Marty O’Brien is a counselor at Discovery House, one of Portland, Maine’s two methadone treatment facilities. He also hosts a weekly radio show called “Grace Street” featuring great music and drug reform conversations. During part of the interview we are joined by Katie, another Discovery House counselor.

Marty: The new face of heroin in this country is 22 years old and with an average addiction of four years, and in many cases has an acquainted social network, but is going down hard and fast.

The average demographic of a user in Maine is someone using oxycontin or heroin, injecting or snorting, and who hasn’t lost everything yet. Girls are getting pregnant while they are using…

Katie: And they go months without finding out because their cycles are irregular in part because they’re not eating. Opiate withdrawal can cause spontaneous abortions, so it is important that girls get into treatment.

Q: Is there any risk of taking methadone while pregnant?

Katie: Absolutely zero. If a mother is on methadone when she gives birth, if her dosage is under 100mg there is a 60% chance that the baby will have no signs of withdrawal at all. Those that do go through withdrawal- the doctors are very good about tapering. They have a whole scaling system to determine whether the baby is in withdrawal and if so, how long the baby should stay in the hospital.

Marty: Overdose deaths in the state in 2002 were 148. There was a coroner’s report done in 2002, issued in 2003, that concluded that Maine needed more clinics.

After that year it went down dramatically. Users just started using better. The bottom line is that people just got scared out on the street.

“About 50-60% of my patients have co-occurring mental illnesses.”

Q: How many clients do you have here?

We have about 550 clients. We average about 20-40 requests a week- from all over the state.

We have one of the highest opiate addiction rates in the country.

Maine had the second highest incarceration rate in the country last year. Everyone knows it’s opiate-related, but no one has done a study on it. There is a skyrocketing problem with probation and how overworked probation is

No one would argue if I said 70% of the people in the county jails are there for drugs. It’s a big problem.

Consider it this way. Consider that Police Chief Chitwood thought there was 1,500 people actively using heroin in Portland. Reduce that by 500 to roughly 1,000 people. The average maintenance dose of heroin is five bags a day. So that is 5,000 bags a day. 35,000 a week, 1.8 million a year. Times ten bucks a bag… That’s just in Portland.

Q: So what is Maine doing?

The Office of Substance Abuse has addressed the problem head on. We have good treatment providers there’s just not enough of them. It really all comes down to funding. I referred three young patients to in-patient programs out of state last week; two in Pennsylvania and one in California.

Whenever the economy drops, the funding for these programs drops as well.

Q: How did you get into this field?

My background is in theology. I pastured churches. I drank three and a half years. I got sober and worked for a substance abuse hospital in New Hampshire. In 1997 and 1998 I started seeing heroin coming in from Connecticut. In 1998 I started seeing patients from Maine with oxycontin addictions. By the time we closed in 2001, we had more patients because of opiates than alcohol and that is normative across New England now. Mercy Recovery Center in Westbrook, over 90% of their patients are there because of opiates now, not alcohol!

After seeing the onslaught of opiate addictions I had a niece die from a heroin overdose at 19. I am not sure if that is was a catalyst or not, but it is certainly in the fabric of how I view the work and my belief that medication assisted treatment is humane, dignity-based treatment.

Q: With the onslaught of opiate addiction, has that translated into increased prostitution?

Prostitution is tricky these days because it is underground.

There is a lot of collateral damage that’s sexual with addiction. Trading sex for drugs- it goes on a lot more than we’d like to think.

Q: How or why did opiates become such a big problem in Maine?

I think Maine has a history of alcoholism and honestly, I think there’s a connection. When heroin became snortable and accessible, people who perhaps would have partied- and don’t leave out oxycontin and painkillers, people have been slaughtered by that stuff- when someone is smoking weed and drinking beers and someone hands them a pill- to someone 16 or 17 years old, it doesn’t seem that dangerous compared to a needle and a bag of dope. Of course it creates the same high. But with misuse, it is not a big leap. And when those little pills aren’t around anymore, people switch drugs. Between being drug sick or in five minutes feeling good again, it’s not a difficult decision.

