 Hello, I'm Lesley McVean. Heroin and opioid use are rising around the country and in Maine. Here in Portland, it has been rising at an alarming rate. In one 24-hour period recently, we had 14 overdoses. It's believed that the addicts are turning to heroin as a replacement for oxycodone. As part of the city's outreach and education campaign, CTN is conducting a series of interviews with city officials. And today, I have with me, Toho Sama, who's the acting director of Public Health here in Portland, and Chris Corson, who I'll let you tell us your title. Your coordinator of substance abuse services for the city of Portland. Thank you for being here. Why don't we begin by talking about an overview of what the problem is and some of the statistics involved in explaining where we got here and what we're doing? Do you want me to start? Sure. So certainly, like you alluded to, a lot of this issue around the explosion in heroin use locally can be tied to the increased prescription drug abuse around painkillers, which the state did a great job in stemming that issue in terms of publicizing what's called the PMP or the Prescription Monitoring Program. So that's a service where providers can look up a patient's name and see what other prescriptions are receiving from other providers, because a lot of people were kind of doctor shopping. And getting prescriptions from different people for different reasons. Right. And so we did a great job at curbing that issue. But of course, we didn't really, the consequence of that is then people are still having the addiction issues. And so they're turning to the street drugs that give off the same effects, so in this case heroin. And so I think that's a lot of what's happening. So we've seen, I believe, the deaths related to heroin have quadrupled in the past few years. And of course, that's only deaths. And that's unfortunately the ultimate end in conclusion of health outcomes. But certainly, we're seeing a lot of morbidity and rise in overdoses, like you said, over that 24-hour period. And so it is kind of, like you said, exploded recently. Right. And it's a matter of economics, supply and demand. And we're seeing dealers from New York who are coming up here and making a lot more money than they could right in the city. Do you want to talk a little bit about that and maybe what you've seen? I think there is a demand as far as some of the issues that Toa was talking about is that as a population and if folks, you would never see as someone as what someone might say is the typical addict, as someone who might have been hurt on the job, might have had an automobile accident and have been exposed to prescription medications or more so, heart of drugs that we're talking about oxycodone or oxycodone. And for legitimate reasons, they're seeking pain relief. And through the different programs which were good, sometimes maybe there wasn't enough education or whatnot of how they affect the body, how they affect the mind, how they affect people. Praving for these, the medication is just to feel better. So I just want to add that that's a real important piece that for legitimate reasons people were prescribed these medications. And now we're seeing some of the aftermath with that. And people wanting to have pain relief and or that have become addicted for these medications. There's a pool of people that will have that. And that feeds into the fact that it's not all young people, it's all ages. I know I recently had a knee replacement and I was given an opiate drug for that. And I was afraid to take it and try not to which was a mistake. But that does happen very innocently to people. Yes. What is the city doing to inform the community about this problem and what they can do to seek help if they need it? Sure, I'll say a big piece of what you were talking about and what we at the city of Portland have talked about for a while is that it is all ages. It is all genders, it is all class of people. So that's a big part that I'm glad that you're talking about is that it hits every group of people, including young mothers who are pregnant and then now are bringing children into the world that are opioid addicted. That's a big part of the conversation that we wanna have is that it's everyone. It's from the unborn to the born to the 20, 30, 40, 50 and 60 year olds that are up. So one of our efforts is around trying to get those medications out of the cabinets as you were talking about from anywhere. I mean, I think a part of the segment we don't content and see is from even our local dentist that that prescribed us medications sometimes. For that reason to reduce pain and discomfort, but we're trying as a campaign and we put on our website over at the city of Portland exactly where to go all through Conroy and County to dispose of those medications. So that's one thing that we're very serious about and really putting in good effort to try to get those medications out of the house and then all the proper disposal spites through Conroy and County so they're not diverted and sold for other things. So young children don't get in there. So that's one of the initiatives that we're doing around their prescription drug as far as just the reduction of it on the streets. And I know that the White House recently dedicated $5 million to this. I think it's $5 million. It's about two and a half, maybe half that, but yeah. Okay, plenty. A lot of money. A lot of money, yes. To 15 target states. Correct. Maine is one of those states and it's going to be used to not immediately criminalize people who are victims of this but to help in other ways. How do you see the state using that money? Sure, so I'm not aware of the particular details on how it'll be funneled down to each state and how much we can