MAKING HIS POINT — Dr. Mark Publicker, right, speaks with Maine State Senator Jim Hamper at the Dec. 7 Addiction Conference in South Paris.

(This the second of a three-part series based on information presented at a Dec. 7 Addiction Conference held in South Paris.)

By Gail Geraghty

Staff Writer

SOUTH PARIS — When it comes to opiate addiction, “Maine is really a startling place,” Dr. Mark Publicker said at the Dec. 7 Addiction Conference in South Paris.

Since moving here a decade ago, Publicker has watched the opiate abuse epidemic that began in Washington County spread across the state and the nation, sparked by the over-prescribing by doctors of OxyContin, or “hillbilly heroin,” which hit the market in the early 2000s.

For years, Maine has had the highest rate in the country of residents seeking treatment for non-heroin opiates — about eight times the national average, at 386 people per 100,000 as of 2008, compared to the national rate of 45 people per 100,000.

Publicker said he has also watched the state’s effort to combat the problem with such methods as the statewide prescription monitoring program, begun in 2004 to discourage “doctor-shopping,” drug disposal programs by law enforcement, and the reformulation of OxyContin and its generic form, oxycodone, into a pill that can’t be crushed or liquefied in order to attain the high so craved by addicts. Doctors, as well, are much less willing to prescribe this strong painkiller to patients, especially those with a history of abuse, because of an aggressive effort at physician education by the state.

Unintended consequences

All of these efforts and others are laudable, he said. But OxyContin is nothing more than synthetic heroin, and heroin is one of the most highly-addictive drugs known to man, and one of the hardest to treat. Opiate addicts are becoming more desperate as the supply of their drug of choice has diminished, and because of that, there have been “unintended consequences” to the efforts to combat illegal prescription drug use, said Publicker. Zane Loper, who worked seven years in Oxford County as an undercover officer for the Maine Drug Enforcement Agency, also spoke at the conference, and said he sees evidence of those unintended consequences increasingly on the street.

Among the unintended consequences are these:

• Drugstore robberies have more than doubled this year from 2011, when there were 24 pharmacy robberies. This year there have been 54 such robberies — around half of them at Rite-Aids — with the most recent such robbery occurring Dec. 4 at a Walgreens in Bangor. “There’s no question that the decrease of opiates on the streets is connected to these robberies,” Publicker said. Two separate drugstore robberies took place in the Lake Region in October, at Rite Aids in Naples and Fryeburg. In both cases, the suspect has been arrested and charged with the robberies.

• Heroin is now “flooding into the state,” he said. “Out-of-state drug dealers have a fantastic market here,” Publicker said, adding, “With less availability and high rates of addiction, what do you think happens?” The increase in murders in Maine has been tied to organized drug gangs that have set up operations in the state in recent years, Publicker said. While it’s rare to see intravenous use of oxycodone, heroin is injected with a needle, and “What I’m seeing right now is an explosion of intravenous opiate addiction,” Publicker said. Loper said a ready supply of heroin in Massachusetts means that “I can jump in my car with a cell phone number and I can go to an exit off of I-295 in Massachusetts and I can get as much heroin and cocaine as I want.”

• Burglaries and thefts are on the rise. More than 50% of burglaries and thefts from homes, cars and businesses involve addicts who are seeking their next “fix.” Loper, whose position with Maine DEA was eliminated this summer, now works for the Oxford Police Department, and recently helped with a burglary case involving break-ins at Twin Town Homes and Call of the Wild on Route 26. “They were taking TVs off walls of display units; they stole everything they could,” he said. Eventually they served a search warrant on the home of a man in Mechanic Falls who was allegedly dealing heroin. There, they found all of the stolen goods, and it turned out that area addicts were bringing the stolen goods to the man, who would trade with them for the heroin. “It’s $10 for a quarter gram of heroin, and (addicts reason) that if I can just get that heroin, then I can make the shakes and the DTs go away long enough for me to go out and steal enough stuff so that I can actually get a full bag of heroin and get high,” Loper said.

Failure of distributive justice

While Maine is continuing to tighten laws making opiates less available, state lawmakers have failed to pay enough attention to treatment, Publicker said. “Opiate addiction is a metastatic, socio-cultural disease, and just like cancer, this disease is spreading, and we are not applying tools to be effective in arresting its spread,” he said.

“In this state we have a failure of distributive justice,” said Publicker. “We have cut back on (the number of) rooms for people in residential treatment, because programs are progressively closing” for lack of state funding, he said. “My program at Mercy Hospital is on the ropes,” because 30–40% of his patients are low income and receive MaineCare, and “The availability of MaineCare is being stripped.” As of Jan. 1, 2013, all low-income MaineCare patients being treated for substance abuse who have been taking Suboxone — an opioid-based substitute that is the primary method for treating opiate addiction — for two years or more will no longer be funded after six months. Since the cash price for a month’s subscription costs around $350, many patients won’t be able to afford to continue on the drug, and many of them will relapse. Publicker said policy makers are also considering lowering the income threshold for MaineCare eligibility, leaving more and more people in need of substance abuse treatment unable to afford the cost.

“People with addictions are not popular. If you want to cut money from a budget, pick the guy with the alcohol or drug problem — no one is going to open their mouths and fight” to keep that funding, especially when funding for mental illness treatments is also being cut back.

“If we were talking about mental illness, all of you would be burning torches in Augusta,” demanding action. When it comes to substance abuse treatment, “No one is showing up” to demand that insurers provide the same level of benefits for substance abuse treatment as for other physical disorders or diseases.

“I’m making the case that I don’t think the recovery community has done its job” in convincing lawmakers to put at least as much emphasis on treatment as it has put on enforcement of illegal drug diversion, said Publicker. “When people require treatment, we should be able to give it to them, because treatment works, and it works well.”

(Next week: Alcoholism: king of the addictions)