Maine Bolsters Substance Abuse Outreach Program In Effort To Stem Tide Of Opioid Deaths
In late February, Glenn Gordon — just two months into his new job as a substance use outreach worker in Oxford County — was called to a Rumford apartment.
A man had been drinking and using meth, and he was threatening to kill himself. Police were prepared to take him to the emergency room in handcuffs, but they wanted to see if Gordon could defuse the situation.
Gordon sat down next to the guy on a couch, and over the next hour, they talked about his troubles.
“I was trying to talk to him about what was going on, what his drug use was like,” Gordon recalls. “And then I tried to come around to, did he want help.”
Eventually, the man agreed to go with Gordon for an evaluation at a hospital an hour away.
They stayed in touch. The man didn’t have housing, so Gordon connected him with the owners of a farm outside Rumford, where he could live in exchange for work. In the process, Gordon also helped him get sober, and he remains so six months later.
“Now this guy is having a positive impact on other people,” Gordon says.
It was a picture-perfect example of the type of work that Gordon — and others like him — have been trained and hired to do across Maine over the last year. As part of a new state initiative, they have partnered with local health agencies and law enforcement to meet an urgent need: saving the lives of people who use dangerous drugs.
They reach out to individuals who are struggling with serious substance use, often after an overdose or another crisis has brought them into contact with authorities. Then, they try to connect those individuals with a range of critical resources, including the overdose-reversing medication naloxone.
The administration of Gov. Janet Mills has invested $2.5 million, largely from federal funds, to launch the OPTIONS initiative, which stands for Overdose Prevention Through Intensive Outreach Naloxone and Safety. All but two counties, Knox and Hancock, now have at least one liaison.
Roots in southern Maine
The OPTIONS initiative is modeled after programs that originated in more populous sections of southern Maine.
The most influential began six years ago at the Portland Police Department, when the agency was still led by Mike Sauschuck, who is now Mills’ public safety commissioner. When it started, a civilian responder would go out with police on drug overdose calls, then try to establish a relationship with the person who had been revived.
One of the people who benefited from that new approach was Tony Savoy, who used heroin for much of his early life in the Portland area.
Chronically homeless, Savoy sustained his habit with a string of thefts and burglaries that landed him in jail numerous times. He overdosed frequently — sometimes “around two or three times a day” — and contracted hepatitis C from sharing needles. After making a few attempts to get into recovery, Savoy says that he thought he might be stuck in the dangerous cycle forever.
But he met Oliver Bradeen, who ran the Portland program for its first five years and helped get Savoy naloxone, clean needles and medication to treat his hepatitis, along with more basic essentials such as bottled water. Eventually, after Savoy sobered up during one of his jail stints, Bradeen helped him find a six-month slot at a residential treatment program in York County.
Now 34, Savoy has been off heroin for about five years. He takes the medication Suboxone, which helps prevent the craving for opioids, and he runs a licensed marijuana farm with his wife in Waldo County.
“Oliver was a huge part of it,” he says. “He always made sure the resources were at my fingertips. He was always around, and if he wasn’t around, you knew how to get a hold of him.”
For now, the state has not been able to draw any broad conclusions about the likelihood that people entering the OPTIONS program will have the same sort of success as Savoy.
The state has collected some limited data on the program since it started at the beginning of this year: it served 427 individuals between March and June. The workers distributed naloxone in 265 cases. They connected about 135 clients to addiction treatment programs.
But Gordon Smith, director of the state’s opioid response, says the program is still worth pursuing even if it hasn’t been subjected to a peer-reviewed study. He says that it could save any number of lives at a time when Maine continues to lose ground in its fight against opioids.
More Mainers died from a drug overdose — 504, or an average of 42 per month — in 2020 than in any year before. This year, the state is on track to break that record, with 360 confirmed or suspected overdose deaths through July, or 51 per month.
