Governor Mills: Let’s not be disheartened. There is no simple solution to the opioid epidemic, but there is hope. I know there is.

July 25, 2019

This week’s radio address features Governor Mills’ remarks as delivered during her July 15th opioid response summit, “Turning the Tide: Maine’s Path Forward in Addressing the Opioid Crisis.”

Thank you, Gordon, and welcome to the 2019 Opioid Response Summit!

And thank you to our speakers – Sam Quinones, journalist and author of the landmark book, Dreamland; national policy expert Michael Botticelli, who was President Barack Obama’s Director of National Drug Control Policy; and Dr. Patrice Harris, President of the American Medical Association — and many others who have joined us to share their expertise.

You know, I subscribe to many newspapers, national and local. One I picked up at breakfast the other day began with a description of a city neighborhood which sounded like the setting of a television crime drama. It read:

“It’s the neighborhood where a police cruiser patrols the streets at least two or three times a day while it may pass through quieter neighborhoods only a couple times per week, just to check in.

The sidewalks are littered with cigarette butts and people loiter outside the nearby grocery store. A man and a woman, both in their pajamas, scream at each other from opposite ends of the sidewalk. A driver with all the car windows rolled down yells as he blows through a stop sign. The tires screech loudly as the car whips around the corner.

The neighborhood children spend most of their day outside, riding their bicycles up and down the connecting streets. But by 8 pm they all disappear. Even if they aren’t on curfew, it’s as if they know better than to be alone on these streets at night.

Drug busts seem more common here than on the other side of the…city. It’s usually not difficult to pick out which buildings might be housing drug deals, either. Often it’s the ones with overgrown weeds on the front lawns and porches that look like they are on the verge of collapsing.

Late at night, the dark sky conceals everything except the bright yellow headlights of each new car, alerting neighbors that another guest presumably is paying a visit for drugs. The usual visitors make quick pit stops at these places, and most of the time they don’t stick around for too long.”

The city described in this article is not Lowell or Lawrence, Massachusetts, or Brooklyn, New York, or Boston or even Portland, Maine. It could be Portsmouth, Ohio, described in Sam Quinones’ book. But it is, in fact, Presque Isle, Maine, the “Star City” of our state, a small friendly community always considered a safe place to raise a family on a farmer’s or teacher’s or trucker’s salary, a place where children were safe and community values were strong.

The article in the Bangor Daily News went on to note that while Aroostook County had the highest rate of drug trafficking or manufacturing arrests by the MDEA in recent years, and while it had the second highest rate of substance-exposed babies, the County also had the lowest rates of 211 help line calls relating to substance use in the whole state.

What’s wrong here? What are we missing — not only in Aroostook County but in our fifteen other counties and in every one of our more than 400 communities where we have seen this epidemic take hold in a quiet, tragic and very frustrating way?

For one thing, I think for too long we have viewed the opioid problem with a narrow and occasional lens, like:

— when we announce the overdose death statistics that represent so many hundreds of individuals who should be working, going to school and raising healthy children but who instead are dead and lost to us forever;

— or when we read the annual statistics about drug affected infants, 905 last year alone, and we say, “oh my, isn’t that awful, what’s going to happen to those poor little children?”

— And when we wonder about the growing caseloads of child protection cases, that are increasing by the hundreds, with nearly 10,000 reports last year alone, more children than ever in recent history in state care (2,153 currently), more than half of those children having been removed from their family because of alcohol or drug abuse by a parent.

— or when we see the press conferences on television, now almost routine, announcing the latest arrest of people importing heroin and fentanyl by the pound, or someone manufacturing methamphetamine in the back of their car at high risk to everyone in the area.

— or when we hear that a nurse or doctor or some other professional had their license suspended and the word is that they were caught diverting drugs from a hospital or pharmacy.

— or when we hear of the tragic death of a major athlete like Len Bias or an actor like Philip Seymour Hoffman, and we feel shock and then feigned comfort in the thought that “oh well, that can’t happen here.”

