State’s anti-drug director steps down

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After 7 1/2 years as the director of Maine’s Office of Substance Abuse, Kim Johnson has recently stepped down.

Johnson is regarded by many of her colleagues as a forward-thinking professional with a gift for communication, as well as a tireless advocate for people with addiction.

But her tenure has been marked by a shocking increase in the abuse of prescription drugs in Maine as well as by the proliferation of controversial methadone maintenance clinics for the treatment of opioid addiction.

She also leaves behind a valuable but underutilized prescription monitoring program designed to help doctors prescribe appropriately for the management of pain and anxiety.

At a recent interview at her home in Gorham, Johnson reflected on Maine’s opiate abuse problem and available treatment.

When she took office in 2000, Johnson recalled, the state had asked Bangor’s Acadia Hospital to open Maine’s first methadone maintenance program and the community was embroiled in a contentious debate over the issue.

“I came into the middle of that controversy,” she said. Seven years later, Acadia remains the only nonprofit methadone program in the state, while six private, for-profit clinics have sprung up from South Portland to Calais, including two new programs in Bangor alone. Though methadone maintenance therapy remains controversial, many experts, including Johnson, say it is an important tool for treating addiction to illegal and legal opiates such as heroine and oxycodone.

Johnson is proud of having expanded access to methadone and said it allows many people with opiate addiction to lead productive lives.

“Twenty or 30 or 40 years from now, it will be seen as primitive,” she said. “But now, for a lot of people, it is the difference between life and death.”

Buprenorphine, also called Suboxone, is a more recent medication for treating opiate dependency. Because it has fewer side effects and doesn’t have to be dispensed through a federally regulated clinic like Acadia’s, Johnson said it ought to be tried first, before methadone, for treating Maine’s younger drug addicts. But because Suboxone is much more expensive, some providers are motivated to treat first with methadone, only moving to Suboxone if the cheaper drug is ineffective.

Johnson cautioned that the cost differential could create a two-tiered system of treatment, one for people with no insurance and another for those whose insurance will cover Suboxone or who can pay for treatment out of pocket.

“If we accept that there is a disease of addiction where brain chemistry is changed, it seems logical that medication is an appropriate intervention,” Johnson said. But helping people to understand and change their behavior requires counseling and other interventions as well, she added.

It also demands that more doctors accept and expand their role in identifying and treating patients with substance abuse, she said. Johnson said most medical students get little or no exposure to the issue in school and are unprepared to encounter the problem in their practices.

Physicians in Maine also should take advantage of the state’s prescription monitoring program, she said. The first program of its kind to be used in a public health capacity rather than for law enforcement, the computer-based program allows prescribers to see if their patients have been filling prescriptions from other providers – an indication that they may be “doctor shopping” or getting addictive medications from a variety of sources. Out of about 7,000 medical professionals who write prescriptions in Maine, only about 1,500 have signed up to use the service, Johnson said, and only about 80 log on regularly.

Solving problems

The issue of methadone maintenance treatment sharply divides Maine’s provider community. A number of providers feel the drug simply supports continued addiction and feel true recovery isn’t possible without full abstinence. These providers, however, declined to comment on Johnson’s tenure.

But many who have worked with Johnson over the years remarked on her professionalism, her progressive thinking and her ability to bring people together to solve problems.

Peter McCorison, director of substance abuse services at the Aroostook Mental Health Center, said Johnson is among the first state directors to require treatment providers to demonstrate that their services are actually helping clients. She also spearheaded efforts across the state to integrate mental health services with substance abuse treatment in recognition of the overlap in the two problems.

Along with her promotion of methadone and Suboxone, Johnson has also embraced the use of other medicines for counteracting addiction to alcohol, tobacco and other substances. McCorison said Johnson’s replacement should be equally “future-focused” and comfortable with using pharmaceuticals to treat addiction.

Rep. Anne Perry, D-Calais, said Johnson, shortly after taking office, was quick to respond to the emerging OxyContin crisis in Washington County. Johnson attended local meetings to better understand the nature of the problem and provided guidance and information to local residents. She obtained scholarships for some of them to attend educational sessions on addiction and helped the area open a treatment center, which eventually included a methadone maintenance program.

Perry, a nurse practitioner who serves on the Legislature’s Health and Human Services Committee as well as on a special advisory panel that examines substance abuse issues, said Johnson was effective at educating lawmakers and state officials. Frequently presenting research findings to support her testimony, she helped officials understand the impact of substance abuse on the work force, the corrections system, the child protective system and other programs, Perry said.

And while methadone clinics grabbed the headlines, Perry said, Johnson developed powerful and effective prevention campaigns as well, particularly targeting underage drinking.

“I feel privileged to have worked with her,” Perry said. “Her knowledge and her ability are well-known throughout Augusta and the state.”

Debbie Dettor, coordinator of the Maine Alliance for Addiction Recovery, said Johnson is respected nationally as well. At regional and national conferences, “everyone talks highly of her,” Dettor said.

But substance abuse professionals are typically surprised at Maine’s lack of progress in developing expanded recovery efforts, she added – programs that go beyond treatment for acute substance abuse and include support for finding jobs, housing and other aspects of recovering from addiction. Many states are much further along in providing such services, she said, which is surprising given the extremity of Maine’s opiate abuse problem.

Dettor credited Johnson for accomplishing a lot with a “severely underfunded” budget. “But Maine really needs to get going in the direction of becoming more recovery-oriented,” she said.

Commissioner Brenda Harvey of the state’s Department of Health and Human Services said this week that Johnson was an “eloquent and confident” advocate for Mainers in need of substance abuse services. The relationships she has built with other agencies and departments leaves the state well positioned to integrate substance abuse services with mental health, elder care, child welfare, labor and other programs, Harvey said.

The commissioner said she’s asking for recommendations but is not in a rush to name Johnson’s successor. For the time being, Johnson’s deputy director, Guy Cousins, has been named acting director of the Office of Substance Abuse.

Johnson has accepted the directorship of The Action Campaign, a national program headquartered at the University of Wisconsin and aimed at getting people into substance abuse treatment faster, keeping them in treatment longer, and making it easier for them to obtain related support services.

The program currently works with almost 300 provider agencies nationwide, including 14 in Maine. As the program’s director, Johnson will travel a great deal, but she intends to keep her home in Maine, where she was born and grew up.