With the right public health approaches, though, perhaps the worst can be mitigated and younger generations can learn to avoid dangerous drugs like heroin, according to the ideas of a panel of drug experts and observers last week at the Presque Isle Middle School.
Given all the hubbub over drug use these days, from marijuana legalization referenda to the epidemic of painkiller and heroin addiction, the forum was an effort to spur “frank discussion” and “civic responsibility,” said Shawn Cunningham, news anchor at WAGM TV, who moderated and organized the event through the Presque Isle Kiwanis Club.
“Do we need to panic?” Cunningham asked, considering the troubling statistics? Since 2000, the rate of drug-induced overdoses have doubled, increasing to almost 44,000 in 2013, with more than 35 percent involving opioid-based painkillers and 18 percent involving heroin. Meanwhile, 29,000 Americans died from alcohol overdoses and related diseases in 2013, and youth surveys suggest that around 5 percent of high school students are still being exposed to hard drugs like cocaine and methamphetamine.
“Panic is not the right word,” said Presque Isle Police Chief Matt Irwin. “But there is not the uproar that I would expect from the communities about the services that the state has to offer. If you’re going to try to reduce the criminal penalties for drug addiction, we’ve got to have an alternative to locking people up.”
In the currently dysfunctional criminal justice and health care systems, severe drug addicts who may also face traumatic stress and psychiatric conditions end up going back and forth between facing jail time and trying to stay sober amid uncertainties in employment and rehab — a “vicious cycle that they can’t get out of,” as Irwin put it.
“The problem is, they get sentenced to some sort of treatment, but there isn’t a bed available for the next six months. A homeless person who is addicted may be wandering around, still addicted because they’re not getting treatment, and they’re still committing crimes or getting arrested for possession.”
For people addicted to heroin and opiate painkillers, one challenge is accessing medications like methadone and suboxone, which help quell and taper off the symptoms of withdrawal. For addiction and mental health broadly, the problem is a fragmented treatment system with shortages of both community-based supports and hospital treatment at the local level, said Dr. David Weed, chief medical officer at The Aroostook Medical Center.
“We don’t have enough mental health workers. We certainly don’t have enough programs to help,” Weed said.
From Presque Isle, the nearest psychiatric hospital room is in Fort Kent, at Northern Maine Medical Center, or, to the south, the Acadia psychiatric hospital in Bangor. TAMC, northern Maine’s largest health care provider, operated a 16-bed psychiatric hospital facility in Fort Fairfield until 2007, but closed due to lack of funding.
It “became a sponge,” Weed said. “Everybody sent their patients to us to take care of them, which was fine. However, the reality was there was no reimbursement for the work. In a senior leadership meeting recently, we brought up the topic, because we had a psychiatric patient waiting 17 days for placement.”
Health care leaders need to ask themselves, “Is there a way for us to help with the population of folks who desperately need care?” Weed said. “As health care providers, we’re letting our patients down. The last people who should be taking care of them is law enforcement.”
Whether or not any providers open more inpatient psychiatric hospital space in Aroostook County, hospitals and doctors are focusing more on prevention and their role in contributing to opioid overuse, Weed said. That means rethinking the guidelines for powerful medications that can set off an addiction and trying to limit them to people with debilitating pain from diseases like cancer.
Elsewhere in public health, a major goal should be educating youth about drug abuse, said Carol Bell, Healthy Aroostook project director at the Aroostook County Action Program, whose work has been instrumental in helping reduce high risk behaviors among teens.
Along with health education, youth outreach needs to target issues like peer bullying, Bell said, suggesting that The County would benefit expanded mentoring programs. “When we’re focusing on prevention, we need to look at everything.”
Outreach programs like Healthy Aroostook have been steadily making gains with the youngest generations of teens. As of 2013, 4 percent of middle-schoolers in Aroostook County were smoking cigarettes, half as many as in 2009, according to the statewide youth health survey.
Likewise the rates of middle-schoolers abusing alcohol fell by almost half, to 6.6 percent in 2013, and prescription drug use without a doctor’s prescription fell from 5 percent in 2009 to 1.4 percent in 2013.
