For Mainers seeking recovery from addiction, the past pandemic year has compounded the challenges of finding timely, affordable, and effective treatment.
And with Milestone Recovery temporarily closing its detoxification program due to a lack of staffing, the safety net for people struggling with addiction is further strained, despite adjustments made by other community resources.
Milestone had offered southern Maine’s only independent, nonprofit detoxification program and its temporary closure came on the heels of the state recently reporting the highest number of monthly overdose deaths in a year.
Maine saw 58 drug-related deaths in January, more than any month in 2020, according to data released by the Office of the Attorney General and the Office of the Chief Medical Examiner. The total included 29 confirmed and 29 suspected drug deaths.
The state average for overdose deaths in 2020 was 42 deaths per month; June was the deadliest month of the year, with 53 deaths.
The state said overdose deaths were expected to decline in February and blamed the increase in Maine’s overdose deaths in 2020 in part on the coronavirus pandemic.
The spike was also seen on a national scale. According to the U.S. Centers for Disease Control and Prevention, the country had 81,000 drug overdose deaths during the 12 months that ended in May 2020, the most ever recorded in a 12-month period. CDC data suggests that while drug overdose deaths were already climbing before the coronavirus pandemic, the crisis caused them to accelerate.
Oliver Bradeen, who has served as Milestone’s executive director since last October, said in an interview last week that the decision to close the detoxification program was not made lightly. He said he knows it could mean “life or death” for many people.
The program has opened and closed several times throughout the pandemic, Bradeen said, because it doesn’t have enough medical personnel available. He said staff shortages sometimes meant despite beds being available, there was not enough staff to perform intake.
The program’s inconsistencies last year led to fewer inquiries about its detoxification program than normal.
“It makes me sad to say,” Bradeen said. “Some people, I think, lost hope that we’re here for them.”
2 crises in 1
Milestone closed temporarily when COVID-19 first hit Maine, Bradeen said, because “no one knew how to safely operate.” The program lost several staff members who were afraid of being exposed to coronavirus; many of them never returned.
By the time Bradeen joined Milestone as its executive director five months ago, he said the agency had “ironed out” how to operate during the pandemic, but its staffing issues persisted.
Because it offers a 24-hour medical detox program, Milestone needs at least one registered nurse working at all times. Ideally, Bradeen said, it would operate during the day with two registered nurses and a certified registered nurse anesthetist.
The statewide and national nursing shortage made staffing hard enough, he said, but adding COVID-19 caused more trouble. Milestone usually hires some nurses who work part time or per diem at other facilities, but the pandemic made that nearly impossible.
“Almost all of the nurses in the state are tied up, working overtime with their own organizations or helping with vaccines or testing,” Bradeen said. “They just don’t have the capacity to work a second job beyond what they’re already doing.”
Many medical institutions are also not allowing their nurses to work in more than one facility right now, he said, to minimize the spread of the virus.
Another hurdle is the nature of the work at Milestone. Because there are no other detox facilities in the area for personnel to learn the skills needed, Bradeen said, some people may be uncomfortable or unaware of what comes along with the work.
The pandemic also prevented student nurses from coming to work at Milestone, removing another opportunity for potential new staffers to join the agency.
Bradeen said it makes him “very sad” to close Milestone, but the agency was just unable to operate. “I was also burning out all of the staff that I had by making them stay open and working overtime,” he said.
Without Milestone, though, people struggling with addiction in the Portland area will be left with few options, none of them nearby.
Wellspring in Bangor runs on a similar structure as Milestone, Bradeen said – a social service nonprofit that offers some residential programming and detoxification services.
Saint Mary’s Regional Medical Center in Lewiston and Pen Bay Medical Center in Rockport are hospital-based options that “have the potential to be (detox facilities),” he added.
Bradeen said accessing detox services can be difficult, however, because many offer both mental health and substance abuse treatment, and are often full of patients experiencing urgent mental health issues like psychosis or suicidality. That makes it difficult to call ahead and get a bed the same day, as is usually possible at agencies like Milestone.
For-profit detoxification centers also exist and will take private payor health insurance, but many Mainers seeking help have either MaineCare or few resources, Bradeen said, which usually rules out such agencies.
People can get help from Milestone, he noted, regardless of their ability to pay.
With the pandemic, Bradeen said, the need for programs like Milestone is “higher than ever.” He said the increase in isolation has contributed to the increase in both substance abuse and suicide during the past year.
He said he would like to be discussing how to expand Milestone’s services, but in the short term, the agency needs new skilled nursing applicants to supplement its workforce and make it possible to reopen.
Bradeen said it is also difficult to compete for staff with large hospital organizations that can offer more money, and especially during the nursing shortage are offering large sign-on bonuses and other perks.
He said funding of social services is a “systemic problem” that needs to be addressed in order to attract people to work and stay in the field. He acknowledged, however, that since the state’s expansion of MaineCare, aftercare options for people leaving detoxification programs have improved.
Prior to working for Milestone, Bradeen worked as the city of Portland’s substance abuse liaison, which gave him a special perspective on the issues Milestone’s clients face. He said he remembers making calls to Milestone before he worked there, for instance, and finding no beds available.
“That’s part of what I keep thinking about when we’re closed, is watching someone get their hopes up and then the disappointment wash over them when there’s no bed,” he said. “They’re thinking, how do I survive until tomorrow?”
Hope for the future
At Portland Recovery Community Center on Forest Avenue, Executive Director Leslie Clark said the pandemic has been “extremely difficult” because part of what makes recovery achievable is connecting with other people.
The center has seen its clientele increase during the pandemic, she said, and although virtual support groups are “not the same” as meeting in person, she said many people have expressed their gratitude.
“I think it’s not the people that are participating online who are struggling as much as those who say ‘I’m not going to do a Zoom meeting,’” she said. “Those are the ones that get kind of lost and are harder to reach out to and connect.”
In the first couple of months of the pandemic, Clark added, her organization made approximately 900 calls to check in with people in the community and continues to do so.
One of the bright spots in the effort to help those in recovery is MaineWorks, which helps people early in recovery find employment. Founder Margo Walsh said there was an increase in demand for her organization’s services during the pandemic.
The people MaineWorks employs are “trying to start their life over,” Walsh said, and require the economic stability that comes with full-time employment.
MaineWorks’ workforce has doubled during the pandemic, she said, which points to how fragile its clients are, since many did not have the stable employment necessary before the pandemic to receive unemployment benefits when it hit.
The organization was designated an essential business last year, Walsh said, because it supplies workers for Maine’s construction industry. Many MaineWorks employees helped build the new Abbott Laboratories building in Westbrook, which manufactures COVID-19 test products.
Walsh said operating MaineWorks came with a new set of challenges during the pandemic, such as safely transporting workers in separate vehicles due to social distancing concerns and the shutdown of public transportation.
The organization works in tandem with the Maine Recovery Fund, which pays for the essential expenses of maintaining employment through MaineWorks – things like transportation to work, clothing, and equipment.
If they can stay employed for two weeks with MaineWorks, Walsh said, clients’ odds of long-term success are approximately 80 percent.
“If they’re able to stay for two full weeks and get up and come to work every day,” she said, “their chances are beyond their wildest imagination.”