Recovery and harm-reduction advocates notched key wins during the last legislative session, including securing funding for more treatment beds, expanding access to a drug that reverses overdoses and nearly passing a bill that would allow communities to open drug consumption sites to prevent fatal overdoses.

And while the bill for prevention sites, also known as harm reduction health centers, did not pass, Gov. Janet Mills agreed to study what it would take to open such centers, which allow people who have acquired drugs to use them under medical supervision, something that is prohibited under federal law.

The original bill, sponsored by Rep. Grayson Lookner, D-Portland, received bipartisan support in the House of Representatives but came up two votes shy in the Senate. Even if it passed the Senate, it faced a near-certain veto from Mills, a former prosecutor who generally does not support the decriminalization of drugs.

Courtney Gary-Allen, director of the Maine Recovery Advocacy Project, is disappointed that the bill was changed to a study since hundreds of Mainers continue to die of overdoses every year. Still, she said it represents progress on an issue that has not been well received in Augusta.

“We know that overdose prevention centers are the only life-saving intervention that has a 100% effective rate of keeping our friends and family members alive that use drugs,” Gary-Allen said. “While it’s disappointing that the State House didn’t get it done this session, it’s at least encouraging that the conversation will be continued.”

The idea, supported by medical professionals at a public hearing, is to create a space where people can use previously obtained drugs in a safe and supervised environment, where help and sterile equipment are available. The centers also act as a gateway to medical care and treatment, recovery, and other services.

Such sites typically face opposition over fears that they will encourage drug use or compromise community safety. But advocates say the sites reduce street-level drug use and discarded needles, while preventing overdose deaths, halting the spread of diseases, and building trusting relationships that can eventually lead to treatment and recovery.

The creation of a safe consumption site has been discussed repeatedly in Portland in recent years as a way to reduce fatal overdoses. State lawmakers voted against a similar proposal in 2019.

“For me, it’s no longer a question of if overdose prevention centers are coming to Maine,” Gary-Allen said. “It’s more of a question of when and how at this point, which is a stark difference than just a few years ago when we started having this conversation.”

OVERDOSE DEATHS SLOWING BUT STILL HIGH

The opioid crisis continues to ravage Maine, which has set records in each of the last three years for fatal overdoses. Last year, 723 people died of an overdose, an increase of 92 people over 2021 and roughly four times as many deaths as in 2013.

This year, the pace has slowed, although advocates and state officials say the numbers are still too high. Through June, 307 people died of suspected or confirmed overdoses – a 7% drop from the same period last year.

While hopeful, Gordon Smith, the state’s opioid response director, is not ready to declare victory, especially since Maine saw a drastic spike in overdose deaths at the end of last year, including a record 28 people dying of overdoses in the last week of December.

“We’re watching those numbers very carefully,” said Smith, who noted that the state is doubling the number of recovery outreach workers to 36. They accompany emergency professionals to overdose calls. “I’m optimistic, but we have to be cautious. One bad week, or one bad month, could wipe that out.”

Successes in the last session include $3.6 million in funding for a new treatment center in either Washington or Kennebec County. The Department of Health and Human Services will make the final decision on where to locate the facility, which will have at least 10 beds.

The original bill, sponsored by House Speaker Rachel Talbot Ross, D-Portland, called for two new residential treatment centers – one in each county – but the budget committee funded only one.

Smith hopes the second treatment center will receive funding from the millions of dollars in settlement funds the state is receiving annually from various lawsuits against opioid manufacturers.

“The goal is to avoid Washington County and Kennebec County from having to compete for one funded treatment facility,” he said. “They both need beds.”

Over the next 15 years, Maine is expected to receive more than $235 million in settlement funds from various lawsuits against opioid manufacturers.

Half of that funding will be distributed by the Maine Recovery Council, a 15-member board appointed by the governor, that comprises legislative leaders, the attorney general, and county and local officials. County and local officials will distribute 30% of the funding, and the Office of the Maine Attorney General will disburse the remaining 20%.

So far, the state has received about $34.6 million, the AG’s office said.

