|
Wednesday, December 17, 2003
New rite of rural poverty
Copyright © 2003 Blethen Maine Newspapers Inc. | ||||||||||
 |
Also on this page: Hidden Faces of Poverty | |||||||||
They call it the "wall of death." Newspaper obituaries hang on the bulletin board of the Hancock County probation office. Faces of dead men and women greet visitors as they enter the waiting room. Many of the dead are young. OxyContin and heroin hooked them in their teens and killed them by their early 20s. This year, between March and June, three young Hancock County men died of overdoses. Nicholas Johnston died in March. He was 22. He overdosed on heroin. Cooper King died in May of an OxyContin overdose. He was 21. Robert Dembek died in June of a cocaine overdose at a Bangor hospital. He was 20. All three were from small rural towns. They seemed so ordinary. Johnston grew up in Ellsworth. He played baseball, soccer, ran cross-country and track. King grew giant pumpkins as a kid and proudly showed them at the Blue Hill Fair. He played "The Star Spangled Banner" on the violin at his Hancock County Grammar School graduation. He made the dean's list for two semesters at the University of Maine at Presque Isle. Dembek played the drums and guitar. He snowboarded, rode his dirt bike, and loved the ocean and hanging out with his baby sister. Johnston. King. Dembek. Their deaths mirror a tragic statewide trend. Maine's accidental drug overdoses increased six-fold from 1997 to 2002, soaring from 19 deaths annually to 126, according to the state Medical Examiner's Office. "Opiates are overtaking alcohol addiction," says Hancock County Probation Officer Candice Kiefer. "And it's killing many of our young. With alcohol, it's often a slow death. But with opiates, a young person can go from a user to a dead addict in two years." In the past five years, the average age of the overdose victims was 40. Today, probation officers and drug treatment counselors expect more funerals for the young. The age of drug addicts is dropping. Problems are more intense in Maine's sparsely populated counties, where the traditional jobs of logging, farming and working in factories and mills are disappearing. Also disappearing is hope. "In the past year, we've started seeing kids as young as 12 and 13 needing help," says Barbara Royal, director of Open Door Recovery Center, a drug treatment facility in Hancock County. "We're seeing 13- and 15-year-olds who try OxyContin and then graduate to heroin. They're young kids whose lives are destroyed before they turn 18," Royal says. Other rural states grapple with OxyContin, or "Hillbilly Heroin," but Maine's addiction to the prescription painkiller is one of the most severe. "Maine was one of the first places to identify OxyContin abuse," says Bill Lowenstein, associate director of the Maine Office of Substance Abuse. In 2000, Maine led the nation in drug treatment for OxyContin and other opiates, excluding heroin, at a rate of 63 per 100,000 people, according to the U.S. Substance Abuse and Mental Health Services Administration. Maine's number of treated opiate addicts was six times higher than New York's, triple that of Connecticut, almost 16 times higher than New Hampshire's, the administration reported. The federal Drug Enforcement Administration ranked Maine among the top 10 states for abuse of prescribed painkillers like OxyContin, Percocet. "Other states like Kentucky, West Virginia are experiencing prescription drug abuse, but nowhere has been hit harder than Maine," says U.S. Sen. Susan Collins, R-Maine. "It's a growing crisis in most of the rural communities in our state. We've always had a sense of safety and security in Maine, and the idea that we're in the midst of an explosion of drug abuse is so contrary to our image it's hard to comprehend." A poor county is hit hardest Washington County, Maine's poorest and one of the state's most geographically isolated, has been hit hardest by OxyContin addiction. Treatment rates for the prescription drug are double those of Cumberland County. "You've got people who have lived for generations with low incomes, people who try their damnedest to make a living," says Paula Frost, who heads outpatient drug counseling at Lubec Regional Medical Center. "But when you've got several industries going belly up, not even a shot at a minimum wage job, you're going to look for an escape. For generations, alcohol was an escape. Now it's OxyContin, " Frost says. Keya Smiley saw OxyContin as a way to forget her troubles. She lives in Indian Township, a Native American reservation in northeast Washington County. Smiley was 18 when she first tried painkillers like OxyContin. She is 23 now and has been drug-free for nearly a year. She travels to South Portland once a week for a dose of methadone from the Discovery House clinic, one of four such clinics in Maine. None of the clinics is in Washington County. At least seven