Ryan Paige is never far from his phone.
He's the guy people call when they've hit rock bottom and want treatment for substance use disorder, but can't find any place to go. He's their last ditch attempt at getting help.
Sitting in his kitchen, his phone rings. "How you feelin'? You sound tired," he says to the caller.
Paige isn't paid to do this work. It's just something he does on his own, by word of mouth. He fell into this role after he recovered from substance use disorder a few years ago. Friends would call to ask him for help, and he put together a network of inpatient detox and treatment facilities he could send them. Both of these options are hard to come by in Maine, says Paige — especially for people without insurance.
"Right now, as far as residential treatments and detox beds for people that don't have insurance don't have any money, it's dire. It is dire."
So dire, says Paige, that more often than not, he has to send people out of state. On this day, he's on the phone with a man he got into detox in New Hampshire. Now, Paige is working to place him into residential treatment, also in New Hampshire.
"You'll like it," he tells the man. "I went there to tour. It's a very nice facility. Great people. It's one of my favorite places to send people."
Paige says it's easier to find beds outside of Maine — even as far away as Virginia and South Carolina.
"As far as availability of treatment, [it's] much better if you're in New Hampshire, Massachusetts, Connecticut, New York. Anywhere else but Maine," says Paige.
Last year, Maine saw a record 716 drug overdose deaths. The numbers give Maine the dubious distinction of having one of the highest rates of drug overdose deaths in the nation. Both advocates and treatment providers say gaps in access to critical treatment are a major problem.
"People are literally dying to get in here," says Tom Doherty.
He's executive director of Milestone Recovery in Portland. It's one of only two detox centers in Maine that accepts patients on MaineCare. And it only has 16 beds. He spoke to Maine Public in December, eight months after he took the position.
"Not wanting to sound dramatic," says Doherty, "But, you know, since I've been here, I think we've had 11 Narcan reversals of people, either in our shelter or trying to get into detox, and were, ya know, maybe topped up their use just before coming in and overdid it."
The lack of detox beds is a major bottleneck to treatment. Milestone's director of detox Corey Westleigh says only about a quarter of people who are screened are actually admitted.
"We know that our call volume is so high that there are people who do not get through on our phones and are not actually getting screened," Westleigh says. "So I actually think that the percentage of clients we're actually admitting is a lot lower than even that 20 to 30%."
Wellspring in Bangor provides 10 beds for detox and 40 for residential treatment but Executive Director Suzanne Farley says that's also not enough.
"Particularly for men's care," she says. "All of our programs have a minimum of three to four months waitlist for residential care."
Despite these gaps, she says Maine has made some progress expanding access to treatment. A recent boost in reimbursement rates helped.
"A year ago, I couldn't hire nurses, because the reimbursement rates for detox programs was abysmal," says Farley. "We couldn't make ends meet, we were running in the red for three years straight, even with grant support."
Farley says Wellspring is now running in the black. Maine's director of opioid response, Gordon Smith, points out another sign of progress: outpatient treatment is readily available. Smith says the number of providers who treat substance use disorder has more than doubled during the Mills administration to 1,400, with roughly 980 actively prescribing for patients.
"I feel quite good that throughout the state, within the day, people can get started on buprenorphine," says Smith. "And you wouldn't, one wouldn't have to wait very long now to get into a methadone program. The beds are not as good a situation."
Smith says the state is working to increase beds. A 2020 federal waiver lifts a 16-bed cap at residential facilities, and Maine recently awarded contracts to six organizations that will add dozens of residential beds for people who are on MaineCare. Milestone will add at least 12 detox beds, and Aroostook Mental Health Services plans to open a detox bed in Presque Isle. And Gov. Janet Mills has proposed $7 million in her two-year budget to respond to the opioid epidemic, a portion of which will support detox and residential bed capacity.
"I'm really optimistic that there'll be quite a difference in even the three to six month period," says Smith.
Maine also received $28 million in opioid settlement funds last year that will be used to bolster treatment. And independent local efforts are underway, including York County's plan to use $15 million in federal American Rescue Plan Act funds to build a 58-bed recovery center.
But it's unclear when Maine will have enough bed capacity to meet demand. And other issues could also pose a barrier to treatment. Providers say staffing continues to be a major challenge. And Suzanne Farley of Wellspring says lack of transportation and housing limit people's ability to get help.
"I mean, housing, housing, housing," says Farley. "And this is what I told my board of directors just recently. You know, we can't look at it as a separate thing. People who need treatment need housing. You can't get well if you don't have a stable place to live."
Back on the phone with the client in New Hampshire, Ryan Paige offers words of encouragement about residential treatment.
"You're choosing this, so be proud of yourself, man," he says.
Paige and his wife, Cynthia, recently launched a nonprofit dedicated to their effort, called Access Direct Recovery Network. He says it's gratifying to help others, but he's also frustrated that finding treatment for people desperate for help is such a battle.
"I liken it to somebody that calls 911 and says, I'm having a heart attack. And 911 says, 'Okay, well just, you know, try to get comfortable. And give us a call again tomorrow, and we'll see if we can get help.'"
It's a small window of opportunity, says Paige, that can mean the difference between life and death.
