Maine’s health care providers have dispensed fewer opioid prescriptions for about a decade, but the state still had the highest opioid prescribing rate in New England in 2020, according to data from the US Centers for Disease Control and Prevention.
The steady decline shows the state’s progress in dispensing fewer opioids that fueled an addiction epidemic that killed thousands of Mainers, as well as the effects of a 2016 state law that restricted opioid prescriptions. Maine’s opioid prescription rate has been lower than the nationwide since 2017.
But Maine’s still relatively high rate for New England is a relic of opioid manufacturers’ strategy years ago of targeting areas that had worked in labor-intensive manual jobs. such as manufacturing and lobster, according to addiction experts.
Maine Attorney General Aaron Frey announced last week that the state had reached a $130 million deal with Johnson & Johnson for the company’s role in manufacturing opioids. Native American tribes reached a $590 million federal settlement with the drug company earlier this week.
However, as settlements grow and prescriptions decrease, drug overdoses in Maine continue to rise. More than 630 Mainers died of drug overdoses in 2021, setting an annual record.
Maine health care providers dispensed 40.3 opioid prescriptions per 100 residents in 2020.
New Hampshire’s opioid prescription rate in 2020 was 35.2 per 100 residents. Vermont’s was 34.8, Massachusetts’s 33.3, Connecticut’s 37 and Rhode Island’s 36.5.
The overall prescribing rate in the United States was 43.3 prescriptions per 100 people, while Alabama had the highest rate at 80.4 and Hawaii had the lowest at 27.3.
These figures do not include opioid agonists like methadone or buprenorphine, commonly known as Suboxone, which are used to treat substance use disorders.
Maine’s dispensing rate in 2020 is less than half its peak rate in 2011, when prescribers dispensed 93.1 opioid prescriptions per 100 residents. Addiction experts have pointed to the decline as evidence of the state’s success in tightening prescription regulations and making it harder for people to get opioids like OxyContin.
But Maine’s current status as the state with the highest opioid prescribing rate in New England reflects its role as one of the pharmaceutical leaders in states specifically targeted for opioid marketing, said Maine Opioid Response Director Gordon Smith.
Salespeople for Purdue Pharma, the company that makes OxyContin, aggressively targeted states like Maine, West Virginia, Virginia and Kentucky because they had a critical mass of workers in prone job sectors. to injuries such as lobster, forestry and mining and were likely to seek pain relief treatment.
“We may not be at the average New England level because we’ve had the farthest to come,” Smith said.
Noah Nesin, innovation advisor for Penobscot Community Health Care in Bangor and its former chief medical officer, said overprescribing is still a problem in Maine, noting that while Maine has cut its rate by more than half in recent years, the current rate is still significantly higher than in 1999.
The majority of those prescriptions are likely for people with long-term opioid prescriptions who were prescribed the drugs before a 2016 law made it harder to get those drugs, Nesin said.
It is difficult to stop patients from these drugs because people who have taken opioids for an extended period worry about how they will react when they are no longer taking opioids, so doctors can be reluctant to stop prescribing, Nesin said.
“They’re very worried, understandably, about ‘What’s my life going to be like without this pain medicine?'” Nesin said.
It’s also possible that a small group of prescribers don’t think opioids are dangerous and continue to prescribe them in large numbers, he said.
Maine’s opioid epidemic grew deadlier as the rate of opioid prescriptions plummeted because those who had become addicted turned to cheaper and more readily available illicit drugs like fentanyl and heroin because it has become harder to access prescription opioids, said Jeff Barkin, a Portland-based psychiatrist. and president of the Maine Medical Association.
“The illegal market is not stupid,” Barkin said. “They understood that and probably increased the purity and decreased the price in response, and that’s where you saw a problem, prescription drugs starting to turn into illicit drugs.”
Seventy percent of fatal overdoses in Maine in 2021 were due to fentanyl, a synthetic opioid that is 80 to 100 times more potent than morphine. Fentanyl is increasingly cut into illicit drugs, and because it cannot be tasted or smelled, people often unknowingly ingest drugs containing the powerful opioid and overdose.
It’s pretty easy for people to go from taking legitimate opioid prescriptions to developing a substance use disorder, said Jacquie Wilks, executive director of the Together Place Peer Run Recovery Center in Bangor.
A woman she works with was prescribed Vicodin, a combination of non-opioid and opioid painkillers, when she had a caesarean section. When her doctor stopped prescribing the drug, she started buying other drugs on the street before turning to Together Place for treatment for a substance use disorder.
“It just started with a simple prescription from a doctor saying, ‘I know you’re in pain, here, take this’ and then, the next thing you know, she was pretty hardcore,” Wilks said.