Q: How do you define addiction?

Addiction is a compulsive need to use an illicit substance even when you know doing that is creating harm for yourself and others.

Q: How often do your patients express co-occurring disorders?

About 50-60% of my patients have co-occurring mental illnesses. There is a relatively low HIV rate, but Hep. C is high right now.

Q: What would you like to see done?

I would like to see the recovery community break the silence- their own silence- and advocate on behalf of drug addicts. We, as the recovery community, ask a lot from the state and federal government, but not ourselves.

We need to reduce the stigma. We can take great lessons from women who spoke out about breast cancer and gays who spoke out about HIV. For the most part we are very silent.

We need more treatment, but that’s not it. We need sanctuary and communities where people can get well. We need compassionate and dignity-based services. But it’s not just what happens in the hospital- it’s also what happens after they leave and go back out in the community.

Q: Overall, how has community responded to advent of heroin? This dramatic shift?

The string of OD deaths in 2002 was when it got the most publicity. Sadly, the opiate problem in Maine has gotten worse, but it’s more underground so the press has not paid a great deal of attention to it. I think the treatment centers, agencies throughout the state, and law enforcement who are dealing with it have come together. There has been a dramatic shift. Law enforcement and treatment providers have been working more and more together and that’s been a very important step in the right direction. The opiate overdose group in Portland and other groups like it in Maine have formed, and so there are people paying attention to it, it’s just, there’s a lot of ground to cover for the people who are paying attention.

Washington County has been decimated by opiate addiction. I just heard that there’s a bunch of new heroin in Washington County lately. Oxycontin, delotid, and now a bunch of heroin. As much of 10% of the population is addicted.

Citizen peer-state campaigns in and around methadone treatment. They’ve done education campaigns with patients to not divert their medication.

The state has the one main initiative which is really a large chunk of money to do prevention work with younger kids. In many communities, I’ve heard that it has gone pretty well. That’s not specifically opiate prevention work though.

They did a poll with kids and the kids said their two biggest fears were suicides of friends and drug use. If the kids are saying this is a big concern, adults should be addressing it, and addressing it in ways that are relevant for kids, because most of it isn’t.

Q: What did your own use stem from?

Well the easy question is drinking too much. I come from a long line of drunk men. It’d be hard to find one sober men. Whether I had a predisposition to alcoholism or was brought up for it, I am not sure what the cause was.

Q: What was the catalyst for recovery for you?

It was in the early 1990’s. I hadn’t lost everything, I still had family. But I had lost creativity, a sense of myself, it was a “spiritual winter.” I talked to a friend of mine and I had made several attempts at getting help, but my HMO wouldn’t pay for treatment. My friend finally got me into a detox in New Hampshire. But the HMO had a lot of restrictions. That’s a legitimate reoccurring theme: detoxes are so short now people have no chance. And it’s in part because of HMO’s.

Q: How did the media coverage on OD deaths affect public opinion regarding the drug problem?

The community at large was concerned about the opiate problem. It certainly had some misconceptions about what methadone treatment was doing in the mix. It’s not uncommon in any opiate culture to have methadone. Most diversion in this state does not come from clinics. SAMSHA did a study nationally and found very, very few patients attending clinics were diverting methadone. Most of that diverted was in pill form- so it was prescribed by doctors for pain management and their patients were diverting it.

The origins of the new heroin came out of Myanmar. Communities were being devastated by cocaine and mandatory minimums were chasing quantities. So some war lord thought of making a purer form of heroin that could be snorted. It got to California in the early 1990’s and Quentin Tarantino picked up on it right away (ie: Pulp Fiction). The drug lords in Mexico realized they were losing billions of dollars and realized they could grow poppies. So now, much of the east coast heroin is being smuggled in with cocaine from South America. So the supply is greater. The purity is higher.