MORE BEDS, BETTER ACCESS

The state has struggled to meet the need for treatment beds in recent years. Smith noted that several facilities closed during the pandemic, but the state is beginning to replenish that inventory and expand capacity.

Smith said the current budget funds an additional 140 treatment beds across the state, which will bring the total number of beds to 561. That’s up from the 390 licensed beds in 2019, he said.

Assessing the need for recovery beds is more difficult. Smith said there are about 7,000 regular clients of the state’s syringe exchange program, which aims to prevent the spread of diseases among intravenous drug users. Since those clients also might be picking up supplies for others, he said it is likely 15,000 people rely on the service.

Advocates also have pushed for financial support of nonclinical recovery centers, or sober houses.

They rallied for a bill sponsored by Rep. Ambureen Rana, D-Bangor, that would have dedicated 12% of the tax revenue generated by recreational cannabis sales to support community recovery centers, which provide nonclinical, peer recovery support services to aid long-term recovery. That bill was carried over into the second session.

Several other bills were enacted to expand the awareness and availability of naloxone, which can reverse an overdose, including clarifying state law to allow naloxone to be distributed at municipal buildings such as libraries; requiring all police officers to carry naloxone while on duty; and offering lessons to secondary school students on how to administer naloxone nasal spray to someone who is overdosing.

Lawmakers also enacted a bill that would allow General Assistance payments to be made directly to the operator of a licensed recovery center.

Recovery advocates will continue to push for additional harm reduction strategies, which aim to keep people who use drugs alive until they are ready for treatment and that treatment is available.

Maine already operates syringe exchanges and the previous Legislature passed one of the most progressive Good Samaritan laws in the country, providing legal immunity to most people who call for medical help for someone overdosing. Republican lawmakers sought to roll back the Good Samaritan law but were not successful.

Although the $15,000 in funding for the overdose prevention site study will not be available until January, Smith hopes to assemble a working group this fall.

That group, he said, will look at existing overdose prevention sites, including those in New York City and a site that is being established in Rhode Island, for lessons about how such a site could operate in Maine.

Smith said his goal is to ensure a balanced study – one that accounts for the concerns of law enforcement, whose buy-in will be critical.

“It’s an important issue, not just for the advocates who want to do it, but it’s also an important issue for our public safety partners, who almost uniformly do not want it to happen,” he said.

ADVOCATES WANT MORE

Another harm-reduction strategy is decriminalizing drugs – a proposal that faces a much steeper climb in Augusta. Gary-Allen said a bill sponsored by Rep. Lydia Crafts, D-Newcastle, which would treat substance use as a public health emergency and repeal criminal penalties for the use and possession of schedule W, X, Y, and Z drugs, will be heard next session.

Recovery advocates have clashed with Mills, a former prosecutor, over policy proposals in the past. But Gary-Allen credited Mills with keeping an open mind to their proposals and for being willing to revise her position when new information comes to light.

That was the case with both the Good Samaritan law, which Mills initially opposed but eventually found common ground on with advocates, and the overdose prevention site, which she opposed but signed a law agreeing to study.

“I don’t think we have ever had a governor who has cared as much about this issue in the history of Maine,” Gary-Allen said. “We sometimes go toe-to-toe on particular policy issues, but at the end of the day, I know our governor cares about people who use drugs and is trying to find ways to lower the number of friends and family who are dying.”

Gary-Allen is optimistic about additional progress being made, both in the second session of the Legislature and for the next three years of Mills’ term.

The overdose crisis is affecting everyone, including lawmakers, which is shifting attitudes. That, coupled with the millions of dollars the state will receive in settlement money from lawsuits against opioid manufacturers and more effective organizing and advocacy from the recovery community, presents a unique opportunity to keep the momentum going.

“Maine is on the cusp of a revelation about how we address substance use in our communities,” she said. “We have a once-in-a-lifetime opportunity with this money and where politics is at in Maine to shift and invest. That makes me hopeful that we’re going to be able to truly turn the tide of this crisis.”

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