing throughout the continuum of care.  

 

A small amount of funding (3.6%) has been added to existing contracts to meet this goal.  It is not adequate to meet the demand for healthcare professionals, particularly nurses, as salaries are significantly lower in this field than in other healthcare specialties.  The increase in Medicaid rates will add to agencies’ ability to recruit and retain qualified staff. In addition, the Office of Substance Abuse is creating a workforce development plan for the field of substance abuse in order to maintain a well-trained workforce using current best practice standards and methodologies.  This plan will be in place beginning in 2002 and will include training offered for entry-level clinicians through agency executives. Despite these efforts, there are not enough adequately trained people entering the field of substance abuse treatment to address the need.  Strategies to attract young people into this field still need to be developed.

 

Recommendation 8:  Address barriers to treatment and ensure the existence and consistency of support services throughout the continuum of care.

 

As part of the Office of Substance Abuse’s ongoing needs assessment, we are attempting to address this issue within existing funding constraints.  Much of the tobacco fund allocation is going to address geographic and economic barriers.  Other barriers will need to be addressed in order to make our system open and welcoming to all who have addiction problems, but this can be a very expensive proposition. How does a rural state ensure easy treatment access to all citizens?  What is a reasonable distance to travel in order to access any specialized medical service? 

 

In addition, there are specific population groups with significant barriers of their own.  Women often have children in their care, which makes participation in intensive services difficult.  The elderly population has significant transportation barriers among other issues.  The severely mentally ill, a population with a high rate of substance abuse, require a higher intensity, and longer term treatment that is not generally available in Maine.  The population of people with developmental disabilities also has a high rate of substance abuse problems, but require a different type of treatment than the cognitive behavioral therapy that is effective with most other populations.

 

Recommendation 9:  Institute action oriented outreach programs that target isolated populations.  Target substance abuse education and training programs to members of special populations groups.

 

While there is some outreach to the homeless population in southern Maine, we are not providing adequate outreach in other areas of the state, or to populations like women and the elderly.  According to the state needs assessment, the system is already working at 110% of capacity.  The treatment system could not meet the needs of the additional people outreach activities would bring into treatment.  As in the response to the question above, there are significant needs that remain unaddressed.

 

Recommendation 10:  Develop and carry out a media campaign to encourage respect for diversity.  Develop a standard curriculum that focuses on cultural diversity and make licensing of substance abuse providers contingent upon completion of this curriculum.

 

The Maine Alliance for Addiction Recovery supported a day of training in August of 2000 on diversity.  There is a general interest in this topic from the provider community and the Office of Substance Abuse will continue to work with them to increase the knowledge base and improve clinical practice. Cultural competency will also be included in the workforce development plan cited in #7.  Much effort has been expended in working to expand competency working with the disabled, including the deaf population and people with mental health issues.  OSA is involved in a department wide effort to increase knowledge of diversity issues among our own staff.

Recommendation 11:  Maximize the use of Medicaid funding to support the costs of substance abuse services for Maine’s low-income people.

 

The Office of Substance Abuse plans to use tobacco funds to seed increases in outpatient treatment rates and to provide seed for substance abuse residential (Private Non-medical Institutions, PNMI) programs.  Substance abuse treatment is one of the few areas where Medicaid increases have been minimal over the past five years, with five-year growth of PNMI at less than 1% total.  In 1994, addiction was removed as a disability from the SSI program, which took many alcoholics and addicts off the Medicaid roles.  During the two years following this decision, Medicaid expenditures for substance abuse decreased.  State funds have only partially replaced the services provided to this population. 

 

Recommendation 12: Provide training for Department of Human Services caseworkers and supervisors, as well as assistant attorneys general to improve their recognition of substance abuse, to make sure they understand confidentiality, and to underscore their responsibility to refer people for substance abuse treatment.  Increase referrals to substance abuse treatment by DHS.

 

In 1998, the Office of Substance Abuse held a training program on confidentiality for AAGs and DHS caseworkers.  The Office of Substance Abuse has begun working with DHS in order to improve treatment services for parents who are neglectful or abusive due to substance abuse.  We have identified eight areas of concern to be addressed, and will report to a legislative committee in 2001 on progress.  Additionally, the Office of Substance Abuse has begun work with the Muskie Institute to research system improvements.  As the drug courts expand judges knowledge of the treatment of substance abuse, we foresee working with judges to require assessment of all parents/caretakers involved in child protection custody cases and mandatory treatment as necessary.

