Funding for harm reduction interventions in Maine received a much-needed boost on February 6. Newly-elected Governor Janet Mills signed an executive order redirecting funds from the state’s Office of Substance Abuse and Mental Health Services (SAMHS) towards naloxone distribution in hospitals and syringe programs, increased Suboxone access in emergency departments, and the development of a medication-assisted treatment program for incarcerated people, among other things.
It seems like the state with the seventh-most opioid-involved overdose deaths in 2017 could be improving its response. After all, racist former-Governor Paul LePage, who had pushed for a bill requiring people who overdose multiple times to be billed for naloxone, is out of office.
But despite Governor Mills’ effort, Maine remains the state with the highest federal funding disparity for state-level responses, according to a report published on April 20 by Mission LISA—a research foundation launched by big data company Lumina to study the opioid-involved overdose crisis using artificial intelligence.
Currently, states with larger populations, like California, receive the most federal funding—even though they have not, comparatively, been hit hardest by the crisis. Agencies like the Substance Abuse and Mental Health Services Administration (SAMHSA) allocate funds by considering the absolute scale of non-prescribed opioid use, addiction and drug-related deaths in a state.
That’s why Maine—along with West Virginia, the District of Columbia, Maryland, Kentucky, New Hampshire, Delaware—continues to be underfunded. Mission LISA found that many agencies, including Center for Disease Control and Prevention (CDC) and the Department of Justice (DoJ) do not utilize prevalence measures, which highlight the proportionate severity of addiction and overdose in a given state.
“Smaller states are bearing the brunt of this crisis, and this updated formula would provide them the funds they need for prevention, treatment and intervention,” said Vicky Liao, director of Mission LISA.
Using an alternative methodology for funding and appropriation that takes prevalence into account, Mission LISA found that the distribution of federal funds to tackle the overdose crisis could be optimized by committing an additional $108 million to at least 37 states and the District of Columbia.
The report identifies Maine as the state most underfunded by SAMHSA’s State Targeted Response to the Opioid Crisis (STR). The grant uses a formula based on “the number of people who meet criteria for dependence or abuse of heroin or pain relievers who have not received any treatment” and “the number of drug poisoning deaths.”
Considering this, Maine has the 10th highest prevalence, but ranks 36th for absolute size. Since SAMHSA did not take the former into account, the state experiences the highest deficit for STR funding, based off of Mission LISA’s recommendations of an STR allocation of $9,085,739. Right now, Maine is only receiving $2,039,029—a deficit of $7,046,710.
The $7 million must be put into the establishment of safe injection sites and other low-barrier harm reduction services that are consistently ignored and marginalized
This confirms what Jesse Harvey, the founder of Church of Safe Injection and Journey House Sober Living in Portland, Maine, has heard from other service providers and suspected himself. “Funding? What funding? I have heard so many people in this industry … asking ‘Where are the STR dollars?'” Harvey told Filter. “Everybody feels failed by government, both Augusta and DC.”
“While treatment and ancillary services have been increasing both in number and in geographic dispersion in Maine,” Harvey explained, “most of these still fail to meet our most vulnerable friends and neighbors where they’re at, resulting in more Mainers needlessly dying.”
Access to medication-assisted treatment is impacted by the insufficient funding of the Maine Opioid STR Program, which prioritizes MAT access for pregnant people and people who inject drugs. A Fiscal Year 2018/2019 application for federal grants, including STR, filed by Maine SAMHS reported that the lack of funding for MAT infrastructure, as well as “the vast size of the state,” means patients who utilize MAT services often must travel up to five hours a day to access treatment. In an effort to boost funding for Maine’s MAT programs, SAMHSA pre-selected Maine applicants for the Medication Assisted Treatment—Targeted Capacity Expansion grant.
An increase in funding for Maine’s STR program might not greatly bolster harm reduction programs, however. Mission LISA uses a baseline model that assumes that 70 percent of funds should go to recovery and treatment programs, while harm reduction interventions—like naloxone, syringe programs and drug checking—should receive 3 percent. (In Maine, Mission LISA suggests slightly less, at 2 percent for harm reduction.)
That’s because Mission LISA calculated harm reduction funding proportion by considering how much money would be needed to “mitigate the crisis” as given by the number of annual opioid overdoses. Evidence suggests that safe consumption spaces are associated with lower overdose mortality, fewer ambulance calls for treating overdoses, and a decrease in HIV infections.
When building its model, Mission LISA drew from a New York Times survey that recommended safe consumption spaces alone should receive 2 percent of funding, and harm reduction in general 15 percent. The research foundation also looked at an AP analysis that included naloxone, an opioid overdose reversal drug that is often considered to be a harm reduction intervention, as a treatment resource. With that in mind, AP recommended that 68 percent of funding go to “treatment.”
For Harvey, the allocation of funds to programs that hold a set of assumptions about how people should be using drugs—specifically, that they shouldn’t be using drugs—will not meet the needs of everyone.
“Counseling, sober houses, and competent pharmacotherapy are great, and they save lives; but what are we offering the person who does not want—or is not ready for—any of these?” he said. “We continue to offer them lip service followed by sad elegies.”
Jill Kernes, the senior vice president of communications Mission LISA’s parent company, explained to Filter the process of determining how funds ought to be allocated. “We built our baseline model to account for different approaches and recommendations.” In terms of harm reduction, “We look at HIV, drug checking, surveillance and syringe exchange. We did not add a consideration for supervised consumption spaces in our analysis.”
With such idiotic and shallow policy at the federal level, it is no wonder so many people are dying and contracting preventable diseases.
This means that the additional $7 million in funding does not take into account the growing movement for safer consumption spaces (SCS) in Maine. Even if it didn’t, it most likely would not be put towards a state-sanctioned SCS given federal hostilities. But this flies in the face of what on-the-ground activists like Harvey see as most needed.
“The $7 million must be put into the establishment of safe injection sites and other low-barrier harm reduction services that are consistently ignored and marginalized, despite the overwhelming body of evidence showing their irrefutable effectiveness,” wrote Harvey.
Harm reduction in Maine will continue to remain underfunded because of a federal regulation that prohibits federal funds from being used to purchase hypodermic needles or syringes, even though Obama lifted the ban on funding for other syringe exchange programmatic functions in 2016. For FY 2018-2019, $75,000 was appropriated by Maine CDC for hypodermic apparatus exchange program functions, none of which could go towards the needles and syringes themselves.
“The federal ban on funding of any sterile syringes makes it abundantly clear that the federal government intends to maintain the broken continuum of care that is only equipped to serve people if and when they STOP using drugs, showing no concern for their lives WHILE they are using drugs,” Harvey contended. “With such idiotic and shallow policy at the federal level, it is no wonder so many people are dying and contracting preventable diseases. The real question is why are we so surprised that people keep dying?”
SAMHSA and Maine HHS did not respond to requests for comment by the time of publication.
Photograph: Sessi Kuwabara Blanchard