Fatal overdoses in Washington County have dropped by approximately 40% over the past two years, signifying a turning point in the battle against synthetic opioids even as new concoctions are entering the drug supply. The county continues to face challenges in accessing recovery tools, however, and that access is further jeopardized by the loss of federal funding. The information was shared by the state's director of opioid response, Gordon Smith, at a public presentation hosted by Sunrise Senior College at the University of Maine at Machias on Wednesday, May 21.
      There were 16 fatal overdoses in Washington County in 2024, compared to 25 in 2023 and 24 in 2022. This year, six people have died in the county, mirroring last year's figures. Non fatal overdoses in 2024 totaled 225, compared to 215 in 2023. Statewide, the total number of non fatal overdoses dropped 20% to around 8,000 last year.
      "Some of it is what we're doing on the ground," Smith said, noting in particular that improving access to treatment has been a big help across the state. Increased availability and training for overdose reversal drug Narcan have helped, along with faster access to medication based treatment such as buprenorphine and methadone. When someone seeks help for a substance use disorder today, they will have access to medication based treatment within 24 hours.
      Just two years ago, by comparison, doctors were federally required to complete training and receive a waiver to prescribe buprenorphine, a drug that is increasingly being favored as an alternative to methadone in part due to having less effect on respiration. It is now available at Down East Community Hospital in Machias and will soon be in Calais, Smith said.
      Along with better access to treatment, the lethality of the national drug supply also appears to be decreasing, Smith said. Nationwide, there was a 26% decrease in fatal overdoses last year. "What we're doing here is making an impact, but something is going on around the country. It has to be in the drug supply. The drugs being taken today that are being brought into Washington County are not as lethal. They're still bad. They're still killing people. But they're not as bad as they were 12 months ago."
      In the wide majority of state overdose reports, Smith said, multiple drugs tend to be present. Fentanyl is present in around 70% of cases, with cocaine appearing around 45% of the time and methamphetamines around 37% of the time, according to . Both cocaine and meth are on the rise, along with a new class of synthetic opioids called nitazenes that are considered to be more lethal than fentanyl.
      The overall decrease in drug lethality is important, as Smith does not see stopping the supply of drugs as the most viable path forward in addressing the drug epidemic. "I'm much more interested in the demand side, not the supply side. And that's because we have 100 years of evidence that you can't stop the supply. The drugs are going to come into Maine." Even if the supply could be stopped or slowed, as happened during COVID, drug users will experiment with new drugs and risk overdosing due to being unfamiliar with their potency.
      Recognizing that stopping the supply isn't the singular solution, Smith said, "What we have to do is work harder on the demand side, so that even though drugs are here, people are living joyful, happy lives, and they aren't using." To do so requires getting at the root causes of drug usage and addiction, meaning the focus is shifting to identifying and working with individuals who have experienced trauma such as childhood poverty or cultural genocide, as in the case of Indigenous communities. "We need to improve the social issues that caused people to use drugs in the first place."
      Reducing stigma is important to this work, Smith said, and Washington County has come a long way in doing that. The county has two recovery community centers operated by AMHC, one in Calais and one in Machias, where people can "come in and not be judged" and get connected with treatment options, while the Community Caring Collaborative has had success with its Recovery Friendly Workplace initiative. Recovery coaches proliferate the county, and the state's new OPTIONS -- Overdose Prevention Through Intensive Outreach, Naloxone and Safety -- program has 30 staff who are connecting with communities statewide. Safe Harbor, meanwhile, provides residential treatment in Machias for women and children in recovery.
      "We still have some really significant gaps" in the county, Smith noted. "People need a continuum of care." Most importantly, Washington County lacks recovery and treatment beds for the general population -- but not for lack of trying. In 2023, the Office of Behavioral Health put out a request for proposals for between 8 and 10 beds in the county with $1.5 million offered, but no responses came in. The amount was increased to $2.4 million, but still no reasonable proposals were received.
      "I get it," Smith said. "It's expensive." Regardless of the number of beds, treatment facilities must have a nurse available 24/7. Apart from the initial offered funding, reimbursement would come from Medicaid, but the rates aren't yet sufficient -- and they aren't increasing fast enough to offset costs.
      Funding is a major portion of the opioid recovery picture, Smith said, with the expansion to Medicaid ordered by the Mills administration enabling 120,000 Mainers to receive healthcare, including access to medical treatment for substance use disorders. The federal government pays 90% of that cost currently. "If we provide more people with financial resources to get into care, more people will get into care."
      Apart from the Medicaid expansion, the state's efforts to combat the opioid epidemic benefited from COVID era programs that have since expired or been eliminated, with $11 billion in funding for addiction and mental health resources cut by the federal government in late March.
      The cuts come at a time when the state is tracking an uptick in drug usage and overdose deaths in both children and the elderly, along with an outbreak of 24 cases of HIV in the Bangor area among the homeless population. "This is not the time to be cutting back on harm-reduction activities," Smith said. "Our work is more important than ever."
      Recognizing that the drop in mortality is significant, Smith said that it's important to keep it in perspective that between 2010 and 2024 "over 5,000 individuals died from an opioid related overdose -- our neighbors, our colleagues, our friends and our family members." That's twice as many Mainers as those who died during World War II, he added.