 

 

 

 

Recommendation 13:  Enact legislation to allow the involuntary commitment of individuals in need of substance abuse services who are in danger to themselves and whose lives are at risk.

 

This legislation was submitted and defeated in 2000.  It is not anticipated that it will be brought up again in the near future.  It is unfortunate that there is no political will to enact this legislation, which is law in most other states.  Every year people die due to untreated addiction, whether due to exposure, loss of liver, kidney, or other system function, or violence and accidents.  We are seeing a greater number of deaths of people in our mental health system due to alcohol and drug abuse in 2000.  While we can institutionalize these people when they threaten to kill themselves with other weapons, we can do nothing about their drinking or drugging themselves to death.  This poses a problem for law enforcement, as well, as they have no tools to deal with the public inebriate. 

 

As recent deaths, particularly in the Portland area, have brought the problem of what to do with the public inebriate, the OSA will work with police departments, hospitals, and treatment providers to attempt to find an acceptable solution to this difficult problem.

 

 

 

 

Recommendation 14:  Create opportunities for youth to participate in the development of legislation and policies that affect their lives. 

 

In 1998, Maine applied for and received a federal grant to fund Maine Youth Voices, a project that has youth in communities across the state involved in developing prevention activities addressing the norms within their communities regarding underage drinking.  In April 2000, Maine PBS broadcast a special highlighting four of these groups.  They worked with PBS to develop and film public service announcements with a prevention theme. This PBS broadcast recently won a Parent’s Choice silver medal.  Maine PBS is following an additional four groups this year. The Office of Substance Abuse has received notice of award of additional federal funds to assist youth in addressing the issue of substance use in their communities by utilizing environmental strategies such as changing public policy.

 

Recommendation 15:  Expand substance abuse prevention programs in traditional and alternative schools and communities statewide.

 

As schools become overcrowded and local communities restrict funding, or focus on meeting learning outcomes rather than on student’s readiness to learn, increasing numbers of school systems have eliminated school substance abuse counselor positions over the last 10 years.  The Office of Substance Abuse and the prevention field see this as a serious problem. The alcohol and drug issue has not been given the priority it once had in schools, and both our schools and communities are paying the price. $650,000 of the tobacco monies is targeted for increasing prevention programs in schools and/or communities.  The funding will be directed toward programs using two proven techniques:  improved parenting or mentoring programs; and environmental strategies that address community norms, and access and availability of alcohol and drugs.

 

Recommendation 16:  Develop and maintain a revolving loan fund at the Office of Substance Abuse to assist communities with start up funds for substance abuse prevention.

 

There has been no activity on this recommendation.  A similar fund for treatment services has been underutilized.  OSA continues to work with communities to secure grant funding for program start-ups and this may be a more successful approach.  Maine just received a $400,000 federal grant through the Office of Juvenile Justice and Delinquency Prevention to begin youth sponsored prevention programs in five communities.

 

Recommendation 17:  Develop a system to ensure that technical assistance in program development, grant writing, and coalition building in relation to substance abuse issues is available to all Maine communities.

 

In 1999, the Office of Substance Abuse began holding best practice forums across the state for prevention providers to share successes and experiences. In addition, Maine’s Communities for Children program obtained a federal grant which will be used to develop the infrastructure outlined in this recommendation.  The Maine Alliance for Addiction Recovery has begun working with community groups to develop grant writing skills.  The OSA has held best practice forums for prevention providers in communities statewide where providers can share knowledge of what has worked for them.

 

Recommendation 18:  Develop funding partnerships involving the Office of Substance Abuse and other public and private organizations to support the continuation of coalitions in efforts such as the study circles.

 

The Office of Substance Abuse has worked with other groups to provide funding for prevention coalitions.  Prevention coalitions are active in 60 communities in Maine.  Some of these groups got their start as study circles, and continued as problem solving committees for the community.

 

Recommendation 19: Conduct a public information campaign to develop awareness about the devastating effects of alcohol and other drug abuse and to encourage individuals and communities to take action.

 

We have cooperated with the Office of National Drug Control Policy in implementing their media campaign. We have also partnered with Maine PBS to publicize the Maine Youth Voices program.  The teens involved with Maine Youth Voices created their own anti- drinking/drugging public service announcements, and worked with Maine PBS to air a half hour show on underage drinking in May of 2000.  The state has funded a powerful and effective media campaign to prevent tobacco use funded by tobacco settlement dollars.

 

Recommendation 20:  Review the status and outcomes of primary prevention programs across Maine, how these programs are funded, and how they can collaborate to work more effectively and efficiently.

