PORTLAND, Maine -- Maine's providers of substance-abuse treatment and some other behavioral-health services are seeing a major increase in reimbursement rates going into effect this month.

But advocates for mental-health support say many agencies are facing major workforce shortages and other crises that prevent them from billing at all with the new rates.

Oliver Bradeen is executive director of Milestone Recovery, a nonprofit helping people facing homelessness and addiction. It's one of the few medically monitored withdrawal centers in Maine, often known as detox centers.

"Even with the increased rates, we're still struggling with workforce, and I know that's a common theme with the added level of COVID being a challenge," Bradeen explained. "There's just such a nursing shortage that it's hard to attract new talent from the nursing field."

He said their detox is currently closed because of those staffing shortages. He added while the improved rates are a step in the right direction, it could take time for providers who've been struggling to use them.

Malory Shaughnessy, executive director of the Alliance for Addiction and Mental Health Services, said the increase in demand during the pandemic, combined with the severe impacts on the workforce, are putting a huge strain on providers, and waitlists for services are growing daily.

She emphasized it is important the Department of Health and Human Services invest more of the federal relief funding into these services now, as well as begin the proposed regular review of MaineCare's reimbursement rates.

"It's all going to be really good for the system of care," Shaughnessy projected. "But the current reality of many agencies is the situation is pretty raw. And it needs some direct infusion of resources and support right now."

Jeff Tiner, chief program officer for clinical services at Catholic Charities Maine, said putting more funds toward substance-abuse treatment is the right thing to do to support Mainers, and saves taxpayer money on emergency services and the criminal-justice system.

Data shows nationally, more than 85% of the prison population either has a substance-use disorder or were incarcerated for something involving drugs or drug use.

"We see the overdose rates that have increased exponentially," Tiner observed. "I don't think there's anyone in my world that has not been affected pretty close to home for those losses. Investment in prevention and support and recovery is really well worth it, and is a smart as well as compassionate."

More than 1,000 New Mexicans die from drug overdoses each year, and while there's been a slight drop in overdoses from opioids nationwide, it's mostly offset by those from cocaine and other stimulants.

James Besante, chief medical officer at the Santa Fe Recovery Center, said the opioid crisis is evolving - sometimes described as "waves." Now in its fourth wave, he said the nearly 4% decrease reported by the Centers for Disease Control and Prevention is good news, but doesn't reflect what he's seeing on the ground. He noted that it's common that multiple drugs are involved in overdose deaths.

"Increasingly we are seeing individuals overdose on substances other than opioids," he said, "where their substance has been adulterated with an opioid like fentanyl."

When the United States' opioid crisis was at its peak, New Mexico was sixth among the 50 states for overdoses - about 50 individuals per 100,000 people. If preliminary CDC data showing opioid deaths decreased in 2023 is confirmed, it would be the first annual decrease in drug-overdose deaths since 2018. Besante said any success is good news and offers hope to suffering individuals and families.

About 30% of New Mexico residents live in rural counties, which Besante said are medically underserved - with fewer treatment centers and providers prescribing life-saving medications.

"While in some areas of the country we've seen an explosion of tele-medicine, tele-addiction treatment - that has not found its way into very rural communities," he said, "and oftentimes the local pharmacy is not stocking the medications that are prescribed."

In 2021, almost 107,000 drug-overdose fatalities occurred in the United States. West Virginia was the hardest-hit state, approaching twice the number in New Mexico. Besante saif approximately 25% of clients at the Sante Fe treatment center are unhoused and don't have health insurance.

Drug overdoses are decreasing in Indiana. The data is encouraging, but too late for one mother who lost her son to a heroin overdose.

The Centers for Disease Control and Prevention say the state saw a nearly 18% drop in drug use over a one year span starting in December 2022.

Founder and CEO of the nonprofit Overdose Lifeline, Justin Phillips said after she lost her son she channeled her pain towards one of advocacy, education, and support for others affected by addiction.

"I learned that hydrocodone and heroin were the same drug with different chemical makeup, and all of this stuff that I - as a fairly educated person - didn't know," said Phillips. "So, I knew I had to do something with my grief and loss."

A 2021 Indiana Department of Health report shows opioid as the most frequently found substance in overdose deaths.

Public health officials warn fatalities will rise linked to non-opioid substances - such as cocaine, benzodiazepines, and amphetamines.

Removing the stigma, shame and misunderstanding behind substance abuse associated with opioid use disorder is another objective of Overdose Lifeline.

Phillips' efforts led to lawmakers passing Aaron's Law in 2015, named after her late son.

