Fighting heroin



By Senator Susan Collins

A heroin epidemic is sweeping across America. Going beyond their traditional urban centers, drug cartels and big-city traffickers are targeting new lucrative markets in states and communities previously untouched by this scourge.

Maine is one of those targets and has been hit particularly hard. In 2014, there were 100 overdose deaths in our state from heroin and other substances – up from just 16 in 2010. In the first half of this year, 63 overdose deaths were reported. In the month of July alone, the city of Portland had 14 suspected heroin overdoses, including two deaths in one day. As another measure of the extent of this crisis, the number of people seeking treatment for opiate abuse has tripled during the last four years.

This epidemic is the result of a “one-two punch.” First, more than a decade ago, the increased use of prescription opiate painkillers for legitimate medical purposes led to a dramatic increase in the abuse of those medications and also in overdoses. Second, as medical and law enforcement officials took steps to make it more difficult to obtain prescription opioids illegally, the street price of those drugs soared, and cheap, readily available heroin filled the void. A single recreational dose of a prescription painkiller can cost $40 or more on the street, while a single dose of heroin can be purchased for as little as $5. Users often initially become addicted to the prescription drugs they wrongly consider safe, and then, due to the cost of feeding a daily addiction, switch to the cheaper illegal heroin.

The reason big-city traffickers are targeting northern New England is also a matter of economics. According to the Centers for Disease Control, Maine and New Hampshire have the dubious distinction of having the most prescriptions per person for long-acting and high-dose painkillers. Thus, our states have a high concentration of potential heroin customers.

All too often, the road to addiction begins with a legitimate medical issue. Not long ago, a young man in Maine told me that he was prescribed an opioid painkiller after he was injured playing high school football. He began abusing prescription drugs in college, and that led to heroin. His is a tragic but common story.

But perhaps most tragic is the effect of this epidemic on the most vulnerable in our society – the babies born to addicts. It is heartbreaking that nearly 1,000 babies suffering from addiction have been born in Maine already this year, a number which represents about eight percent of all births in our state.

Nationwide, there has been a staggering 300 percent increase in the number of infants diagnosed with newborn withdrawal since 2000, and the cost of treatment for these newborns was more than $700 million in 2009. Researchers estimate that more than one baby every 25 minutes is now born dependent on drugs and suffering from withdrawal.

In October, the Senate passed the Protecting Our Infants Acts, a bipartisan bill I sponsored that will help address the growing crisis of opioid use and abuse among pregnant women and its effect on newborn babies. This law will help some of our most vulnerable children receive the best possible start in life. The doctors and other health care providers treating them do an extraordinary job of helping these infants, but clearly more needs to be done to prevent this problem from occurring in the first place.

This legislation commissions a broad strategy to identify current gaps in prevention and treatment, improve coordination among federal programs, and help ensure that our public health system is best equipped to treat opioid addicted mothers and their babies in Maine and across our country.

Early this month, the Senate Health, Education, Labor and Pensions Committee held a hearing at my request on the heroin crisis and the abuse of prescription painkillers. The expert testimony and the keen interest shown by my colleagues from throughout the nation make it clear that this truly is an epidemic.

The time for action is now. This crisis calls for a three-pronged approach:

The first is prevention through education. We must better educate our young people so they know how dangerous prescription drugs, as well as heroin, can be. We need to educate patients that there may be safe and effective alternatives to strong and potentially addictive painkillers.

And we need to do a better job of educating health care providers about those options.

The second prong is law enforcement. Our law enforcement agencies need the resources to shut off the supply of heroin coming from international cartels, such as Mexican drug gangs.

The third is treatment. I am distressed that we have seen the loss of treatment options, such as the closure last spring of Mercy Hospital’s outpatient center, because of low reimbursement rates and a lack of funding for that important work.

As a result of the shortage of treatment options, this epidemic is playing out in emergency rooms, county jails and on Main Streets throughout the country. Maine sheriffs tell me that their jails are overwhelmed by those struggling with addiction and that they cannot arrest their way out of this epidemic. Jails are not designed to take the place of treatment centers, yet sheriffs and police chiefs must train their officers to look for signs of withdrawal and monitor mental health status.

I believe the federal government could assist in forging greater cooperation between law enforcement and treatment centers.

I have asked the administration to act on one particular issue immediately. Right now, primary care physicians are restricted on the number of patients they can treat with drugs that help wean people off of heroin. The cap of 30 initial patients, with the possibility of a waiver for 100, was arbitrarily set 15 years ago. Most of the witnesses at our hearing agreed with me that the cap should be eliminated altogether.

This drug epidemic is a national crisis that has its greatest effect at the local level – on our streets, in our homes, in our schools and communities – and that touches all lives, from infants to adults. It is encouraging that so many of my colleagues from across the country share my concern and are committed to finding solutions.

U.S. Senator Susan Collins is the senior member of Maine’s congressional delegation. www.collins.senate.gov

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