 

The Office of Substance Abuse has begun requiring grantees for all of our prevention funds, including safe and drug free schools, to use methods that have been proven effective either nationally or locally.  Funding for prevention comes from a number of different departments.  The Bureau of Health and Maine Communities for Children have begun funding primary prevention programs in addition to the Office of Substance Abuse.  The three groups are beginning discussions on how to better coordinate efforts.

 

Recommendation 21:  Study the issues related to certification standards for prevention specialists in Maine.

 

The Office of Substance Abuse will begin to explore this recommendation with prevention providers and develop a plan for following through by September, 2002.

 

Recommendation 22:  Establish a taskforce comprised of representatives from Maine’s public and private post-secondary schools with the mission of addressing underage and abusive drinking by students.

 

The Office of Substance Abuse has developed the Underage Drinking Task Force which recently released their recommendations. One of the sub-committees of the Task Force dealt specifically with underage drinking in institutions of higher education.  Due to a number of accidental deaths and alcohol poisoning cases of college age drinkers, there may be an increased willingness on the part of institutes of higher education to address this issue.

 

Maine is involved with the governor’s spouses initiative to stop underage drinking.  At a press conference in October, 2000, First Lady Mary Herman and Department of Mental Health, Mental Retardation, and Substance Abuse Commissioner, Lynn Duby, signed a pledge to work to stop underage drinking.

 

 

 

 

Recommendation 23:  Complete the Office of Substance Abuse’s development of and fully implement the comprehensive differentiated program of evaluation and treatment for juvenile offenders. 

 

Assessments are being completed statewide.  Tobacco funds will be used to complete the curriculum development.  There is a shortage of available treatment, however, and waiting lists for service are occurring in some areas.  OSA will be monitoring these trends closely to develop strategies to address the shortages.

 

Recommendation 24:  Provide stable long term funding through the Office of Substance Abuse to the regional networks to increase differentiated treatment capacity to meet the treatment needs of juvenile offenders who are substance abusers and living in the community.  Also use funding for:  family treatment and intensive outpatient treatment services; long-term residential treatment; and the development of programs in all regions based on proven national models.

 

Most of this recommendation is funded through two federal grants, one of which is ongoing.  The Office of Substance Abuse will use tobacco funds to continue existing services beyond the life of the federal demonstration grant, but there is inadequate funding to expand beyond the existing system.  OSA and the Department of Corrections will continue to seek out funding in order to fully implement the system.

 

Recommendation 25: Provide stable long-term funding through the Office of Substance Abuse to implement a differentiated therapeutic intervention program at the southern and northern Maine Youth Centers.  

 

The Office of Substance Abuse will continue to support existing services to the southern Maine Youth Center.  Services at the Northern Maine Youth Center will be based on available funding at the time of completion of the facility.

 

Recommendation 26:  Implement juvenile drug court projects in each of the four corrections regions through a collaborative process involving the judicial department, Attorney General’s office, District Attorneys, Department of Corrections, and Office of Substance Abuse.

 

Drug courts have been established in Biddeford, Portland, Augusta, West Bath, and Bangor using federal funds.  Two more are in the planning phase in Houlton/Presque Isle and Lewiston.

 

 

 

Recommendation 27:  Provide stable, long term funding through the Office of Substance Abuse for a seamless, statewide comprehensive adult offender substance abuse service system which includes: screening for all offenders; a five level differential therapeutic intervention program for offenders in prison; a residential pre-release transitional treatment center for offenders in prison; and services provided through four regional treatment networks for adult offenders in community corrections.  

 

Some of the levels of treatment will be funded through the tobacco settlement allocation.  The prison based therapeutic community and the halfway house/pre-release center are currently funded through a federal demonstration grant which will run out in 2002.  State funds will be necessary to replace this grant.  Outpatient treatment for community corrections clients will be made available in some areas, as will treatment for offenders in some of the prisons. All offenders in the prisons are currently being screened.  We are developing a pilot program to screen all probationers in one or two of the regions.  Providing assessment and treatment to all offenders in the state system would require an additional $2.5 million.  We will be looking at strategies to address this need.

 

Recommendation 28:  Assess the need for substance abuse treatment for adult offenders in county jails with special attention paid to treatment for incarcerated OUI offenders.

 

There is limited funding to address this recommendation completely.  Because individuals in the county jail system are incarcerated for less than a year, and many for only a few days, the Office of Substance Abuse has chosen to direct our resources toward the prison and probationer populations.  However, the need is great.  Some of the county jails provide substance abuse treatment as part of their health services.  Some community treatment agencies provide limited services in the county jail system.  Both the prison and the county jail populations have addiction rates as high as 70% of the population.

