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."

Hundreds of Ohio teens join together today to bust myths about teenage substance use.

The "We Are The Majority" rally promotes the fact that most young people do not use drugs or alcohol.

Over the past ten years, thousands of young Ohioans have gathered at the Statehouse for the rally, but it will be virtual for a third year due to COVID.

High-school senior Ally Sprow is an Ohio Youth-Led Prevention Network Youth Council member. She said they'll specifically discuss the impact of the pandemic on teens.

"It's really made all of us struggle with just trying to navigate every single day," said Sprow. "So, we thought that it was important to talk about how we can improve our mental health, but also to let teens know that they're not alone and that substance misuse is not the way to handle it."

The theme is 'The Teen Experience: Own Your Power.' Sprow said it speaks to the ability of young people to make the changes they want to see in their lives and the lives of their peers.

The virtual rally starts at 6 p.m. and will feature regional "watch parties" being held in five locations.

The Prevention Action Alliance hosts the rally, and alliance Community Prevention Manager Julianna Fellows explained it's truly a youth event, built by teens from all over Ohio.

"The biggest thing for them is the excitement of being able to share with their peers, but also the adults," said Fellows. "To say, 'This is our time now, and we are impacting our time right now.'"

Sprow added that young Ohioans will share what the teen experience means to them, how adults can be better allies, and what they want the future to look like.

"Making connections with one another, as well as making connections with the generations ahead of us and the generations to come, are really important," said Sprow. "Because when we try and change the world, we need to do it together."

About 8% of 12 to 17-year-olds in Ohio report using drugs in the past month. Links to the rally and on social media are online at 'preventionactionalliance.org'

April is Alcohol Awareness Month, highlighting serious consequences of drinking too much.

Excessive alcohol use contributes to more than 95,000 deaths each year, according to the Centers for Disease Control and Prevention.

Dr. Scott Itano, a family medicine physician at Kaiser Permanente Washington in Seattle, said the pandemic has exacerbated dangerous drinking habits.

"People used to have normal coping mechanisms such as travel, sports, seeing their friends," Itano explained. "And when they were locked into their houses in quarantine, they really had fewer outlets and some of them turned to alcohol. And then that alcohol use spiraled, I saw in some of my patients, and turned into alcohol use disorder."

Alcohol use disorder is the medical term for alcohol addiction, which is considered a disease. Itano noted it is possible to have a healthy relationship with alcohol, but as with other things, the problem is using it in excess. He advised the general rule is men should limit themselves to two drinks a day, and women one a day.

Itano pointed out alcohol use disorder has serious health consequences, including an increased risk of multiple types of cancers. He cautioned drinking is sometimes seen as a method of self-treatment for underlying mental-health concerns, such as depression or anxiety.

"If you ever feel like you're starting to go down that path where you're drinking more alcohol than you typically do, or you're feeling more stressed or anxious or depressed, and drinking at the same time, reach out early," Itano recommended. "That's our job here as primary care clinicians, and we're comfortable dealing with this and want to help."

Given how common the disease is, Itano emphasized most people know someone who has struggled with it or still is struggling. He suggested speaking directly to the person if you feel there is an issue.

"I think the important thing is just calling it out and having a face-to-face conversation, conveying your level of concern and that you care about them, and just what you've noticed and witnessed," Itano outlined. "And then, seeing what they say from there."

Kentucky lawmakers are considering a bill that would increase criminal penalties for fentanyl distribution.

But critics say the legislation will only result in people being locked up for longer amounts of time and doesn't include any measures to address the state's overdose crisis.

House Bill 215 passed the House yesterday and now heads to the Senate. It would require individuals convicted of aggravated trafficking or importing of fentanyl to serve at least 85% of their sentence before being eligible for release, and prohibits pre-trial diversion.

Carmen Mitchell - criminal justice policy researcher with the Kentucky Center for Economic Policy - explained that it can be challenging in practice to differentiate between importing and possession, and could result in harsher sentences for people who use drugs but have never sold them.

"So there's a lot of discretion with system actors to decide what to charge people with
based on the context," said Mitchell.

She said research shows that as long as demand is high, incarcerating more people for selling drugs does not reduce the supply of drugs or make communities safer.

Under current Kentucky law - people who are convicted of aggravated trafficking of carfentanil, fentanyl, or fentanyl derivatives can be sentenced to between ten to 20 years in prison and must serve at least half of their sentence before being eligible for release.

She added that extending sentences for fentanyl also can potentially exacerbate racial disparities in the criminal justice system, pointing to a 2020 report that found 75% of people serving federal sentences for trafficking fentanyl were people of color.

"And so we know that unfortunately, from the start," said Mitchell, "Black people tend to be charged with the higher, harsher sentences like trafficking and aggravated trafficking."

Mitchell said she believes lawmakers should focus instead on expanding access to mental and behavioral health treatment.

"Kentucky is in the midst of a very serious overdose crisis," said Mitchell. "We stay around the top 10 nationally of all states for overdose fatalities, and it's a very serious problem that continues year after year."

Nationwide, drug overdoses have hit record levels. According to the National Center for Health Statistics, more than 100,000 Americans died of overdoses in 2021 - up almost 30% from the 78,000 deaths in the prior year.