Heroin use rising among Maine teens

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The Bangor region already could use more substance abuse treatment services, but the need will grow even more dramatically because of a new wave of heroin use among eastern and northern Maine’s teens and young adults, medical experts say.

According to Maine Office of Substance Abuse statistics, Penobscot County residents seeking treatment for heroin addiction increased more than fivefold, from 22 to 134 cases, between 1995 and the 2001 state fiscal year.

Heroin historically has been rare in Maine north of Portland and Lewiston, but police see it taking root in this region today because it is relatively inexpensive initially. And it is increasingly pure so abusers can snort it instead of injecting it.

Just one or two heroin experiments can rewire the minds of young people so they forever crave it or other drugs in the same class, known as opioids.

The growing heroin use across Greater Bangor creates immediate health concerns that come on top of existing substance abuse problems from other opioids such as OxyContin. The problems are adding up, and community health providers are seeing the results every day.

“It’s boom time for drug therapy, and there’s an unending client base,” said Jack Keefe, who oversees the substance abuse counseling program for people with mental health and addiction problems at Northeast Occupational Exchange in Bangor.

Bangor’s year-old methadone treatment program at The Acadia Hospital turns people away almost every day. Consequently, hospital officials want gradually to increase the number of people it can serve from 150 to 300.

At the same time, the for-profit Discovery House of Providence, R.I., is looking to open its first methadone clinic in Bangor. It has two other Maine clinics in South Portland and Winslow.

“They have business models and clearly they see enough of a demographic need,” said Kimberly Johnson, director of Maine’s Office of Substance Abuse.

Just two years ago, one Acadia Hospital official said the expectation was that the need for methadone treatment would dwindle as the illegal diversion of prescription narcotics like OxyContin slowed. But the increase in heroin use changed that assumption.

“When we opened a year ago it was relatively rare for someone to use heroin, and now many people are coming in having tried heroin and it seems to be a drug of choice,” said Lynn Madden, Acadia Hospital’s chief operating officer.

Penobscot County overdoses

Doug Bouchard, director of Shaw House, a shelter for 12- to 17-year-olds, said overdoses in the area among the young are now more common. In one case a few weeks ago, an area teenager took a combination of heroin, Ecstasy and oxycodone that sent him to the hospital.

“They thought his heart was going to blow up,” Bouchard said.

Educating teens about the dangers is hard because they don’t fully understand the real risks and often see themselves as immortal. After this recent incident, Bouchard recalled, this teenager just said he needed to be more careful.

State data on unintentional overdose deaths in 2002 is a work in progress, but so far the number of cases being investigated statewide is a record – up about one-third over last year already, said Jim Ferland, administrator at the State Medical Examiner’s Office. A lot of that overall activity is centered in the Portland area, he said.

Ferland could provide only limited statistics since much of the medical examiner’s data is with a consultant who is preparing a report to be released next month.

Breaking out heroin overdose information is complicated by the state’s budget woes. The State Medical Examiner’s Office rarely spends the extra $160 needed for the test that detects heroin in corpses, he said.

Penobscot County data show there were 10 accidental substance abuse overdose deaths in 2000. In 2001 there were just six. Of county cases already officially completed for 2002, only two have been ruled accidental overdose deaths.

Neither Eastern Maine Medical Center nor St. Joseph Hospital reports an increase in the number of overdose cases seen in their emergency rooms. Dr. Jeffrey Raub, medical director of St. Joseph’s emergency department, said what they do see at St. Joseph is a continuing stream of people showing up in an attempt to get prescription drugs for nonmedical reasons.

The shift to heroin

Police say OxyContin problems are leveling off somewhat as doctors and pharmacists watch for the signs of people faking pain to get a prescription that can be worth a lot of money on the street.

“I think we are seeing more people sliding to heroin more than oxycodone,” said Bangor police Lt. Peter Arno, who until recently was attached to the Maine Drug Enforcement Agency.

Many of those young people won’t be presenting themselves for treatment for three to five years after becoming addicted, notes Scott Farnum, director of the methadone treatment center at Acadia Hospital. A study released this year by the Robert Wood Johnson Foundation reported that fewer than 25 percent of opioid addicts enter treatment.

For teenagers addicted to heroin or other opioids, there are no methadone treatment programs in Maine. The state discourages methadone treatment programs for the young.

Johnson, director of the state Office of Substance Abuse, said there is a chance to move youths away from illicit drugs without resorting to methadone if they don’t have a long substance abuse history. But for an 18-year-old who’s been using an opioid since age 13, methadone might be the right option, she said.

No trouble at Acadia Hospital

When Acadia proposed its methadone program, there was stiff community resistance. Many of the worries haven’t panned out.

Arno said there have been no law enforcement problems related to Acadia’s clients. People are not congregating near the hospital, and there has been no other trouble.

“We attribute that to being able to work closely with Acadia,” Arno said.

Acadia officials say they are doing more than required by state and federal regulations in counseling their clients. Farnum said each potential methadone patient is screened for appropriateness before being put on methadone. When a patient is on methadone, there is a rigorous process to determine if he should be given take-home doses or continue on daily doses dispensed at the hospital.

Once take-home privileges are granted, the hospital does random urine checks to test for other substances. In June, 95 percent of the screens were opioid-free, he said.

Patients are selected randomly to come back into the clinic to prove they still have the supply of methadone necessary for the remaining days before a resupply is planned.

Additionally, many of Acadia’s methadone clients are getting extra help from other community counseling programs, Madden said.

When Acadia made its initial request to establish a methadone program, some community members mobilized to fight it. Today, some of the critics are satisfied Acadia is doing a good job. City police and City Hall seem more worried about the arrival of a new for-profit clinic.

Discovery House did not return requests for interviews placed to its Maine clinics and Rhode Island headquarters.

Does a Discovery House clinic in Bangor worry Maine’s top substance abuse official?

“It really doesn’t [worry me],” Johnson said. “What troubles me is this whole uproar about this particular treatment methodology.”

The methadone debate

Johnson notes that both residential treatment centers and methadone programs have been proven effective in treating opioid addiction. She said that 35 years of experience with methadone shows addicts can get some normalcy back and resume work and other productive pursuits.

“I think what happens with this particular treatment is that people blame the treatment for the problems it addresses,” she said.

Northeast Occupational Exchange officials don’t question that a glut of people need substance abuse help. But they do question whether more methadone treatments are the best course.

Keefe said Acadia’s efforts are hamstrung by reimbursement formulas that don’t provide enough money for counseling and ancillary treatments. Methadone by itself doesn’t treat underlying conditions that may have led a person to substance abuse in the first place, he said. Studies show that many clients in methadone maintenance programs also have psychiatric disorders, according to the Northeast Occupational Exchange.

Keefe and Dr. Charles Tingley, Northeast Occupational Exchange’s director, suggest that a better treatment is being developed. It would use buprenorphine. The as yet unapproved formula would require just one dose per month to be effective.

Methadone misuse

In recent months, drug overdoses have become a major concern in the Portland area. A handful of recently completed investigations by the medical examiner have pointed to methadone poisoning. But those individuals were not clients of either of the two methadone clinics in the Portland area.

Bangor-based experts doubt that methadone is being used recreationally on its own. The drug has more of a sedative than a euphoric effect.

“You’re not going to go out to a party and take methadone for fun,” said Madden.

Farnum explained that when methadone is diverted from its legitimate uses, some drug abusers use it to get them through a pinch because they can’t get or afford their drug of choice.