Experts believe the biggest driver has been the growing availability of fentanyl, a cheap synthetic opioid that can be sold on its own or mixed with heroin, methamphetamine and other drugs. They think the stress and isolation of the coronavirus pandemic has exacerbated the crisis.
And he’s focused on another set of numbers: While 360 people died in drug overdoses that Maine authorities were able to track through July, there were another 4,652 overdoses that people survived thanks to first responders, police or friends and family with naloxone.
“For every fatality, there’s probably at least 10 people who survive an overdose,” Smith says. “But they’re at great risk if we don’t connect with them and offer them more services or pathways to recovery. They’re at great risk of being a future fatality. It’s just a function of who can get there the fastest to help them, or who is there with them.”
Bradeen, who now leads the organization Milestone Recovery and serves as a consultant for the OPTIONS program, made similar arguments. He was thrilled that Savoy and some of his other clients were able to enter long-term recovery, but one of his foremost goals was just equipping them with naloxone, health insurance, primary care and other tools that could help them live another day.
He worked with more than 300 people during his time with the Portland Police Department, and he can only recall about a half dozen dying from overdoses during that time.
Bradeen doesn’t take full credit for that survival rate. He says that other service providers played essential roles, and he notes that other clients had nonfatal overdoses. But he thinks it helps that someone was “checking in on them.”
“There are some people who are going to use for the rest of their lives and don’t want to stop,” he says. “We shouldn't ignore them. We should engage them and try to support them.”
Taking an urban approach to the country
The goals of harm reduction, treatment and recovery are now firmly baked into the OPTIONS program.
But one of the biggest questions facing the fledgling initiative is whether an approach that worked in a dense 70-square-mile city with its own police force and centralized services can translate in smaller communities spread across vast rural counties.
Ambulances have longer drives, sometimes on snowier roads, to get to the scene of an overdose. It takes more law enforcement agencies to cover those areas. There are fewer opportunities for methadone or Suboxone treatment, and only about half of Maine counties now have a licensed needle exchange.
“I do worry that one person in Aroostook County is going to have limited impact unless they’re really talented and able to find partners, like syringe exchanges and mental health clinics,” Smith says.
In Oxford County, Glenn Gordon has run into some of those challenges. He lives in Mexico, one town over from Rumford, and has driven an hour or more to meet clients in the Oxford Hills and Fryeburg areas.
But he spends most of his time in the towns along the Androscoggin River, with more than half of his referrals from Mexico and Rumford. He works out of the Rumford office of Oxford County Mental Health Services and has developed a good rapport with the local police.
It helps that Gordon, who is 57, previously ran a cafe with his wife that served some of the officers. With clients, it also helps that Gordon has a degree in psychology and is recovering from his own “pretty intense history” of drug and alcohol use.
The challenges before him are complex, and growing worse: after Oxford County had 15 fatal overdoses in all of 2020, it saw that same number in just the first seven months of this year.
During an interview, Gordon choked up when noting that one of the victims was a man who had been referred to him just a couple days earlier.
“It’s real,” he says. “This s*** is real. People are dying. That’s why we do this.”
About five new clients are referred to him each week. Like with Bradeen, Gordon says that he works to provide them with naloxone and treatment opportunities.
He’s also a go-between for many other community organizations that have something to offer. He helped one client with serious mental health challenges get an apartment, and raised the funds that another one needed to enter a sober-recovery home. Another just wanted a tent, a sleeping bag and somewhere to put them, so Gordon helped arrange all three.
“For a lot of people struggling with drug addiction, there’s a real bottom line of food, shelter or clothes,” he says. “It’s hard to think too much about treatment or recovery when you don’t have any security.”
Gordon had to adapt his approach in response to the coronavirus pandemic. At the outset, he had planned to spend more time riding around with police officers to overdose calls. Now, many of his referrals come through an online portal set up by the police.
But even with the danger of COVID-19 — and now with the protection of a vaccine that he got as soon as he could — Gordon has still made the effort to meet with his clients in person.
He hopes doing so makes them feel less alone.