‘Tidal wave of addiction’ addressed Sens. Collins, Sununu conduct field hearing on Rx drug abuse

BANGOR – Maine is being hit by “a tidal wave of addiction,” Barbara Royal told two U.S. senators conducting a field hearing Wednesday on the state’s escalating problem with prescription drug abuse.

The Open Door Recovery Center in Ellsworth, where Royal is director, has seen a 50 percent increase in the number of addicts recently, including many young teens from all kinds of families.

“People are suffering unmercifully. Families are suffering. People are losing their babies,” Royal told Republican Sens. Susan Collins of Maine and John Sununu of New Hampshire.

Collins, chair of the Senate Committee on Governmental Affairs, convened the hearing at Bangor City Hall, so she could take testimony from front-line workers in Maine like Royal. Collins’ committee has oversight of the federal agencies responsible for regulation of prescription drugs.

Several members of families who have lost children to drug overdoses attended the hearing, though none testified.

Collins said deaths nationwide from the use of prescription drugs have exceeded deaths from illegal drug use since 2001. In 1998, she said, it was estimated that 1.6 million Americans abused prescription drugs, compared with 9 million today.

Rural states have been hit especially hard, she said, and Maine has been hit hardest of all. Maine’s rate of admissions to drug treatment programs is six times the national average, she said, and the highest in the nation.

According to a 2002 study conducted by the Margaret Chase Smith Center for Public Policy at the University of Maine, the incidence of accidental drug overdoses here jumped from 19 in 1997 to 126 in 2002, a fivefold increase. Drug-related suicides also have increased, from 14 to 36. Prescription drugs have been a factor in the great majority of the deaths, with methadone the most prevalent.

Collins identified methadone, specifically, as a prominent presence in the abuse community, coinciding with the growth in the number of facilities using it to treat opiate addicts as well as its popularity for managing severe pain. In Maine, there are four outpatient clinics that use methadone to control addicts’ cravings for heroin and other narcotics.

A synthetic narcotic itself, and highly addictive, methadone has been used since the 1960s to treat heroin addiction. In recent years its use has been expanded to treat addictions to other drugs, such as the painkillers OxyContin, Vicodin and Percoset. Properly used, clinicians say, methadone satisfies an addict’s cravings without mental impairment, allowing the user to live a more normal life.

A federal ruling in 2001 loosened restrictions on methadone clinics, allowing them to administer much larger doses and to dispense take-home supplies for up to 30 days instead of requiring all clients to report daily for their doses. Early indications point to the possibility that the lifting of federal restrictions may have worsened the problem, Collins said. Take-home supplies make it easier for clinic clients to sell or share their methadone, and larger doses intensify the possibility of deadly interactions with other drugs.

Researcher Marcella Sorg of the Margaret Chase Smith Center testified that of the 374 drug death victims in her study, blood tests found narcotics in 71 percent, anti-anxiety drugs in 32 percent and antidepressants in 37 percent.

In 58 percent of the deaths involving methadone toxicity, Sorg said, the victim had no prescription for methadone – the remainder of the victims had prescriptions for pain control or were clients in methadone treatment clinics.

Dr. John Burton, an emergency department clinician and researcher at Maine Medical Center in Portland, said diverted methadone in the abuse community is especially dangerous, because of its long-acting nature and the lack of any real “high.” People who take it often ingest other substances afterward, not realizing the lethal interactions that may occur.

Portland Police Chief Michael Chitwood accused methadone clinics of dispensing the drug without adequate oversight, counseling and education. Clinics also release take-home supplies inappropriately, he said.

Law enforcement officers testified to how rapidly many Mainers became addicted to a variety of prescription drugs and to how widespread the problem is.

“We had to understand that nobody was immune to this. The schoolteacher was an addict and selling to the students. The waitress was addicted as well as the business owner. Carpenters, store clerks, fishermen, government employees – it seemed everywhere you looked there was someone you’d never expect, addicted,” said Lt. Michael Riggs of the Washington County Sheriff’s Department.

Physician Richard Dimond of Bar Harbor decried recent cuts in state drug enforcement budgets and personnel as well as the lack of treatment facilities in Hancock County. Dimond has been active in a citizens group that has proposed a hike in county taxes to pay for a drug enforcement team.

Witnesses agreed on what’s needed to counter the problem. In addition to expanded and better-funded law enforcement, all identified public education as a priority. Even physicians seem not to understand the scope of the problem and the role they play in being too quick to prescribe addictive medications, witnesses said.

Many witnesses called for the implementation of a statewide computer registry that would allow pharmacists and physicians to see if a person was attempting to obtain multiple prescriptions. In the last legislative session, Maine lawmakers passed a bill to establish such a registry, but never approved funding to implement it.

Others said emergency room staff should be mandated to report patients admitted for drug-related problems, and called for greater coordination of law enforcement, treatment and prevention efforts.

Collins said the committee would look into ways to support Maine and other states struggling with the problem of prescription drugs, including helping to finance stepped-up law enforcement and education efforts. She said an online tracking system for pharmacists and prescribers, such as the one pending in Maine, might qualify for federal seed money.

And she said, the decision to lighten federal regulation of methadone clinics should be reviewed. “Insufficient oversight can create a real problem,” Collins said.

Lynn Madden, operations officer at Acadia Hospital in Bangor, sat in on the hearing but did not testify. Afterward, she said Acadia’s methadone clinic doesn’t dispense the high doses that some clinics do, and take-home medications are given only after a client has demonstrated responsibility. “I am concerned that methadone … is becoming a scapegoat for a much larger problem,” Madden said. The real problem, she said, is the addictions that lead people to seek treatment in the first place.