They are among Brunswick’s stay-at-home moms, its career criminals, its 50-year-old businessmen—even its high school students—and they all have at least one thing in common. They are Brunswick’s heroin and prescription opiate addicts.
The opiate addiction epidemic has gained national attention in the past year as the number of fatal heroin overdoses has skyrocketed, particularly in New England. In January, Governor Peter Shumlin of Vermont dedicated his entire State of the State address to the problem. In March, Governor Deval Patrick of Massachusetts declared opiate abuse a public health emergency.
In his own State of the State speech in January, Maine Governor Paul LePage called drug use a “troubling epidemic,” and said that 927 babies in the state—more than 7 percent of all newborns—were born addicts in 2013.
LePage had been hesitant to approve the distribution of nalaxone—an overdose reversal drug—fearing that it would give addicts a false sense of security. Last week, after intense criticism from lawmakers, health professionals and the media, LePage finally approved a bill that allows family members of addicts to receive the potentially life-saving drug.
Everyone the Orient interviewed for this article—a substance abuse counselor, the director of the outpatient behavioral health at Mid Coast Hospital, Brunswick police officers, a defense attorney, and a psychologist—said that Maine’s opiate problem is not unique to certain cities, ethnicities, ages, or socioeconomic levels. Addiction exists everywhere, Brunswick included.
The most common path to heroin addiction begins with medicinal or recreational use of prescription painkillers like Vicodin, OxyContin and Percocet. These powerful drugs are often prescribed to patients following surgeries and can quickly lead to dependence.
“One of the fastest growing populations for addicts in the opiate world is adults who have had surgeries, weren’t recreational drug users, and now are breaking into their neighbor’s house going through their medicine cabinets because they’re desperate for drugs,” said Geno Ring, a licensed substance abuse counselor who works both with Bowdoin students and at Brunswick High School.
“Nothing on their radar prepared them for this happening in their lives. They’re married. They’ve got kids. They’ve got careers—and all of a sudden they’re spiraling out of control,” said Ring.
Yet it is not only adults developing opiate dependence through prescribed drugs. Sixty-seven percent of teens receiving treatment for opiate addiction were prescribed painkillers in the previous year, according to the American Society for Addiction Medicine.
Director of Outpatient Behavioral Health at Mid Coast Hospital Eric Haram said that failing to dispose of unused pills also poses a risk, since teenagers will often find them and use them for recreational purposes. Most teenagers fail to realize the risks involved, or simply feel invincible, but Haram said everybody is vulnerable when it comes to opiates.
“Nobody chooses to be an addict; nobody wants to have track marks all over, be losing their kids, be losing their teeth…Black teeth are a tough thing to see in the morning at the jail,” said Brunswick defense attorney Chris Ledwick ’95.
“Opiates always produce physical dependence. It’s not one of those things that doesn’t happen to people—it’s simple biology,” added Haram.
Ledwick said that in the last five years, about 70 percent of the drug cases he had seen were based on legal drugs and prescription pills.
“Anyone who goes into a surgery comes home with 50 pills for getting a tooth pulled. It’s crazy,” he said. “So you can have a grandparent with 500-pill bottles in their houses, and the nephew, grandson, stepson, they know about it and that’s how they get hooked on this stuff.”
The progression from occasional recreational use of painkillers to addiction can be rapid.
“The way it usually works for people is that they’re using this once or twice a month at parties, and then it’s once a week, and then it’s three to five times a week, and then they’re an addict,” said Haram. “I’ve heard that story thousands of times in the last few years.”
He said the number of patients he sees has doubled to 800 in the past seven years. In the past year, about 200 of those patients were Brunswick residents.
Responses to the rise in painkiller addiction have included reducing availability and reformulating pills like Oxy 30 to make them more difficult to abuse. An unintended consequence of these changes has been a spike in the use of heroin—a cheaper, more accessible and often more potent alternative.
“It’s a demand issue no matter how you put it,” Haram said. “When you restrict access to pain medication, you haven’t reduced the volume of addiction; you haven’t reduced the demand in a community for that high.”
Since heroin is an illegal substance with an established social stigma, newspapers and politicians tend to devote more attention to it than painkillers. But from a treatment and public health perspective, Haram said, there is no difference.
“Opiates are opiates,” Haram said. “There’s social stigma associated with [heroin]—did you get that Oxy from your mom’s medicine cabinet or did you get heroin in the alley—so it sounds much graver.”
The likelihood of an accidental overdose from heroin and prescription painkillers is the same, according to Haram.
Brunswick is home to one of the country’s most effective addiction treatment centers. The Addiction Resource Center at Mid Coast Hospital, which Haram oversees, has won national awards for improving patient outcomes using science-based approaches. According to Mid Coast’s website, the Center’s approach has reduced wait times from 11 to two-and-a-half days and improved its treatment completion rate from 60 to 94 percent.
Treatment for opiate addiction generally includes detoxification, followed by counseling and the controlled use of medications like Methadone or Buprenorphine (often referred to by the brand name Suboxone). These medications act on the same parts of the brain as heroin and can reduce withdrawal symptoms and cravings.