 

Recommendation 29:  Continue the Drug Court project for adult offenders in Cumberland County and expand it to three additional sites in Maine. 

 

Adult Drug Courts will be created in Biddeford, Portland, Lewiston, Bangor, Rumford and Machias during 2001.  Funding from the tobacco settlement will be used to pay for treatment and case management services.

 

 

 

 

Recommendation 30:  Create by executive order a Law Enforcement OUI Task Force to develop comprehensive joint action plans for providing the most effective and efficient means possible to reduce the incidence of intoxicated drivers.

 

This recommendation has not been addressed directly.  Maine has a good track record in enforcement of OUI laws, and is in the process of revising its driver evaluation and education (DEEP) program in order to provide a state of the art impaired driver education service.

 

Recommendation 31:  Report to the legislature by January 15 of each year the results and recommendations regarding the effectiveness of the Young Driver legislation passed in 1998.

 

This legislation which has proven successful when implemented in other states.  We intend to provide a preliminary report on current program status on January 15 and more comprehensive information by 2002 when some experiential data has been collected.

 

Recommendation 32:  Develop legislation to allow more flexibility in the design of the Office of Substance Abuse’s Driver Education and Evaluation Program.

 

At present, the structure and content of the adult offender program is being revised and improved to reflect current knowledge about motivating people to change behavior and the progression of substance abuse to addiction. A new program will be offered beginning in July, 2001.  This program will be less expensive for the participant and more cost effective.  In other states where this program has been implemented, recidivism has been reduced by as much as 40%.

 

Recommendation 33:  Make training in the use of the intoxilyzer machine, Horizontal Gaze Nystagmus, and advanced OUI recognition techniques a mandatory requirement of Basic Police Training.

 

The Maine Criminal Justice Academy has improved its OUI training for basic police training to meet the National Highway Traffic Safety Administration’s recommendation of 24 hours of OUI education including all of the above.  State police receive 32 hours of training in OUI recognition techniques.

 

Advanced training added within the past two years include DRE (Drug Recognition Expert) training and refresher courses, DRT (Drug Recognition Technician) school, and statewide Field Sobriety Testing courses.

 

Recommendation 34:  Restore funding to the Maine Drug Enforcement Agency to the 1992 level.

 

Funding has not been restored to pre-1992 levels.  The Maine DEA has faced a significant increase in workload since 1998 as a significant influx of heroin has made its way into Maine, there is increased diversion of prescription opiates, and increased use of so-called designer drugs like Ecstasy.  While alcohol remains by far Maine’s most abused drug, the growth of opiate abuse is alarming. In 2000, MDEA was appropriated an additional $450,000 to replace other funding.  It did not add any new agents.

 

Recommendation 35:  Direct Maine State Police and Maine DEA to develop and execute a joint plan for illicit drug control designed to provide Maine law enforcement officers with training to enhance their skills in identifying and prosecuting offenders.

 

This recommendation will be discussed at a region wide meeting of DEA and state substance abuse directors in January of 2001.

 

Recommendation 36:  Expand Training at the Maine Criminal Justice Academy to focus on drug trafficking, drug recognition, and expanding threats to law enforcement officers from the hazards of clandestine drug laboratories.  Provide grant funds for local communities, so that they can expand drug recognition training for local law enforcement officers.

 

The threat from the hazards of clandestine labs still needs to be addressed.  There are ongoing efforts in the other areas of this recommendation, however.  Trainers from the Federal Law Enforcement Training Center were brought to Maine to conduct a training entitled “Rural Drug Enforcement Train the Trainer” which covers drug identification, trafficking, clandestine lab safety, as well as many other related topics.

 

Recommendation 37:  Enhance the Maine State Police capability to track and identify suspected and convicted drug offenders and provide pertinent data to all local and county law enforcement agencies.

 

The MDEA is tracking a large increase in drug related crimes, particularly trafficking in heroin and synthetic opiates.  Heroin arrests were up 40% in 2000, and arrests for pharmaceuticals was up over 300%  since 1998.

 

 

 

 

Recommendation 38:  Amend Maine’s health insurance laws to require “parity” benefits for substance abuse treatment under the same terms and conditions as benefits for other conditions and illnesses.  If parity does not pass, amend the current law to mandate coverage in HMO plans as well as all individual and group policies.

