Is Maine Finally Turning the Tide on Overdose Deaths? May be.

Whenever a Milestone Recovery patient, past or present, dies of a drug overdose, the staff typically logs into a critical incident system to report it.

One day this fall, CEO Tom Doherty went to log in, but had to update his password because it had expired after 90 days of inactivity.

It had been at least 90 days since someone died.

Service providers like Doherty aren’t taking victory laps, but there is a glimmer of optimism as 2024 sunsets that Maine could reverse a deadly trend that has ravaged the state for a decade.

Between January and October, there were 403 drug overdose deaths, an average of 40 each month, according to state data. This is a 21% decrease from the same period in 2023, when there were 513 overdose deaths, and comes after a 16% decrease from 2022 to 2023.

If this year’s pace continues into November and December, Maine will end 2024 with fewer than 500 fatal overdoses for the first time since 2019.

Gordon Smith, Maine’s opioid response director, said deaths aren’t always the best measure of success or failure, though he understands that’s what generates the most attention.

“We could do everything we need to do right, and our deaths could go up,” he said.

And it’s clear that there are larger forces at work. Overdose deaths have declined nationally this year, although the decline in Maine is more dramatic than the national decline.

Still, Smith said, Maine’s historic investments in treatment, harm reduction and prevention could pay off. Just last month, the state awarded 14 million dollars for 43 projects through his share of the opioid settlement funds, and those funds will continue to circulate in Maine for another 17 years.

Doherty said greater buy-in to harm reduction efforts was a key factor. Harm reduction means everything from the widespread distribution of naloxone, the overdose-reversing drug, and drug-testing strips, to the Good Samaritan law which allows anyone to call 911 following an overdose without fear of arrest for felony drug possession.

Milestone has two mobile outreach teams that spend their days traveling around Portland looking for people at the highest risk. Other agencies, including Maine Access Points, which focus on harm reduction efforts in rural areas, have the same goal. The goal is to get them into treatment, even if it takes many tries.

“Not everyone is going to clean up their mess on the same day,” said Angel Trotter, a Milestone worker.

So the goal becomes simpler: keep them alive.

“I’m trying to have a good time”

Trotter and her outreach partner, Courtney Bass, spend most of their days working in a Nissan NV3500 passenger van filled with supplies and food.

One day this month, the two women also donned personalized Christmas stockings that volunteers had filled with candy and personal care items.

Their goal every day is to reach out to clients living on the street, most of whom also experience substance use disorders—the most vulnerable to overdose.

“I’m not sure how long I’d live behind the ball field and have people not even look at you or yell, ‘Get a job,'” Doherty said.

Trotter and Bass said their work has gotten harder since Portland passed an ordinance banning homeless encampments. Now, the homeless individuals who don’t make it to shelter are scattered into neighboring communities like South Portland and Westbrook.

With Bass behind the wheel and Trotter in the passenger seat on his laptop or phone, they begin their route.

“Meeting people where they are” is a common phrase, and that often means in library parking lots or large retail stores. Sometimes it’s just the side of the road.

Trotter has been on the job for 18 months, but said she was also living on the street not long ago.

“It’s changed a lot,” she said.

Bass has been with Milestone for more than a decade. She said a big part of her job is making sure people have what they need to stay safe.

“You don’t think about these things when you run, you just try to get by,” she said.

At one stop, a young man asked Trotter to look at a rash on his stomach that wouldn’t go away. She asked if she could take a picture and send it to someone at the free clinic.

Back in the van, she makes a phone call and tells a doctor that she will send the photo to see if he needs to be treated immediately.

They work closely with other service agencies, including Common Space, which operates a needle exchange program and other harm reduction initiatives. Executive Director Brian Townsend points to two factors contributing to the drop in overdose deaths: 1. A dramatic increase in supplies available for safe use and 2. Increased sophistication and knowledge of overdose response.

There is still resistance, he said, to harm reduction initiatives such as needle exchange programs. Townsend doesn’t begrudge anyone having a strong emotional reaction, such as complaining about dropped needles or the impact on emergency crews.

But he also tries to explain that harm reduction is not the same as making drugs easier to use.

“Our efforts are strictly to keep people safe and keep them alive,” he said.

At their last stop, Trotter and Bass waited nearly 20 minutes in a parking lot across from the Lowe’s on Brighton Avenue near the Portland-Westbrook line for a customer who was supposed to meet them. They didn’t show up even a day before.

Bass said if they go more than a few days without seeing a regular customer, they start to get a little worried.

“Then we’ll go look,” she said.

“Too many more”

Maine is not alone in documenting fewer deaths. Fatal overdoses fell nationally by about 14 percent between June 2023 and June 2024, according to recent data released by the U.S. Centers for Disease Control and Prevention.

Some experts attribute some of it to the supply chain.

Fentanyl, the powerful synthetic opioid that years ago replaced heroin as the go-to drug for many, has become less potent as the country has begun cracking down on cartels and other international suppliers. This fall, the head of the US Drug Enforcement Administration, Anne Milgram, announced that for the first time since 2021, her agency had seen a decrease in the potency of fentanyl.

Smith said Maine probably saw some of that, too. In addition to fewer deaths, the number of non-fatal overdoses fell by 13% over the same period in 2023.

Still, fentanyl appeared in three out of four overdose deaths in Maine this year, often in combination with another substance, such as cocaine or methamphetamine, according to state data.

Smith also said officials have little control over the supply of the crisis. Cartels and such have always found a way to stay one step ahead.

“I’d rather work on the demand side,” he said.

To this end, Maine built a network of recovery coaches throughout the state that did not exist five years ago. Naloxone has become widespread in most communities. There are more than 1,000 recovery beds nationwide.

The state has never had more people on methadone and Suboxone, the two main forms of medication-assisted treatment. And more and more are choosing to use Sublocade, which is a month-long injection that blocks opioid receptors and effectively makes it impossible to get high.

In Portland, Milestone has doubled its number of detox beds. Combined with other beds in the city, they are 5 times more than before the pandemic.

“It used to be like Willy Wonka and the golden ticket,” Doherty said.

There are always challenges. Experts say tracking other substances that might mix with fentanyl, methamphetamine or cocaine is critical. Some newer mixers are resistant to naloxone. It’s one reason agencies like Milestone and Common Space distribute test strips. Longer-term residential treatment, which is expensive, is still insufficient and they often face local resistance.

Townsend said that independent of the state’s investment, the conversation about opioid use and overdose has evolved so it’s okay to talk about it. For the most part.

“Stigma remains one of our biggest problems,” he said. “It hasn’t completely changed, but it’s moved in the right direction.”

Although there is more hope, experts are not declaring any victory. “There are still too many (overdose deaths) in a state our size,” Smith said.

Doherty agrees and is always quick to temper his optimism.

Shortly after logging into the critical incident system with his new password, the agency saw two consecutive overdose deaths.

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