get locally. But certainly what I really appreciate about the effort is that they're looking at a public health approach and a law enforcement approach and kind of covering the whole spectrum, which I think is great, you know, because we can't arrest our way out of this problem. It's certainly, like I said, a spectrum of services that are needed. So the stuff that Chris and his staff does we're on prevention and education and then continuing the treatment and then also the law enforcement side as well. So I would, you know, you know we have a great relationship with the main CDC and the substance abuse and mental health. Program up at the state and so, you know, however they see fit to spend, you know, the public health dollars at least, we would love to partner with them. It's a real holistic approach to dealing with the problem, which isn't gonna go away overnight. Exactly. What about these dealers who are coming from New York? Of the people who've been arrested, 17% are from out of state. How do we keep them from coming in? I mean, that's really scary. What's happening there? Do you know, or is that more law enforcement dealing with that issue? I would say it's more law enforcement dealing with that issue and certainly I know you're gonna interview Chief Soschuk and we partner with them a lot on whether it's the needle exchange or the educational outreach we do. We partner with the police a lot, but I'll let him answer that because he has his own strategies around that. Well, I know there are families who are concerned maybe about loved ones. Where can they go? How can they reach out to somebody to help them? I think that's a big part of the last question you just asked and the current one is that when you have any city, I mean, Portland isn't, and you'll hear from other people, isn't any different than a lot of the cities in Northeast Corridor that's dealing with this issue. Other cities and other counties have been very creative as far as accessing treatment to people. Different communities like Gloucester Mass has a program where you can walk in with your drugs, with your paraphernalia and just say, I need help. And instead of arresting you, they say have a seat, so I'll be right out. And this came out just last week that they have enrolled 109 people and 109 people were all served, no one was turned away. So I think a real big part of looking at both things is really getting the community involved, parents involved, as certain parents have been very loud and I'm glad they're loud about what's out there, that Toho and Orn myself, Northern Police Department can do it alone. And everyone knows that it has to be a community effort saying we need more treatment because sometimes it's easy to say there's a lot of treatment available. But unless you fit a certain criteria, you won't have access to treatment. And then those kind of vulnerable folks will always be left to kind of be preyed upon from people from that estate. And it's just so scary. I mean, heroin is just, there's no, you can't do it on your own. You really can't. You need help. You need help, you need support. And I would say, in addition to that, some people may say it doesn't really affect me personally. I don't know anyone in my family, but certainly if we might see an increase in drug-related crimes and break-ins and things like that it may eventually affect you. It affects all of us. Now I, we have some information about where people can call or a website. Do you wanna just say it briefly and we will also put a graphic? Sure, so any kind of information around resources, around what's out there for treatment, if folks are interested in the new Narcan law that comes out that gives people the opportunity to purchase Narcan through getting a prescription from their doctor, things of that nature, about the law, who could use it, who can't. Overdosepreventionproject.org. There's information there about what the city's doing, resources people could print out. So that's a great website. We encourage people to look at. Thank you. Thank you both for being here. Thank you for having us. Thank you. Thank you for joining us today. As we continue our conversation about the alarming rise in the use of heroin in Maine and in particular in the greater Portland area. Joining me today are Portland Chief of Police, Michael Soschuk. Good morning. Good morning, and Fire Chief, Jerry Lemoya. Good morning. How are you both? Wonderful. Great, thanks for having us. You're welcome. Your departments are integral in helping to stop and eventually prevent the use of heroin in this area. I'm gonna begin with you, Chief Lemoya. Your department oversees the paramedics, and they're the ones that get called out when there's an overdose. Could you tell us a little bit about it from their perspective? Sure. You're absolutely right when dealing with substance abuse. The Portland Fire Department's on the front line of that effort and the response to that. And we deal with the aftermath and a very, very high number of our emergency medical service calls for service have some aspect of substance abuse attached to that, whether that is the heroin overdose or substance abuse such as alcoholism. We deal with that on a daily basis, and it is a very large part of our response in our workload. And how it's treated, now there's Narcon. Is that something? Narcan, excuse me. Is that something that is used? Are all your paramedics carrying that? Not only our paramedics, but every single one of our EMS care providers, basic EMTs, all the way up to paramedics are trained in the use of that as a drug, as a tool for us. And the city of Portland administers, the administration of that has grown exponentially over the last couple of years. We've seen a very large increase in the