Along the way we have done things that have made us feel better and that have perhaps made a difference in some way:

  • We have armed our pharmacies with cameras and robbery and diversion prevention tools.
  • We have convened task forces and submitted bills and held hearings and conversations with public policy makers.
  • We have organized drug take back days every once in a while, where we clean out our medicine cabinets and turn over tons of pills to be crushed and incinerated, taken out of circulation.
  • We have softened felony penalties for criminal possession cases, but without providing real help for those arrested for drug related crimes.
  • …though we have created more drug courts, veterans courts and co-occurring disorder courts that offer intensive supervision for the handful of people charged with drug offenses who are brave enough to stay the course for 18 months or more.
  • We have supported “Operation Hope” and similar programs that allow people with substance use disorder to seek help from the one place they ordinarily would be loath to approach — the police department.
  • We have finally imposed prescribing limits for opioids and required E-prescribing and data entry into the Prescription Monitoring Program, but we have not yet fixed the PMP’s reporting requirements or its functional interaction with other states.
  • And, after much needless delay, we have finally allowed dispensing of the life-saving drug Narcan over the counter in our state’s pharmacies.

Now, that took a while. And let me tell you, that was really frustrating. Thank you to Ann Perry and Speaker Gideon for their efforts, year after year, to get Narcan where out is needed.

As Attorney General, I determined that I could legally provide Narcan to law enforcement agencies. So, rather than wait for the Pharmacy Board to adopt rules, I drew down some money from pharmaceutical settlements. With that money I bought a room full of Narcan and we drove it around the state. I gave it out to nearly a hundred police departments. And, as of last week, that Narcan has saved 772 lives.

Until now — until today — though, we have looked at drugs as just a criminal justice problem, or just a health care issue, or just another challenge for overburdened teachers in our schools, as we point the finger to some publicly identifiable source of the problem and we readily blame some bad actor, some specific villain, passing off the ultimate responsibility not onto ourselves but to some dealer or trafficker or another, or to some agency of government or another.

It’s always somebody else’s problem, and somebody else’s responsibility.

It’s time to get out of the silos and halos and out of that solipset silo’d mindset.

And that’s why we are here today.

We are going to hear from law enforcement, the medical establishment, public officials and, yes, the most important voices — those of the recovery community.

For too long, the voices of Mainers in recovery have been missing from the conversation about how to stem the tide of this deadly epidemic.

I am so grateful to the more than one thousand Mainers here this morning, including so many who are in recovery and those who have lost family members to this disease, who have taken the time to share their histories and to brainstorm all sorts of solutions, and to support recovery and prevention today.

When I took office this January, I gave my word to Mainers suffering from substance use disorder that help was on the way.

I told them then, and I tell them now, that they are not alone, that, together, we will do everything in our power to bring them back, to make our communities, our families, and our state whole once again.

In the past five years, more than one thousand seven hundred people in Maine have died from drug overdose – more than the entire population of Chesterville, or Eastport or North Berwick. 418 people in 2017 and 354 in 2018 alone,74 deaths the first quarter of this year.

Now, for goodness sake, if seventeen hundred baby seals washed up on the shores of Cape Elizabeth, we would be marching in the streets. We would not stop until we knew what had caused it and how we could stop one more seal from dying.

But we are so inured to the bodies piling up. It’s as if we are in a war zone and don’t even know where the battlefield is anymore or what ammunition to use against this insidious enemy.

Meanwhile, just last year, 908 drug affected babies were born in Maine. That’s nearly 8 percent of all babies born in Maine, double the number ten years ago.

While overdose deaths have decreased slightly in the most recent reports, we have no cause to celebrate.

Nearly one Mainer a day is dying from substance abuse.

And I firmly believe, that one life lost is simply one too many.

These people are not ‘junkies.’ They are our neighbors, coworkers, family members, schoolmates, graduates of high schools, CTEs, universities and colleges.