 

This legislation was submitted in 2000, but did not pass.  There is still strong interest nationally and locally in obtaining parity in insurance coverage for substance abuse.  The cost is minimal compared to the annual growth of other healthcare costs and could reduce the cost of emergency room care, decrease the length of hospital stays for chronic illnesses, and substantially decrease the cost of mental health care.

 

This legislation has been reintroduced in 2001.

 

Recommendation 39:  Revise insurer’s utilization review standards based on the medical necessity guidelines adopted by the American Society for Addiction Medicine (ASAM).  Require training in substance abuse treatment for those who review and approve managed care plans.

 

The Office of Substance Abuse is currently rewriting Medicaid and licensing regulations and is adding ASAM criteria as standards of practice, which will be implemented by April 2001.

 

Recommendation 40:  Improve the quality of Employee Assistance Programs (EAPs) by encouraging the development of programs that use core technologies and by initiating state licensing for qualified and certified EAP professionals.

 

The Office of Substance Abuse will begin review of these regulations in summer of 2001.

 

Recommendation 41:  Streamline the statutory and regulatory provisions governing EAPs and drug testing policies. 

 

The Office of Substance Abuse will begin a review of these regulations in summer of 2001.

 

Recommendation 42:  Examine the issues related to drug testing by employees, including screening for alcohol.

 

As alcohol is a legal drug that may show up in a drug screen for up to 24 hours after use, there are difficulties in enforcing rules regarding alcohol in urine drug screening.  However, employers are seeking guidance on dealing with employee’s intoxication at work.  The Office of Substance Abuse has begun work with other state departments regarding state employee alcohol use on and off the job.  Any effective strategies developed will be shared with the private sector. 

 

Tobacco Settlement Allocation

 

 

Of the 24 million dollars estimated to be needed in 1998, this is the amount met by the tobacco funds.  Some of the estimates made in 1998 were low.  For example, drug courts were estimated at $250,000, yet $750,000 will only pay for drug court in six of the sixteen counties.  This chart reflects percent of need met compared to need anticipated in 1998 only.  It does not reflect the cost of implementing drug courts statewide or a true cost of improving training levels of clinical staff.

 

All Others includes the following categories:  Outreach services; transitional services; interim services; crisis services; homeless services; deaf services; cultural diversity services; OSA legislation; program development; grant writing; coalition building; support services in continuum of care; DHS outpatient services (TANF clients) involuntary commitment services; utilization review standards; parity; study circles; opportunities for youth; public awareness campaign; employee screening/testing for alcohol; training of other professionals; education and training of special populations; media campaign (cultural diversity); standardized curriculum (cultural diversity); training caseworkers, supervisors, and AAG; training to increase DHS referrals; EAP training and licensing; intoxilyzer machine training/OUI; training law enforcement (track and identify); Maine Criminal Justice Academy (drug trafficking); university research capacity; revolving loan (start up prevention funds); measure effectiveness of young OUI offenders; Maine state law enforcement planning/skills to identify offenders; state tracking/identification of drug offenders; community drug recognition grants; restoration of DEA funds; and independent consumer initiative.

 

 

 

 

 

Summary of Tobacco Settlement Funding

of Task Force Recommendations

 

 

The 119^th Legislature identified $5.75 million in tobacco settlement funds to address the recommendations of the Joint Task Force on Substance Abuse.  The governor’s 2001 – 2002 budget allocates $4.75 million per year of those funds toward substance abuse treatment and prevention.  The majority of the funds will be used to increase treatment services.

 

Through expansion of Medicaid funding task force recommendation #11 is met, but we also help to alleviate the problem of treatment gaps, which the Task Force Report identified as the single most alarming problem in Maine’s substance abuse system.  The state share of the increase in Medicaid funding for treatment will be covered by the tobacco funds.

 

An additional $650,000 will be used to expand treatment services statewide.  This funding will be given to existing treatment programs to expand services and decrease waiting lists, primarily for detoxification and residential services.  (This partially addresses Task Force concerns on gaps in the continuum and waiting lists.)

 

Because there is a great cost savings to the state when it invests money in treatment for the addicted criminal offender, Maine is investing a large portion of the tobacco funds in this population.  This funding addresses Task Force recommendations #23 – 29.  The Office of Substance Abuse will add $1.1 million to add treatment in the Youth Center, prisons, and for people in community corrections.

 

In order to allow treatment providers to recruit and retain appropriate and adequate staffing (recommendation #7), the Office of Substance Abuse has allocated $250,000 toward a 3.6% increase in the Office of Substance Abuse budgeted staff line of all contracted providers.

