Maine Opiate Collaborative: Prevention and Harm Reduction Task Force

Final Recommendations for Comprehensive Plan of Action to Address Opiate Use Disorders in Maine

Summary: The Prevention & Harm Reduction Task Force of the Maine Opiate Collaborative has met bi-weekly since the creation of the Collaborative to research, discuss, and propose a series of recommendations for how to move Maine forward in addressing the opiate crisis. Task force members have volunteered many hours of time, in and outside of meetings, to bring their experience and expertise, in crafting these evidence-based prevention, harm reduction, and recovery approaches to this dire public health issue.

Statement of Purpose: The Prevention/Harm Reduction Task Force recognizes the importance of collaboration among all groups of people in the community in order to facilitate effective prevention, harm reduction, and recovery services. Substance use disorders are community problems that require community responses. While much emphasis is often placed on educating people about the dangers of substances, research shows that it is more helpful to address underlying causes. A wide variety of risk factors for individuals, families, and communities (related to access and demand of substances) contributes to trauma and substance use; likewise, a variety of protective factors contributes to healing and resiliency. This task force consists of prevention specialists, members of the recovery community, physicians, and other healthcare professionals. These recommendations are evidence-based programs and systems that address risk and protective factors at the state, community, and grassroots levels, and they are outlined in the following 2 goals and associated objectives:

Goal 1: Promote good public health and safety, and reduce the harmful effects of opiate use.

Objective 1: Increase understanding of harms and decrease stigma surrounding opiate and heroin use disorder.

Objective 2: Decrease youth use of opiates and associated risk factors.

Objective 3: Reduce unnecessary access to legal opiates.

Objective 4: Decrease the number of drug-affected babies born in Maine each year.

Objective 5: Decrease opiate overdose and death in Maine.

Objective 6: Increase opportunities and decrease barriers to recovery for people with substance use disorders.

Goal 2: Strengthen and enhance Maine’s public health infrastructure to prevent and reduce opiate use disorders and overdose deaths.

Objective 1: Enhance the state’s capacity to implement a comprehensive approach to prevent and reduce opiate use disorders.

Objective 2: Increase district and local level capacity to prevent and reduce opiate misuse and overdose in Maine.

 

(The following pages will provide narrative and more detail on how the task force recommends implementing the plan to meet the objectives and achieve the 2 goals.)

 

Goal 1: Promote good public health and safety, and reduce the harmful effects of opiate use

 

Objective 1: Increase understanding of harms and decrease stigma surrounding opiate and heroin use disorder

Strategy: Educate the general public about the opiate/heroin problem in Maine.

Conduct a comprehensive statewide public education campaign consisting of traditional and social media (website, PSA, social media messaging) to:

• De-stigmatize substance use disorders;
• Increase understanding of risks and harms specific to opiate and heroin use;
• Increase understanding of substance use disorders and their prevalence; and
• Increase knowledge of harm reduction, treatment and recovery resources.
• Create awareness of importance of primary prevention in addressing Maine’s substance use problems.

Hire a marketing/advertising firm to create the comprehensive statewide public education campaign. Recruit volunteers from the Opiate Collaborative, or other professionals from Maine’s prevention, treatment, and recovery community, to advise on content of campaign. Engage Maine youth in developing messages and social media content. This could be done through a contest supported through corporate sponsors.

The Task Force recommends utilizing the Addiction Technology Transfer Center's (ATTC's) nationally recognized anti-stigma toolkit for guidance in this process. This guide was created to provide the addiction treatment and recovering community with practical information and tools to enhance their capacity to engage in effective stigma reduction efforts.

Prevention and health communication research demonstrate that the most effective prevention efforts are those that (1) include multiple components, (2) are designed so that the components are integrated or share common goals, and (3) are sustained over substantial periods of time. With this in mind, this guide seeks not simply to help people engage in stigma prevention efforts, but to engage in stigma prevention efforts that are effective.

This guide is designed to help people who are concerned about addiction-related stigma to channel their concerns into positive action. It will help you to get organized. It is meant to empower people by providing them with tips, recommendations, tools, and resources to engage in stigma prevention efforts. The task force believes it will be a valuable tool to aid in developing messaging.

 

Objective 2: Decrease youth use of opiates and associated risk factors.

Strategy: Increase the capacity of adults who care or work with youth, to educate and support youth to prevent opioid use.

Parents are vital in the effort to prevent substance use disorders among youth. Family values along with strong communication between parent and child are among many protective factors that play a huge role in keeping youth from experimenting with, and developing addictions to, substances. Parents should be supported in their efforts.

