The $130 million Maine is set to receive over the next 18 years as part of a deal with opioid dealers is nowhere near enough to offset a relentless epidemic that has disproportionately ravaged Maine and killed thousands of residents, the opioid director said the state’s response.
But Friday’s announcement of the settlement, which will direct funds to Maine cities and school districts to cover costs associated with opioid addiction, marked the resolution of part of a larger fight to combat the opioid epidemic.
Maine has played a paramount role in this struggle, not only because it has had a disproportionately high death toll. According to interviews with three drug use experts, the state has also played a large role in raising awareness of the dangers of opioid abuse, leading to successful lawsuits against manufacturers and distributors.
The settlement with Johnson & Johnson and others follows a year in which Maine hit a record 636 overdose deaths, a sign the crisis has only gotten worse. Seventy-seven percent of those who died overdosed on fentanyl, a synthetic opioid 100 times more potent than heroin and increasingly being incorporated into a growing number of illicit drugs.
Dozens of Maine cities and school districts have joined federal lawsuits against manufacturers such as Purdue Pharma, the Sackler family-owned OxyContin maker, and the consulting firm McKinsey, which advised such companies on how to market their products.
Maine is set to receive an additional $20 million from Purdue as part of a statewide settlement.
“The human cost is so appalling that it almost feels cheap to say, ‘Oh, by the way, it costs the state a billion dollars a year,'” said Gordon Smith, Maine’s director of opioid control.
The settlement amounts so far pale in comparison to the funds Maine has received under the 1998 settlement, which so far has channeled more than $1 billion from tobacco companies to the state to fund smoking prevention, smoking cessation, and others to pay for public health programs.
“It doesn’t make us healthy by any means, but it’s new money that can be channeled into worthwhile projects like harm reduction, prevention, treatment and recovery support,” Smith said.
After Purdue began marketing OxyContin as a prescription pain reliever in 1996, its sales force targeted states like Maine, Virginia, West Virginia and Kentucky with high concentrations of injury-prone manual labor, said Noah Nesin, innovation consultant for Penobscot Community Health Care in Bangor and his former chief medical officer.
Such states are more rural and their medical providers have smaller professional networks, making them more vulnerable to promises made by drug companies to solve their patients’ chronic pain, Nesin said.
“It seemed like an answer to a problem that hadn’t been solved yet,” he said.
Maine was – and still is – one of the states with the highest prescription rates for opioids. The latest data from the US Centers for Disease Control and Prevention showed that Maine’s rate of opioid prescriptions per 100 people was 40.3 in 2020, the highest in New England.
Law enforcement and other officials sounded the alarm about opioid abuse as early as the 2000s, almost a decade before Maine reached its peak prescription rate of 93.1 prescriptions per 100 residents in 2011.
Jay McCloskey, then the US Attorney for Maine, was one of the first officials to identify the threat OxyContin posed in a February 2000 letter to Maine doctors, he later told the US Senate Judiciary Committee.
“It’s a very effective pain reliever for people with legitimate pain problems, but it’s easily abused,” McCloskey said at an August 2000 news conference while announcing the charges against 11 people accused of illegally buying and selling OxyContin, according to the archives of the Bangor Daily News.
Maine began tracking drug overdose deaths in 2002 when then-Attorney General Steve Rowe directed researchers to collect overdose data dating back to 1997, said Marcella Sorg, a medical anthropologist who compiles Maine’s overdose data and director of the Rural Drug and Alcohol Research Program at the University of Maine Margaret Chase Smith Center.
The state also began monitoring prescription drug data in 2004, Sorg said.
The crisis was particularly rooted in rural communities in Down East Maine, where Michael Riggs, a former Washington County sheriff’s deputy, called it the “worst thing we’ve ever faced” before the US Senate in 2003.
But it wasn’t until around 2012 or 2013 that efforts by medical experts to raise awareness of how bad the opioid crisis had become began to resonate, Nesin said.
“We started to accept the idea that the prescribing doctors were part of the underlying problem of the opioid crisis and that it wasn’t just a handful of irresponsible prescribers, it was a really broad prescribing pattern that had started this opioid crisis,” Nesin said.
Nesin touted efforts such as the expansion of drug-assisted treatment and the Maine Naloxone Distribution Initiative, which distributes the overdose-reversal drug, as factors in preventing more deadly overdoses, as well as the passage of a 2016 law restricting opioid prescribing.
The COVID-19 pandemic and the increasing presence of fentanyl in street drugs have led to more overdoses, but naloxone has helped reverse potentially fatal ones, Nesin said.
“Addiction is a disease of isolation, and as the pandemic exacerbates that isolation, people are more likely to use alone,” he said.