They are our sons and daughters. They are people without labels, citizens without stereotype. They are athletes and businesspeople, fishermen, cooks and clerks. Mothers and fathers. People we see every day.

We cannot abandon them. The time for action is now.

We are putting the full force of this Administration behind the families who have lost loved ones, the businesses who have lost valued employees, and all communities that have been diminished by this public health crisis, for as long as it takes until our state recovers from something so severe that is draining our workforce, diminishing our families and eating our soul.

What have we done so far? —

On my first day in office, in January of this year, I signed Executive Order No. 1, at last fulfilling the will of Maine people and expanding MaineCare to more than 70,000 eligible Mainers. Health insurance is part of the solution. In the last six months, the Department of Health and Human Services has already enrolled more than 27,000 people, and many of those are finally able to afford life-saving treatment for substance use disorder.

I then appointed Gordon Smith, an experienced, well-respected and highly qualified public health expert, as Maine’s first Director of Opioid Response. I’ve always said, if any one of us had been Governor five or six or ten years ago, you would have seen this crisis coming. And you would have put someone in charge of it, to report to you every day on what we can do to stem this crisis.

I knew then and I know now that Gordon was the right person for that job, at the right time and the right place, with the right background and with incredible drive.

Among other things, he has educated medical providers around the state and encouraged all physicians to become certified to do Medication Assisted Treatment, taking on patients with sometimes difficult needs, but performing a public service in helping people lick addiction.

As Director of Opiate Response, Gordon got to work immediately knocking down the silos that prevented the departments of state government from sharing information and resources to combat this crisis.

I then issued Executive Order No. 2, on February 6, encapsulating the steps we are taking to address the opioid crisis. That Order established the Prevention and Recovery Cabinet, made up of Commissioners from 14 state government agencies, the Attorney General’s Office and the Judicial Branch. And I’m pleased to see in the audience several of our commissioners — DHHS Commissioner Jeanne Lambrew, Corrections Commissioner Randy Liberty, Public Safety Commissioner Mike Sauschuck and Education Commissioner Pender Makin.

Almost every branch of state government is impacted by the opioid crisis — whether it’s Professional Regulation and Licensing, the Labor Department, Health and Human Services, Corrections, or Economic and Community Development. The Prevention and Recovery Cabinet is identifying, organizing, and focusing our opioid response efforts so that they can be as effective as possible.

No longer will our resources be squandered or scattered piecemeal across departments who don’t, won’t or can’t talk to each other.

The Prevention and Recovery Cabinet has established some specific goals, including expanding safe needle exchanges to prevent the spread of disease; evaluating and promoting recovery housing; and developing the most effective prevention efforts for our schools and communities to give young people the tools to make well-informed decisions in their lives.

That Executive Order also directed the Department of Health and Human Services to use existing federal funds to purchase and distribute 35,000 doses of the life-saving drug naloxone, Narcan.

Now, as I’ve said before, it is not enough to prevent Mainers from dying of a drug overdose. We also must help people turn their lives around after they’ve been revived, provide a different kind of triage.

So that Executive Order also directed DHHS staff to recruit and train two hundred and fifty qualified recovery coaches. Across the country and here in Maine, recovery coaches have had a positive impact on addressing the opioid epidemic and helping in long-term recovery.

The Executive Order also directed staff to fund a full-time recovery coach in up to ten emergency departments in the state and to support low barrier access to buprenorphine in all 33 emergency departments in the state.

These initiatives are being paid for with existing federal funds available through the Department.

Lastly, Mainers working to rebuild their lives after incarceration should not have to face the additional battle of combating addiction alone. That’s why the Executive Order also strengthens programs for Medication Assisted Treatment in the jails and prisons and for those in reentry programs.

Our Commissioner of Corrections, Randall Liberty, is deeply committed to this goal.

