Some substance use recovery advocates are frustrated that Gov. Janet Mills did not use her State of the State address to confront the opioid crisis after Maine shattered its previous record for overdose deaths last year.

But administration officials say that doesn’t mean they’re not focused on the epidemic and making changes to improve services for people struggling with substance use and behavioral health challenges.

“With respect to the State of the State, we believe the people of Maine recognize that the Governor cares deeply about this issue, that her commitment to tackling it is strong, and that her administration is continuing to do all it can to save lives,” Mills spokeswoman Lindsay Crete said in a written statement that outlined the progress the administration has made.

“With drug overdoses in Maine at record levels, which is consistent with trends nationwide, the Mills Administration will continue to work every day to prevent drug use, support recovery, and save lives,” she said.

Last year, 636 people died from drug overdoses, according to preliminary totals presented to lawmakers last month. That’s an increase of 23 percent, or 121 people, from the previous year, when 515 people died.

That’s 1,151 probable overdose deaths in the last two years in Maine, compared to the roughly 1,692  COVID-related deaths over the same time period.

But the opioid crisis, which was the top public health issue prior to COVID-19, received only a fleeting mention as part of a list of challenges cited near the end of the State of the State, the largest policy speech of the year.

“We will make progress on the opioid epidemic, on improving the child welfare system, on combatting climate change, on bringing down the cost of electricity and curbing our reliance on fossil fuels to cut energy costs, and on addressing the devastating impact of PFAS on our health and livelihoods,” Mill said.

One political observer speculated that the timing of the speech could have been a factor. The Blaine House and all of the seats in the Legislature are up for grabs this fall.

Mark Brewer, professor and interim chair of political science at the University of Maine, said the lack of attention to the opioid epidemic stood out to him, but he could only speculate about why.

“Not only was this the State of the State, but this was in many ways, just as much, if not more, of a campaign kickoff speech,” Brewer said. “If I was going to want to kick off my campaign, the state of opioids in Maine is probably not an issue I want to have at the top of my agenda.”

Instead, Brewer said Mills seems to have focused on issues important to more voters, such as COVID and the economy. “If you look at issues that are important to people, those are the two big ones,” he said. 

Zoe Brokos, operations director for the Church of Safe Injection, which operates a syringe exchange service in Lewiston, said she would like to see public health officials give the opioid epidemic the same sort of attention as the coronavirus pandemic, especially since the state has a projected surplus of $822 million. Smaller organizations like hers struggle to afford supplies and stipends, she said.

Mills has proposed returning half of that surplus to 800,000 taxpayers in the form of $500 checks. Only $12 million of the projected surplus remains unallocated in her budget proposal.

Brokos noted the difference between how the state has been handling the opioid crisis and the coronavirus pandemic, which has included regular briefings by Dr. Nirav Shah, the director of the Maine Center for Disease Control and Prevention.

“There are evidence-based solutions that are backed by science and medicine that have been proven to reduce overdose deaths and increase community wellness tenfold,” Brokos said. “But suddenly it’s a totally different tune for this other public health crisis we’re experiencing in Maine that’s getting no attention. There is no weekly briefing by Dr. Shah about the number of people who have died.”

Brokos urged Mills to support overdose prevention sites, which are not allowed under federal law. Such sites in other countries allow people to test their drugs for fentanyl, a powerful synthetic opioid that is combined with other drugs without the users’ knowledge, and to use drugs under medical supervision, reducing the chances of a fatal overdose and other disease transmission. The sites can be a way to connect people with treatment.

Brokos also called on the administration to drop its opposition to a bill to expand the Good Samaritan law, originally enacted under Mills, to make people more comfortable calling first responders about overdoses without fear of being arrested. Brokos also supports lifting restrictions on syringe exchanges.

In a written statement, Crete outlined steps the administration has taken to address the opioid crisis. Mills has appointed a director of opioid response, which has spearheaded efforts to distribute naloxone, the life-saving drug that can reverse overdoses. Mills has also opened recovery centers, trained recovery coaches, expanded harm reduction and prevention efforts, while also supporting community providers, she said.

Crete said the supplemental budget unveiled last week includes an additional $1 million for OPTIONS, the Overdose Prevention Through Intensive Outreach, Naloxone and Safety, program. OPTIONS workers conduct outreach and education to people at high-risk for fatal overdoses, including those who have experienced a nonfatal overdose, to help connect them with treatment and harm-reduction services.

“We would say to those who wanted to hear more from the governor that her commitment to saving lives, to expanding access to treatment and recovery, and to preventing substance use disorders to begin with is unwavering – and the ongoing work of her administration and its unprecedented actions and investments are evidence of that commitment,” Crete said.

But for some advocates that’s not enough.

Malory Shaughnessy, director of the Alliance for Addiction and Mental Health Services, Maine, acknowledged the systemic improvements being implemented by the administration. But she said it was “really disconcerting” not to hear the governor talk about the immediate challenge of keeping people alive.

“They’re looking at big picture, big fixes which are longer-term responses, which are great and we totally support those,” Shaughnessy said. “But they’re missing the serious crisis that’s on the ground right now and not addressing that and that’s disappointing and concerning.”

The Mental Health and Substance Use Disorder Coalition issued a press release last week. The coalition acknowledged the administration’s efforts, but called on Mills and lawmakers to support four bills they believe will not only help address substance use and the lack of mental health services, which is causing people to remain in hospital emergency departments rather than in more appropriate community settings.

The bills – L.D.s 415, 432, 496 and 582 – are bipartisan, they say, and would cost the state about $16.5 million. The bills would increase rates for targeted case management services for substance use treatment, improve behavioral health for children, ensure timely access to mental health services for children, and support community treatment options.

“This is a moment where we could really move forward in leaps and bounds in how we address substance use disorder and mental health and if we don’t do it, it’s (a) real missed opportunity,” coalition spokesperson Betsy Sweet said in an interview at the State House as she was lobbying lawmakers.

Steven Michaud, director of the Maine Hospital Association, said his organization is supporting some of those bills. He said the strain being placed on hospital workers by people with behavioral health challenges has only gotten worse during the pandemic.

“It’s definitely one of the top three problems, and the word I would probably use is crisis,” Michaud said. “It’s enormous. It’s national. Everybody is dealing with it.”

Crete said that Mills has included an additional $28 million for behavioral health in her supplemental budget, which would bring the total two-year investment up to $140 million.

Michaud declined to comment on whether the administration was doing enough.

Dr. Ron Springel, executive director of the Maine Association of Recovery Residences who serves on the state’s Accidental Death Review Panel, applauded the administration’s response to the opioid epidemic, especially its focus on distributing naloxone, which is resulting in fewer people dying because of an overdose.

“It’s not a popular topic. On the other hand, there are some victories,” Springel said. “We didn’t have these things before the Mills administration. I wish she would have mentioned that.”

He added, “But it’s not a criticism.”