use of that and that has provided the ability to save lives in the moment, but it does not necessarily provide a solution for the real problem of substance abuse. Right, it's like a little safety net just to get through that. Through that moment of time. And then what happens after that? Unfortunately, this is one of the largest frustrations from the emergency medical services. We have very few options in regards to our efforts around responding to substance abuse problems with the emergency medical services. We really have one choice, treat on scene, transport to a local emergency department. As far as any long term solutions, we really don't have any. We're responding in a reactive manner. And that is taking a toll on our responders and our system and frankly in the ability of the department to service all of our residents, it has an impact. Right, and there have been an alarming increase in the overdoses. Yes, there has. To date this year, we've administered Narcan over a hundred times. To compare that with 2014, we had 107 last year. So that is a dramatic, dramatic increase. That alone does not tell the whole story of substance abuse and heroin addiction. It's only part of the story. We're responding, many times we respond to overdoses where Narcan is not administered. We administer that, we use that drug as a tool, that medication as a tool when someone presents us with an overdose where their breathing is to a point where imminent death is coming. And we utilize that to bring back spontaneous respirations. Oftentimes we will be at an overdose call where that isn't at that point yet and it's not administered. So our actual numbers of actual substance abuse calls and drug overdoses is much higher. And that brings me to you, Chief Sosja. Sure. Why? Where the supply and demand, we're seeing more and more heroin here. Dealers are coming up from New York. Tell us a little bit about what your department is seeing in this rapid change. Sure, I think heroin use is really an epidemic from a national perspective. And it's certainly happening right here in our own backyard without question. And while cocaine and crack for decades were really kind of the number one drug of choice in Southern Maine as a whole, we've certainly seen a drastic increase in the use of heroin. And the social impacts of heroin are really incredibly difficult to calculate. You're talking about human lives and the destruction, the path that heroin takes these folks down. And it truly is a traumatic for the entire community without question. What is the department doing to try to target these dealers and suppliers? I mean, I can't even imagine that we can't put up a wall around Maine. What are you doing? We have very strong partnerships with other local departments. We have strong partnerships with Maine Drug Enforcement, which is a state entity. And then we have strong partnerships with our federal law enforcement friends as well. So we work, share intelligence, try to really focus our attention and our limited resources on those dealers. You know, the chasing addicts around and putting people in jail that are really just trying not to get drug sick is what they're trying to do day to day. It's not what we're focused on. That's not the answer. We're focused on dealers. But I do think we would be remiss if we really didn't talk about, you know, the enforcement aspect of this, but there's also prevention, education, there's also treatment and rehabilitation, and then there's enforcement. If you don't have all three of those working in concert, then you will fail and you will fail every single time. We know that. And you talk about education. At what level does the education start? Are they still doing drug and alcohol counseling in the schools? They are. We do have some questions out now about how extensive that is. Because I do think we have to get to our kids as early as possible to talk about these issues. We have to continue to educate parents and families overall, and then communities. You have to educate communities about, you know, how big a deal this really is. And then Chief Lamoria talked about, you know, the lack of treatment and rehabilitation options. And it's terrible. You know, so we pick people up. They're dead on the scene. They're brought back to life. It's a miracle. But it's a very short-term fix. They may or may not go to the hospital where they'll be observed for a couple hours and then they'll be released to go back out and do it all over again. At no point in the system as it currently stands is there the opportunity to intervene and try to bring long-term assistance and a long-term solution, which is an awful big word when you're looking at a problem like this, to individuals, you know, when they're in the middle of a crisis. It's what you're both talking about is a more holistic approach to this problem where everyone, we're all working together. And the doctors. Now, education for the prescription of legal drugs, for pain or whatever, they've got to be brought into the mix too, to know when too much is too much. I don't know what the dialogue is there at this point. Well, I can say that the reason that heroin, one of the reasons that heroin exploded in our nation was around painkillers. And obviously, oxycodone, oxycontin, that whole family of drugs were being overprescribed. They were being pushed by pharmaceutical companies and overprescribed by doctors. And then people were bringing them home and then they would become addicted. And in many cases, people were stealing those drugs and they would be getting addicted. And it was just a terrible slippery slope all the way around. So there's no question. I do believe that doctors are doing a better job of that, but we've got a long ways to go without