One way Maine can help support parents is to increase the skills and capacity of other adults in our youths’ lives to bolster prevention efforts. If parents, educators, school staff, and other adult caregivers all use evidence-based and science-based tools, Maine will have a strong prevention network that guides kids away from substances and towards paths of wellness and success. The Task Force recommends the following strategies to build skills and knowledge amongst educators and other adults caring for youth:

• Maine CDC, Maine Office of Substance Abuse and Mental Health Services, and Department of Education partner to establish a workgroup that will create a Substance Use Prevention Toolkit for Schools using existing evidence-based resources and concepts from state and federal partners. Recruit local prevention professionals, educators, other relevant school staff, and behavioral health professionals (including those in recovery) to inform the work. Elements of the toolkit would include:
  • How to partner with local prevention coalitions and/or professionals to support prevention efforts in the school.
  • Guidance on selecting evidence-based prevention curricula and programming appropriate for the school population.
  • State and Federal materials related to opiate, tobacco, alcohol, marijuana, and other drug prevention to be disseminated to students, school staff and parents
  • Supplemental materials that educate students on specific drugs and their effects on the brain.
• Other training areas, for school staff, related to substance use disorders among youth:
• Adverse Childhood Experiences (ACEs), how they effect affect mental health and substance use disorders, and effective interventions when ACEs are identified.
• Resiliency and strength-based models for substance use disorder prevention.

Strategy: Promote prevention and early intervention of child abuse and neglect

Fund communities and neighborhoods to implement Community Partnership for Protecting Children, to lower the rates of child abuse and neglect calls to DHHS.

 

Objective 3: Reduce unnecessary access to legal opiates.

Strategy: Enhance and strengthen Maine’s Prescription Monitoring Program to reduce unsafe prescribing practices among providers.

Legislation was passed this session to facilitate increased utilization of the Prescription Monitoring Program by Maine medical professionals and pharmacists. The Prevention and Harm Reduction Task Force is pleased to see this legislation pass. This is an important step in preventing Mainers from developing addictions to opiates due to overprescribing. The Task Force believes there are still two important matters related to the PMP that will need to be addressed :

• Work with and solicit input from the medical provider community to make the Prescription Monitoring Program more user-friendly.
• Implement a plan to ensure the Prescription Monitoring Program is adequately staffed to provide timely technical assistance, training needs, ongoing administration, and ongoing system enhancements. A well functioning, and efficient PMP program and department will help ensure high utilization.

Strategy: Expand and support efforts promoting safe storage and disposal of opiates.

Programs for the safe disposal of unused prescription drugs, including prescription opiates, are located throughout much of Maine. Twice a year there are prescription drug take back days, and there are also permanent medicine drop-off boxes located in many police departments, town offices, and other locations in Maine communities. While utilization of these programs continues to grow, many Mainers may still be unaware of these services or where they are located. Increased awareness of these programs would lead to more disposal of unused, expired, and unwanted prescription medicines and result in less diversion and misuse of these medicines.

The Task Force recommends funding the creation of a website and database of all of the take back and medicine drop-off boxes located throughout Maine. This would include a one-time funding project to support gathering the data, creating the website, and ongoing funding for the maintenance of the website, including updating the database of medicine disposal services.

In addition, the Task Force identifies that the costs associated with staffing take backs, along with the destruction of the collected medicines themselves, can add up and be quite substantial. To date, the U.S. DEA has helped by providing resources for the destruction of the collected medicines. That said, it is not a given that the U.S. DEA will always be in a position to continue this support. Indeed, they had discontinued the National Take Back program once before resuming again this past year. The Task Force believes Maine needs a more reliable and sustainable means of covering the costs of collecting and disposing unused and expired medicines.

The Task Force recommends legislation to establish a statewide product stewardship program for unused prescription medicines. Alameda County, California is one of the pioneers in establishing a product stewardship ordinance for unused prescription medicines. The ordinance requires any pharmaceutical company that wants to sell their products within Alameda County to create and/or fund a product stewardship plan to deal with the disposal of unused quantities of their products. The Task Force believes pharmaceutical companies have a duty to contribute resources for the disposal of the huge quantities of their products that go unused because of overprescribing and heavy marketing. Requiring pharmaceutical companies that want to sell their products in Maine to participate in and fund a statewide product stewardship plan would be the means to that end. Funding from a statewide product stewardship program could in part, or in whole, support the aforementioned website and database for take backs and drop-off boxes.

More information on Alameda County’s program can be found at: http://www.acgov.org/aceh/safedisposal/index.htm

 

Objective 4: Decrease the number of drug-affected babies born in Maine each year.

Strategy: Improve care coordination: counseling, pre-natal and early intervention after discharge for mothers with opiate use disorders.

