In a stark contrast to the previous administration, Gov. Janet Mills is committing a significant amount of state resources in response to the opiate crisis, which killing a person a day in Maine, but she won’t consider two strategies which evidence suggests would save lives.
According to Mills’s newly appointed Director of Opiate Response, Gordon Smith, the state of Maine will not be pursuing any strategies that involve safe-injection sites and the decriminalization of drug possession.
“We’ve ruled those out for now,” said Smith in a phone interview with the Phoenix. “Primarily because they are a clear violation of federal law. We don’t want to use resources defending federal lawsuits. It’s also an issue of political capital. Right now, Janet Mills has a lot of goodwill in the State House and out in the community. And we don’t want to start an opiate response package with the most controversial thing.”
Safe-injection sites, or overdose prevention sites, are facilities where people addicted to drugs can inject opiates safely, with clean needles and under the supervision of a medical professional. They exist across Europe and Canada, and studies have shown that they are effective at decreasing drug-related fatalities. Two studies from a safe-injection site in Vancouver showed that within a 500-meter radius of the facility, fatal overdose deaths decreased 35 percent compared with a 9.3 percent decrease in the rest of the city.
Studies out of Portugal — where possession and use of all drugs was decriminalized in 2001 — show dramatic drops in problematic drug use, overdose deaths, and HIV infections, and drug-related crime.
Smith says that another reason Maine isn’t considering these radical approaches is because no state in the U.S. has already done so.
“We haven’t really examined the effectiveness of those strategies — we don’t want to be tilting at windmills,” said Smith. “I hope I’m in this position long enough that we might eventually look at some of those cases in Vancouver or Portugal…actually I hope not because that would mean that we haven’t been successful in our other initiatives.”
WHAT THE STATE IS DOING ABOUT OVERDOSE DEATHS
This isn’t to say that the new administration isn’t taking harm reduction seriously.
According to Smith, the Mills administration will focus on different harm reduction strategies like increasing supply and access to the anti-overdose drug nalaxone and clean needle exchanges. The state of Maine recently purchased 35,000 doses of both intramuscular and intranasal Narcan, which qualified professionals can request for free. The state is also committing $3.5 million dollars to open at least four new needle exchanges — one in every public health district.
Additionally, the state is investing $1 million for the training and hiring of 350 new recovery coaches, ensuring that there are treatment options available in every hospital and clinic across the state. Smith says they are also looking at expanding the number of medically assisted treatment sites, and making rapid induction suboxone available in 33 emergency departments by the end of the year.
“We need more of everything,” said Smith. “Addiction needs to be treated the same way as diabetes or a heart disease.”
This approach is undoubtedly a positive shift from the LePage era, when opiate addiction largely wasn’t viewed as a public health emergency. However, those on the front lines of the crisis say that by refusing to consider efforts around decriminalization and safe injection sites, Mills’s plan is missing some key foundational pieces toward progressive drug policy.
“If we don’t engage with these evidence-based solutions, we are dancing around the problem,” said Kenney Miller, the executive director of the Health Equity Alliance. “Mills’s plan is great step in the right direction, but need to go all the way on compassionate care, not part of the way.”
Miller helped spearhead the Maine Coalition For Sensible Drug Policy — which includes at least 20 Maine-based justice organizations like the ACLU of Maine and Maine Equal Justice Partners — in January of 2018 in response to a list of policy ideas from the state’s Opioid Task Force. Then-Attorney General Janet Mills and Smith, at that time the executive vice president of the Maine Medical Association Gordon Smith, both served on that Task Force.
The coalition drafted their own 18-point plan, two of which included safe-injection sites and decriminalization, and made it public last month. Smith said he has read the coalition's recommendations, “appreciates their contribution to the debate,” and notes that the only two points that Mills won’t endorse are the ones on decriminalization and safe-injection sites.
“[The state] relies on our least objectionable recommendations instead of our most effective,” said Miller. “We would like to see a real intentional effort to meaningfully move away from punitive approaches to addressing opiate use and relying on the criminal justice system.”
Although Smith only disagrees with two out of the coalition’s 18 points, that difference is huge. The Maine Coalition crafts policy recommendations under the assumption that it’s impossible to completely eradicate the consumption of drugs, while Smith and the State of Maine seemingly does not.
“If we’re going to address the opiate crisis as a public health crisis, we have to lead with prevention,” said Smith. “If we can stop our sons and daughters from going down this path then we don’t have to deal with treatment or harm reduction. So in a way it’s the most important thing.”
ARE COPS DOING MORE HARM THAN GOOD?
The Maine Coalition also disagrees with the state on the role law enforcement should play in addressing the opiate crisis.
According to Miller, one of the biggest ongoing barriers to progressive drug policy is when cops throw people in jail for possession and/or petty crimes instead of investigating the links between those crimes and substance use disorder. Miller recognizes that cops are often first responders to people with drug problems and should either leave them alone or divert them toward treatment instead of incarceration.
“Sinking money into enforcement and incarceration is causing more problems for these people, making it harder for them find work, housing, and rebuilding their lives post-incarceration,” said Miller.
Meanwhile, Smith says that law enforcement are doing “extraordinary work” on this issue and trusts their ability to identify people who are “ready to recover” and people who are “primarily criminals.”
“I’m incredibly impressed with the more enlightened and progressive law enforcement officials who have said ‘we’re just arresting the same people over and over again who are sick, why don’t we try to get them in treatment,’” said Smith.
Smith is opposed to decriminalization because it would hamper efforts to “vigorously prosecute the people who are bringing this poison into the state and the people who are getting it for them.”
Despite the state’s unwillingness to consider the Maine Coalition's most controversial recommendations, advocacy for them is ramping up in 2019. The Maine Coalition will attempt to shift attitudes toward these ideas through a number of community forums planned in Portland, Rockland, and Hallowell throughout the spring. There’s also a legislative effort — state Rep. Mike Sylvester (D-Portland) is sponsoring a bill that would certify safe-injection sites in the state of Maine.
“Even if Gov. Mills doesn’t support the bill directly we hope she declines to veto it,” said Miller.