 

We will use $150,000 to enhance substance abuse treatment for the mentally ill.  This population is the largest special needs population we have in Maine.  Our inadequate treatment of this population has resulted in excessive costs for mental health treatment, and poor outcomes for those particular clients. (Task Force Recommendations # 8 and 9)

 

Funding for adult drug courts ($745,000) was specifically allocated by the Legislature. Drug Courts will open in March, 2001 in six Maine communities.  This program development meets Task Force recommendation #29.

 

The Office of Substance Abuse will add $650,000 to the statewide prevention effort utilizing two proven prevention techniques, parenting/mentoring programs and environmental strategies. We expect new programs to begin in early April.  (Task Force recommendations # 14 – 22)

 

Conclusion

 

Much progress has been made in addressing the recommendations made by the Joint Task Force on Substance Abuse in 1998, however, it is too early to quantify the impact.  Some changes have not had time to reach their full effect.  Increased and more effective prevention efforts, for example, will not bear fruit for at least five years.  We are seeing the effects of inadequate prevention efforts of the early 1990’s just now, with a cohort of 17 – 25 year olds that have a higher rate of tobacco, alcohol, and other drug use than any group seen since the late 1970’s.  The redoubled prevention effort seems to be showing effect in the young adolescent age group, particularly 7^th and 8^th graders, whose alcohol consumption has decreased by as much as 10% since 1995.  Tobacco use has shown a similar dramatic decline in this cohort.

 

Because of changes in funding, including the dramatic move of private insurers to managed care, decreases in state funding in 1992 and 1996/97, the removal of a significant number of addicts from the Medicaid roles in 1995, with a concurrent decrease in out-patient Medicaid rates, the substance abuse treatment system has been in a state of crisis for a number of years.  The tobacco fund allocation will stabilize the system, but more resources are needed to expand services to individuals with special needs or in remote locations.

 

Similarly, law enforcement efforts face a crisis in their inability to respond to increased trafficking in heroin and diversion of prescription opiates. The Maine DEA is staffed at a level lower than it was in 1992, a time of the lowest drug use since 1974.

 

 As we have increased criminal penalties for drug offenses over the course of the past fifteen years, we have filled the prisons with drug addicts, but have offered them no treatment leading to a high rate of recidivism, full prisons, and a costly prison construction boom.  Several state including Arizona, California, and Massachusetts have held referenda on mandated treatment rather than imprisonment.  Arizona and California, where these polices have been adopted, bears watching to see if the changes are successfully implemented.

 

Maine decriminalized public intoxication, but was unwilling to mandate or involuntarily commit alcoholics to treatment, leaving police officers with limited alternatives to deal with the public intoxicant.  They may spend hours trying to get one person into the emergency room or a detox program, only to have him walk out of the hospital or program as soon as he is capable of walking.

 

In some communities, drug courts will help the criminal justice system cope with the load of nonviolent drug offenders that might otherwise be placed in prison.  However, drug courts are relatively expensive programs that can only serve small numbers of individuals.  The therapeutic community in the Windham Correctional Center and the half way house in Hallowell will treat the sickest of the prison addict population.  All prison inmates, and eventually all probationers, will be screened for substance abuse treatment needs, but only a small portion of those treatment needs can be met with current resources.

 

What have we learned over the course of the past two years?  We know that prevention and treatment of substance abuse are effective means to reduce the social costs of addiction and substance abuse to society.  We know that treatment will lower the incidence of all criminal activity including domestic violence and child abuse.  We know that substance abuse treatment will lower emergency room admissions, psychiatric hospitalizations, and shorten hospital stays for treatment of chronic illness.

The State of Maine has made a great effort toward reducing the use and misuse of one drug: nicotine.  With a similar effort, we can make inroads toward reducing the impact of the abuse of alcohol and other drugs in our state.  The allocation of a portion of the tobacco funds is a first step toward making necessary policy changes.  We need to take a fearless look at our beliefs and the public policy to which they lead, as we have done with tobacco.  Who would have predicted ten years ago that we would ban smoking in restaurants in 1998?  Could we have envisioned a smoke free work place as recently as 1980?

 

The commitment of all Maine’s citizens is needed to battle Maine’s deadliest drug.  We need to address our beliefs about youth and alcohol, our feelings about alcoholics and drug addicts, and create public policy that reflects scientific knowledge rather than historically based myths and misperceptions.  Study after study has demonstrated that an investment in substance abuse prevention and treatment saves lives, families, and money.