Pubdate: Tue, 07 Jan 2003
Source: Portland Press Herald (ME)
Copyright: 2003 Blethen Maine Newspapers Inc.
Author: Michael J. Chitwood and Julie Osgood
Note: Julie Osgood is the president-elect of the Maine Public Health
Association. Michael J. Chitwood is the Chief of Police in Portland


Late last month, the Press Herald reported that deaths caused by drug
overdoses have reached epidemic proportion ("Drug deaths skyrocket," Dec.
28, 2002). It said that state officials had released a report with dire
statistics on deaths from overdoses and vowed to work for policy changes to
curtail the dangerous trend.

While policy changes are imperative, we believe that they should be part of
a comprehensive, coordinated approach.

Opiate abuse is a complicated problem that will require a multifaceted
solution involving collaboration among diverse professions.

With the release of the state's report, we now know more about the nature of
the problem: the dramatic increase in drug deaths over the last five years;
the increase in accidental overdoses; the abuse of prescription drugs; the
pervasiveness of the issue throughout Maine.

A comprehensive approach should include several components: law enforcement
(control), public/professional education (prevention) and treatment
services. These components can be strengthened by policy changes and must be
implemented in a systematic, coordinated manner throughout the state of

First, resources must be available to ensure effective law enforcement. Drug
enforcement agents enforce state and federal drug laws and conduct
comprehensive investigations into the trafficking of narcotics and other
dangerous drugs. The Maine Drug Enforcement Agency should have increased
resources - both human and financial - to carry out its mission.

Second, education is essential to primary and secondary prevention
initiatives. Just as we have campaigns to educate people about the dangers
of smoking, we need programs to teach people about the risks they are taking
when they abuse opiates.

Health care professionals must also receive education on this public health
crisis so that they may become part of the solution. For example, there
should be implementation and widespread use of tamper- resistant
prescription pads and systems to track prescriptions.

Third, comprehensive substance abuse treatment services, which offer
comprehensive programs based on best practices, must be highly accessible to
those who need them. These services include medical treatment, cognitive
behavioral therapy and other types of rehabilitation and recovery services.
Treatment services should be integrated into all comprehensive health care
delivery systems and need to be responsive to the community.

Currently there are deficiencies in each of the aforementioned areas. While
the drug abuse problem is growing in Maine, the number of drug enforcement
officials is shrinking as part of a trend over the past decade. Budgetary
restrictions have forced the MDEA from about 76 agents in 1992
(approximately a $2 million budget) to roughly 34 today (approximately a $1
million budget).

We cannot expect to see positive changes in the opiate abuse problem in
Maine if MDEA resources continue to dissipate. Moreover, there is no
statewide, coordinated approach to education.

State officials need to work with multiple communities (e.g. medical, public
health, education, law enforcement, etc.) to get the word out. Also,
treatment services need to be integrated and the treatment community must
collaborate with other stakeholders to ensure a sustainable solution and a
reversal in the current trend.

We have a responsibility to work together and to find the resources to solve
this public health crisis. Another person need not die before we begin
collaborating on a comprehensive approach to the drug problem in Maine.
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