• Establish a pilot project to fully implement and evaluate the Snuggle Me Project at a minimum of two Maine hospitals. Further work with medical community on implementing appropriate screening and care guidelines for women with substance use during pregnancy and drug affected babies. Consider a formal learning collaborative to provide education and quality improvement support to providers.
• Continue work to improve care coordination and support for families with infants exposed to substances. Pilot the work in at least 2 communities with hospitals with Level 2 NICUs with an aim to spread work statewide after pilot. Explore outpatient treatment model for substance-exposed infants that has been started in Bangor to see if it can be spread to other locations.

 

Objective 5: Decrease opiate overdose and death in Maine.

Strategy: Increase access to Naloxone for people using opiates, their families, and friends.

• Provide information and educational opportunities to at risk populations and the general public on the harms of opiate use, safer drug use, the efficacy of Naloxone and accessing Naloxone kits. This would be accomplished through a collaborative effort that draws on the strengths of medical providers, harm reduction providers and peer advocates. Currently there are several ongoing projects lead by the Maine Medical Association and several opioid overdose prevention and reversal programs (including those funded by the Attorney General). These are connected through, and coordinated in part by, the Maine Harm Reduction Alliance, a program of the Health Equity Alliance, a network of people, programs and organizations dedicated to advancing the health and wellbeing of people who use drugs through education, advocacy and action.

These programs educate prescribers and physicians how to effectively interact with people who use drugs and encourage them to prescribe Naloxone to those at risk. Further, these programs work directly with people with a history of drug use, conducting outreach through syringe exchange programs, treatment and recovery programs, county jails, homeless shelters and other venues where people with a history of drug use may congregate. Additionally, peer networks have proven effective in facilitating the adoption of safer drug use practices, as several pilot progams are working with peer advocates to increase safer drug use practices among people actively using drugs.

• Provide education to providers on the efficacy and importance of Naloxone including the logistics, proper guidelines and changes in laws.
• Institute collaborative practice agreements for pharmacies and medical providers to dispense naloxone directly to consumer at their professional discretion.

 

Objective 6: Increase opportunities and decrease barriers to recovery for people with substance use disorders.

Strategy: Build statewide and community capacity to provide recovery supports and services and foster resiliency.

• Establish and fund a network of neighborhood based community recovery centers in each public health district using the standards from the Association of Recovery Community Organization. As a parallel strategy, establish or support existing community based recovery coalitions to advocate for the needs of people in recovery. Ideally, the recovery coalitions are housed, or advise, or are working in partnership with the community recovery centers. Recovery centers should also form close partnerships with groups like Young People in Recovery and the Maine Alliance for Addiction Recovery.
• Establish collegiate recovery communities (CRCs) at all Maine colleges. Currently, CRCs are in their infancy at the University of Southern Maine (USM) and the University of Maine-Orono (UMO), and both have received funding to grow their programs. USM has received funding and technical assistance from SAMHSA's Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS-TACS) initiative, and UMO has received it from Transforming Youth Recovery (TYR). The Task Force recommends creating a task force within appropriate State departments and offices to gather learnings from these two projects as well as from BRSS-TACS and TYR in order to draft recommendations on how to implement CRCs in other campuses of the UMaine system along with the Community College system. In addition, these recommendations can be shared with private Maine colleges and universities.

Strategy: Recovery coaches are integrated into local systems (drug courts, jails, treatment centers, hospitals, recovery centers, etc.) in all public health districts.

• As individuals are being trained as recovery coaches across the state, the Task Force recommends looking at how to integrate these coaches into systems where people would benefit from their help. It is strongly suggested that organizations/facilities include recovery coaching into their contracts to ensure that recovery coaches are effectively and frequently used to help people in their transition out of the organizations/facilities. For example, if someone is admitted to the Emergency Room for an overdose or other outcome of an opiate addiction, it would be beneficial to have recovery coaches embedded within that hospital system to provide linkages to supports in the community. The Task Force recommends public health districts work with the recovery community to identify specific systems where recovery coaches can be embedded and work with the Maine Alliance for Addiction Recovery (MAAR) to train recovery coaches and use them as part of their programs. In addition, the task force recommends that the state of Maine ensure MAAR has adequate funding, as it is the only entity in Maine that trains recovery coaches.

 

Strategy: Increase access to treatment for substance use disorders.

• Support expanded access to healthcare coverage, the federal health exchange and Medicaid for people with mental health and substance use disorders.
• Support a Good Samaritan Law to provide immunity to friends or loved ones calling for help for someone experiencing an overdose or addiction can get help without fear of legal recrimination.
• Support statutory changes that would create an exception where information gathered from someone by law enforcement for the purposes of accessing treatment cannot later be used against them in court.
• Recommendation to hospitals and medical organizations to increase the utilization of Screening, Brief Intervention, and Referral to Treatment to catch problematic behavior related to substance use early before it develops into an addiction. This will reduce the need for intensive and costly treatment services.

 

Goal 2: Strengthen and enhance Maine’s public health infrastructure to prevent and reduce opiate use disorders and overdose deaths.