These actions over the last six months are saving lives and helping protect our children and young adults from the appeal of dangerous drugs. We are making sure that Mainers suffering from substance use disorder in our emergency rooms, our jails, and on our streets will find the resources they need to recover and rebuild their lives and become productive citizens of Maine again.

These actions, of course, supplement the vigorous efforts of law enforcement at all levels to stem the tide of drug trafficking into Maine that is fueling this epidemic, from Portland to Presque Isle and beyond.

And, as noted in the Executive Order, the actions undertaken by this Administration are done always with a view towards reducing the stigma associated with substance use disorder.

During this first session of the 129th Legislature just concluded, we made other strides in addressing the opiate problem.

With the help of the Legislature:

  • We removed the two-year MaineCare limits on medication assisted treatment, limits that were not supported by any valid data, research or experience.
  • We ensured that good Samaritans would not be arrested or prosecuted for calling for help when someone is experiencing a medical emergency — a law already adopted in 40 other states and the District of Columbia and now, finally, adopted here.
  • We enacted a bill to establish additional ‘Housing First’ units in both urban and rural communities.

And, as you will hear from Attorney General Frey later on, the state has brought suit against the big pharmaceutical companies and distributors who caused this epidemic to begin with.

Many of you in this room helped accomplish these important policy changes and I thank you for all your work and continued efforts to ensure every Maine person who seeks help can access it.

Now, I know that healing our state from the ravages of the opioid epidemic is a complicated challenge that will not be erased overnight.

But today, we are getting together to brainstorm and learn and work on a comprehensive and well informed plan to chip away at this insidious crisis.

Let’s not be disheartened. There is no simple solution, but there is hope. I know there is.

Here’s something else I read recently, in a book, not a newspaper. It said:

“Heroin is, I believe, the final expression of values we have fostered for thirty-five years. It turns every addict into narcissistic, self-absorbed, solitary hyper consumers. A life that finds opiates turns away from family and community and devotes itself entirely to self-gratification by buying and consuming one product – the drug that makes being alone not just all right, but preferable.”

The author continues:

“I believe more strongly than ever that the antidote to heroin is community. If you want to keep kids off heroin, make sure people in your neighborhood do things together, in public, often…. Break down those barriers that keep people isolated. Don’t have play dates; just go out and play. Bring people out of their private rooms, whatever forms those rooms take.

Pursuit of stuff doesn’t equal happiness, as any heroin addict will tell you. People…may emerge from this plague more compassionate, more grounded, willing to give children experience rather than things, and show them that pain is a part of life and often endurable. The antidote to heroin may well be making your kids ride bikes outside, with their friends, and let them skin their knees.”

The author of that powerful statement, from the book Dreamland, The True Tale of America’s Opiate Epidemic, is with us today.

This book is perhaps the single most important piece of research and the most influential narrative, weaving science, personal stories and a deep analysis of heroin trafficking and community culture in America, to address the origins and effects of this very complicated crisis. And it is a devastatingly good piece of writing.

Sam Quinones’ description of the city of Portsmouth, Ohio, could well be a description of Presque Isle, Maine, and many other communities across our state.

Published in 2015, Dreamland vividly recounts how a flood of prescription pain medicine, along with black tar heroin from Mexico, transformed the once-prosperous blue-collar city of Portsmouth, Ohio, and other American communities into heartlands of addiction.

Mr. Quinones introduces us to the people at the heart of the opioid trade and describes in great detail the marketing of prescription opiates by unscrupulous pharmaceutical companies.

This book in so many ways has changed the debate in this country about the impact of drugs and the potential solutions to the epidemic.

I am thrilled that Sam and his wife and daughter, who live in Southern California, accepted our invitation to make his first appearance in Maine and I am very grateful to him for sharing his time with us today.

With his help, in the not too distant future, the headlines in our newspapers will no longer highlight isolated neighborhoods, but will read instead, “Maine has turned the tide. We have cured our deadliest disease. We have found our soul again.”

Please join me in giving a warm Maine welcome to journalist, researcher and inspiring author, Sam Quinones.