question. And if I could, we regularly, prior to this point in time, we regularly saw substance abuse in just what you said in prescription medications. And the point to make is that heroin is bad stuff. It's really bad stuff, but we're still dealing with substance abuse. And whether it's substance abuse through prescription pain medicine, or it's substance abuse with something as drastic as putting a needle in your vein, which is really raises that bar in people's perception of the problem, but the problem's been lingering. And we have a, it's about substance abuse. Heroin, when we talk about that, it's a very scary thing for our community because 20 years ago, the heroin addict was someone that most people could identify as, I'll never be there. That was a certain demographic that most people wouldn't equate themselves with. Today we're not seeing that. We're seeing heroin being used by a demographic that spans generations, spans racial lines, it spans economic lines. And we're seeing the use of heroin in communities, neighborhoods, and populations that we have never seen it before. And what we have to really get to grips with is what leads us down this road to where someone who of reasonable mind resorts to intravenous drug use. And the scary thing is that it's always, it's not always just heroin, it's laced with fentanyl. Have you seen incidences of that because that's deadly? Yeah, it's far more potent than straight heroin, generally speaking. I can tell you that the main drug enforcement, our drug agents have done recent raids where they found nothing but fentanyl. There was a time when I was at the drug unit where people were cutting cocaine with baby powder. They're baking soda and they're trying to expand the amount that they have to sell. Well, now they're cutting heroin with fentanyl or they're selling straight fentanyl as heroin. So even in an addict's mind, you're used to a certain dosage. You think you can handle a certain amount. You've been doing it for a long time in many cases. So you're comfortable here. And then you shoot straight fentanyl, which may be 30, 40, 50% more potent, more toxic than regular heroin. And it's killing people. And some of our viewers may open up their medicine cabinets and they've got that leftover two or three pills from their knee surgery or their hip surgery. They can bring them into a place now and get rid of them. So they're not tempting some kid who's opening up the medicine cabinet or someone else who they don't know who's in their space. Yeah, it's actually, you know, the DEA ran a program for years, a drug take back. They stopped briefly the sheriff's association and the state of Maine picked it up. The state of Maine was routinely, year after year, number one per capita in the amount of drugs that we were taking back in these events. Which is a good sign. It's a good sign, but it also tells you how much is out there in the medicine cabinet. But it's great that people are paying attention and using this as a service. But the Portland Police Department, the Cumberland County Jail, South Portland Police Department, people right in this region have 24 hour boxes. You can come into the lobby of the police department today and just give it to us real time. Yeah. Well, I think, you know, the idea of all working together, it's gonna affect all of us in some way. Sure. You know, briefly what can we do and then who can people get in touch with for more information? Could you? I think that really we need to focus on our legislators, our elected officials to say this is a real deal here. We are all concerned about it. We demand action and we demand action on all three of those items again. I'm an enforcement guy, that's what I do. That doesn't work all by itself, it just doesn't. I would like to see, you know, the war on drugs have failed. I would love to see a war on addiction. Not on addicts, but on addiction. And for all substances that are being abused out there day to day. Beautifully said. Yeah, and I also think that we do need to push elected officials to understand how the problem impacts all of our services and the community. You know, it affects everyone. And to, for years, you know, the drug addiction problem was pushed, you know, out of sight, out of the mainstream to where, you know, it was a certain part of town or it was a certain subset of the neighborhood. And we've got to recognize that that's no longer the case, you know, that we see this throughout our community and it's a Portland problem, it's a main problem, it's a national problem. And it's, I agree wholeheartedly with Chief Soschuk. We've worked together along with the Mayor Brennan's Substance Abuse Task Force and to bring a lot of the issues to the forefront. And I agree wholeheartedly that it's really, it's like this three-legged stool, you know, and you absolutely, along with the enforcement of it, you have to look at the education and the treatment of it. And without those three things, it's not a stable platform. You know, this is not a problem that we can knock in our way out of and we can't arrest our way out of it either. And there has to be some other options. Well, thank you both. I think you're doing a wonderful job. And quickly, a telephone number or a website for either one of you will run it as a graphic, but maybe you could say it as well. Yeah, the city of Portland has, their website has an overdose prevention aspect to it. Public Health is doing some nice work on there. So I would go right to the city of Portland website and just look for the Public Health page and that'll trickle you down to get the proper information. That's terrific. Thank you. I feel like we're in good hands. Well, thank you very much for having us. Thank you very much. Thanks for having us.