 

Objective 1: Enhance the state’s capacity to implement a comprehensive approach to prevent and reduce opiate use disorders.

Strategy: Create a high level position (e.g. Commissioner of Substance Use Reduction) to coordinate a comprehensive approach across state and local government to the drug problem in Maine.

Information gathered through the process of the Task Force had underlined that Maine’s addiction crisis cuts across all aspects of life and impacts many systems in local and state government. The Task Force sees the need to increase data gathering and sharing, cross-communication, and collaborations in a formal way. This will allow for consistent approaches across departments and agencies and have all working towards the same goals. The Task Force therefore recommends the creation of a high level State position charged with driving and overseeing the implementation of inter-department and agency collaborations and systems.

The federal government has created intergovernmental task forces such as the Interagency Coordinating Committee on the Prevention of Underage Drinking. This committee brings together various federal government departments and agencies to guide policy and program development with respect to underage drinking. The Task Force recommends the creation of a state-level Interagency Coordinating Committee on the Prevention of Substance Use Disorders. Departments recommended to be part of the Committee include, but not limited to: Department of Corrections, Department of Education, Maine Office of Substance Abuse and Mental Health Services, Maine Centers for Disease Control, Department of Labor, Maine Highway Safety, the Maine Substance Abuse Services Commission, and others. The Committee will institute cross system linkages for intergovernmental collaboration to ensure an effective strategy that spans the continuum of services, includes the intersection with criminal justice, and increases the ability of the State to meet Mainers with addiction when and where they are ready to get help.

Strategy: Enhance the role of the Maine Substance Abuse Services Commission in addressing substance use disorders in Maine.

The Maine Substance Abuse Services Commission was established by statute to provide guidance to the Maine Office of Substance Abuse and Mental Health Services as well as the Legislature and Governor’s Office in matters involving substance use disorders. As it is a body that exists in statute, it is a natural caretaker of the work and recommendations crafted by the Maine Opiate Collaborative. The Task Force recommends creating a charge for the Maine Substance Abuse Services Commission to continue to move forward the work of the Opiate Collaborative through appropriate means, including, as necessary, convening work groups, task forces, and subcommittees related to law enforcement, treatment, prevention, and recovery. Further, the Task Force recommends that the Legislature solicit and receive from the Commission, at minimum, a yearly report card on the progress made towards the goals set out in the Maine Opiate Collaborative recommendations.

Strategy: Build and enhance the capacity of Maine 2-1-1 to serve as the information and resource hub for individuals, families, and affected others seeking services for opiate and other drug addiction.

• Assess the current staff capacity of Maine 2-1-1 and identify additional staffing needs for current call volumes and for additional call volumes if Maine 2-1-1 becomes an advertised “hotline” in PSAs.
• Work with Maine 2-1-1 to identify training and professional development needs for Maine 2-1-1 staff to adequately field the breadth of calls for services related to substance use disorders.
• Review the process for adding and updating substance use disorder prevention, intervention, treatment, and recovery services in the 2-1-1 directory and identify enhancements to ensure information is timely and accurate.

 

Objective 2: Increase district and local level capacity to prevent and reduce opiate misuse and overdose in Maine.

Strategy: Provide support to the Public Health Districts to collaborate with all sectors to implement substance use disorder prevention efforts.

• Fund at least one School Behavioral Health Coordinator in each Public Health District, housed by District Coordinating Councils, and working closely with schools in the districts on education, prevention, and early intervention services and programs for substance use disorders.
• Fund in each Public Health District, a Substance Use Disorder Coordinator to work with the District Coordinating Councils, recovery coalitions, and local entities involved in substance use prevention, intervention, treatment and recovery. The Substance Use Disorder Coordinator can help link community members to services.
• Require Public Health District Coordinating Councils to use a multi-sector (healthcare, law enforcement, schools, treatment, recovery, mental health, social services, youth, parents, faith community, and businesses) collaborative approach to addressing all public health issues, including substance use disorders.

 

Strategy: Support local communities, coalitions, and other groups to use a multi-sector collaborative approach to prevent opiate misuse and other substance use disorders.

• Promote the integration of the community coalition model of substance use disorder prevention into the overall statewide strategy to reduce substance use disorders. Community coalitions would have to be currently working with or have a plan to work with all appropriate sectors in their community (hospitals/healthcare, treatment, local Public Health District, schools, law enforcement, business, recovery, mental health, youth, parents, faith, civic organizations.
• Create linkages at the Public Health District level between the State-funded and coordinated prevention efforts with peer recovery centers and the recovery community. Staff, volunteers, and stakeholders from peer recovery centers and/or recovery coalitions should be invited to participate in the District Coordinating Council planning and implementation efforts around substance use disorder prevention.