But she said she would like to see more legislative action behind stopping the criminalization of syringe possession, and clarity of fentanyl test strip coding.

"Individuals with substance use disorder use syringes - we need to help individuals not punish them," said Phillips. "Secondly, we would like to clear up the language so that people don't feel afraid to use a fentanyl test strip and be able to test their drugs before they use them without fear of criminal punishment."

She admitted that most people are not willing to accept that substance abuse is a chronic disease and that people need help, not judgment.

The National Center for Health Statistics reports in 2022, 43 Hoosiers per 100,000 Indiana residents died from a drug overdose.



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By Mara O'Malley for Kent State News Lab.
Broadcast version by Nadia Ramlagan reporting for the Kent State-Ohio News Connection Collaboration.

Though it is now legal for Ohioans to use cannabis, the 2023 passage of Issue 2 does not prevent employers from drug testing job applicants and employees and instituting zero-tolerance policies. Employers in Ohio are still permitted to penalize workers who use, possess or distribute marijuana.

But the City of Cleveland announced in December that it would eliminate pre-employment drug tests for some city jobs.

"Pre-employment testing can oftentimes create obstacles in filling open positions by preventing otherwise qualified candidates from even applying," said Matthew Cole, director of human resources for the City of Cleveland, in an email. "These policy updates are more cost-effective and will ultimately help us widen the applicant pool for several City positions."

Katherine Mills, a Cleveland-based employment attorney at Fisher Phillips, says companies can still enforce pre-employment, random or reasonable suspicion testing of all employees.

"Each employer will have to evaluate their business needs and balance that against what employees may choose or opt to do outside of work," Mills said. "The bill language does specifically state, though, that employers do not have to permit cannabis use that impacts the workplace."

Cleveland says it intends to maintain a drug-free workplace by making it known that employees are required to be fit for work and will be prohibited to work while impaired, meaning that they must be free from any kind of alcohol and drugs, including marijuana.

"It's really going to be on a case-by-case basis for employers to evaluate their situation and then determine what is going to be the best course of action, both for the business and for their employees," Mills said.

The City of Cleveland has decided to only drug test for certain positions, like those identified as safety or security jobs or those that fall under the federal Department of Transportation.

"We are constantly evaluating our policies to ensure they align with the needs and desires of both our current and prospective employees," Cole said via email.

Whatever a company decides, Mills says it needs to update its employee handbook and published policies so that employees know that even though marijuana is legal, it may still be prohibited in their workplace.

The National Organization for the Reform of Marijuana Laws, or NORML, advocates for cannabis legalization. They say some states that have legalized marijuana go further and prohibit the firing or hiring of an employee based on a drug test.

Several states, including California, Connecticut, Minnesota, Montana, New Jersey, New York and Rhode Island, prohibit most employers from refusing to hire or from firing someone based solely on a positive drug test for marijuana, according to NORML. Three other states - Michigan, Nevada, and Washington - prohibit most employers from refusing to hire someone based solely upon a positive drug test.

"What good is this law allowing for the legalization for production, sale, and use of marijuana if these people who engage in that activity can lose their job?" said Paul Armentano, deputy director of NORML.

Armentano said many states around the country have had marijuana laws in place for years and have not seen occupational accidents or absenteeism skyrocket.

"There isn't a single state that has ever legalized marijuana for either medical purposes or adult use purposes that has ever repealed or even rolled back their legalization law," Armentano said.

Similar policies have been put in place around the country among multiple different states. Through studies that have been done the work-place performance has not been affected from after-work marijuana use.

Workplace policies will have to continue to evolve as Ohio figures out recreational marijuana, Mills said.

"All the regulations of things are still being developed," Mills said. "We're kind of in this gray space of, it's technically legal but there is no dispensary that adults can currently walk into and buy adult-use marijuana."

During this time, Fisher Phillips recommends that companies review and consider updating their drug testing protocols. Whether or not they make changes, employers should update their employee handbooks so that employees know the company's stance on cannabis use.

Beyond that, companies can have last chance policies - in which an employee agrees to seek substance abuse treatment and refrain from further use of alcohol or drugs in order to keep their job - and substance abuse programs. The law firm also suggests that employers offer training, stay up to date on changing regulations and clearly communicate their expectations to employees.

"We can definitely help find that sweet spot of, you know, respecting the ever-changing landscape that we exist in while also prioritizing both workplace needs and safety concerns," Mills said.


Mara O'Malley wrote this article for Kent State News Lab. This collaboration is produced in association with Media in the Public Interest and funded in part by the George Gund Foundation.


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