The Center uses BASIS-24, a computerized outcome measurement tool, to evaluate its effectiveness. Patients are asked questions halfway through treatment and every 90 days thereafter. Their responses receive scores in six categories—depression and functioning, emotional lability, psychosis, relationships, self-harm and substance abuse—as well as an overall score. The scores of Mid Coast’s patients are then compared to the scores of similar patient populations around the country.
Mid Coast performs in the top two percent of treatment centers nationally, which makes it competative with well-known counterparts like the Cleveland Clinic, the Hazelden Foundation and the Caron Foundation.
“People pay 40 grand up front for going to places like this,” Haram said. “We’re a publicly funded, community hospital and can produce those same kind of outcomes, but treatment where I work might cost four grand.”
Despite a sharp increase in the number of addicts over the last decade, public funding for Maine’s Office of Substance Abuse—which funds treatment centers like the one at Mid Coast—was lower in fiscal year 2012 ($26.7 million) than it was in fiscal year 2006 ($29 million). In the same time period, the number of Mainers seeking treatment for opiate abuse increased from 3,023 in 2006 to 4,697 in 2012, according to the Maine Office of Substance Abuse.
Haram’s primary problem has been meeting the demand for treatment.
“The number of beds, the number of detox, the number of outpatient slots—just the number of treatment slots in general—gets cut every year,” he said. “Certain medicines that are available to treat opiate dependence that are FDA [approved]—this administration has reduced access to those medications specifically.”
Providing access to treatment became even harder this January, when cuts to Maine’s Medicaid program kicked in. Haram says that about 15 percent of his patients, or roughly 100 people in the greater Brunswick area, lost their health care coverage.
“Typically what happens is those people drop out of treatment and return to street use,” Haram said.
The opiate addiction epidemic has caused problems for the Brunswick Police Department (BPD) as well. Detective Richard Cutliffe, who works with BPD and the Drug Enforcement Agency, estimated that 95 percent of all crime in Brunswick is drug related. He said that other than marijuana, heroin is now the most commonly used illicit substance in town.
There have been several arrests for trafficking heroin in Brunswick over the last year, including that of Angel Quinones of Connecticut last May. Sergeant Marty Rinaldi of BPD told the Bangor Daily News at the time that Quinones was “a substantial dealer in the area.”
Brunswick’s central location offers one explanation for these trafficking arrests.
“We live on the Route 1 corridor. You’ve got I-95 and you’ve got Route 1. So anybody who’s traveling to bring their drugs anywhere, you’ve got to come through Brunswick,” said School Resource Officer Aaron Bailey, who works for BPD at Brunswick High School.
Once drug offenders enter the legal system, however, district attorneys attempt to differentiate between career criminals and addicts who are simply desperate to continue funding their use.
“When someone’s on probation for a year or two and fails a drug test, the old response used to be to throw them in jail for 30 days… Their life falls apart, and they start using drugs again,” Bailey said. “Probation has been a little ahead of the curve, especially in Cumberland County, about looking at other ways to deal with it, like having graduated sanctions.”
LePage and law enforcement are concerned that recovering addicts will abandon their treatment programs and either abuse or sell synthetic opiates meant for medical use like methadone and Suboxone, a pattern experts call diversion. This has been cited as a reason for limiting access to these drugs; Haram said that he spends around half his time working to prevent it.
“Making people show up to count their medicine, by doing observed urines, by controlling the size of the prescription, that they can only get it at one pharmacy—these are all strategies we use to prevent diversion,” he said.
Diversion mitigation plans are required by law, but Haram said Mid Coast’s is “way more robust than most.” He meets on a weekly basis with Brunswick, Bath and Lincoln County Police to discuss drug and crime issues.
“The first question at every meeting: Have you arrested anybody who had medicine that we prescribed? And month after month after month after month the answer is no,” Haram said.
According to Ledwick, however, these synthetic opiates are a major problem, particularly in Maine’s prisons.
“Suboxone is the big thing right now…We’re really struggling with it right now, almost more than Oxy’s in this region. If you talk to anyone in [the Maine Department of Corrections], that’s the bane of their existence,” he said. “People melt them onto the pages of the letters they send in; they melt them into the glue of envelope, and [inmates] can reactivate them once they’re in there. It’s very easy to hide...You can fit a lot of those strips inside a body. And people get pretty creative with that.”
Ledwick explained that the accessibility of drugs like Suboxone in prison makes it a place where recovering addicts are likely to relapse.
“There used to be this notion that at least if they’re in jail, they won’t be able to do drugs. And that’s just not the case anymore, especially in Cumberland County,” he said. “A lot of my clients will tell me there’s more readily accessible drugs in the jail than there are on the street.”
That is just one of the reasons that people like Ledwick and Haram think that the criminal justice system alone cannot end the opiate epidemic.
“We won’t arrest ourselves out of this problem,” Haram said. “It really is both a public health problem and a public safety problem. We need to expand treatment while at the same time getting smarter about law enforcement strategy.”