other people from the reservation travel to methadone clinics for help, she says. "Most of the people I know use OxyContin or have used it," Smiley says. "I know kids growing up in homes where both their parents use. They're lost in their own little world. They've got to care for themselves." In her community of 900, the per capita income is $14,000 a year. "Most of the people using OxyContin are like 'the hell with it. I'm going to stay high because I don't have anything,' " Smiley says. "A lot of people feel trapped." The wave of opiate abuse that plagues Washington County has rippled across the state. "It's like an infectious disease that's made its way to Hancock, Penobscot counties," says Royal, with Open Door Recovery Center in Ellsworth. "It's sort of like watching this air current slowly work its way toward us." Drug counselors and doctors at the state's four methadone clinics - in South Portland, Westbrook, Winslow and Bangor - witness a steady flow of young heroin and OxyContin addicts from small rural towns. In the past three years, the number of people receiving methadone has spiked from 300 to 1,600. Methadone curbs the craving for opiate drugs. "You can go into all the little villages of Maine and they've been invaded by OxyContin, heroin," says Dr. Stanley Evans, former medical director at the Mercy Hospital Recovery Center. "I have patients who tell me they can't get away from these drugs in tiny little towns," Evans says. "I had a little girl from Bucksport tell me heroin is easier to get in her town than beer." A range of young people are lured by drugs: straight-A students as well as troubled kids, cheerleaders and sports stars as well as truants and dropouts. And when they need treatment in rural Maine, most of them cannot find it because the resources are few. There are no residential drug treatment beds, no detox centers, no methadone clinics in such counties as Washington, Piscataquis and Hancock. "These are not throwaway kids," Evans says. "A lot of them come from very good families, and even though they have the financial means they cannot get their kids help." Youthful addicts get little help Even the unborn are afflicted. In 2003, 38 babies were born drug-dependent at Bangor's Eastern Maine Medical Center - a dramatic jump from the three babies born addicted there in 1998. The hospital serves many of the small towns in northern Maine. Dr. Deborah Franzek heads the hospital's intensive care unit for newborns and tends to the tiny victims. Babies fighting fevers, diarrhea. Shaking, vomiting, crying. The rate of infants born drug-dependent in Maine surpasses big-city hospitals, says Franzek, who previously worked in Indianapolis. "I've been shocked at the high number of babies here in Maine," Franzek says. "I just came from Indianapolis last January and you just don't see the same number of babies with this problem there. You don't expect to see these problems in such a rural state like Maine." As drug abuse ravages rural Maine, there is little help available to prevent it from worsening. About 11,000 children and teenagers have drug and alcohol addictions in Maine. Last year, 1,367 children under age 18 received treatment. "There's not enough help out there," says Hancock County Probation Officer Bill Goodwin. "You end up with kids who grow into adult addicts - addicts detoxing in jail or dying an early death." There are only three programs statewide offering intensive outpatient treatment for children, places where youths can receive counseling three to five times a week. There are 25 residential drug treatment beds for Maine youths, offering live-in programs that span a month to a year. Aroostook Mental Health Center in Limestone has three beds; Phoenix Academy in Augusta, 10; and Day One in Hollis, 12. By the end of the year, Phoenix Academy plans to provide four more beds. If a teenager has a severe drug problem and needs more than outpatient help, he or she may have to wait months. "There's absolutely not enough residential beds out there for these kids," says Christine Merchant, director of Phoenix Academy. "A lot of these kids can't make it in outpatient settings because they're not separated from the things that got them in trouble in the first place." Before a youth can be admitted to such a program, he or she needs to detox first, or get the drugs out of their system. With only hospitals in Waterville, Bangor and Westbrook offering such assistance, it's nearly impossible, Evans says. "These kids can't find any place to go to get detoxed," says Evans, who now heads outpatient services at Mercy's recovery center in Westbrook. "They need a high level of medical attention when they're detoxing, and many hospitals aren't prepared to deal with it. So these kids have nowhere to go when they want to get clean." Nationally, Maine ranked 36th for treating its drug- and alcohol-addicted youth, according to the Fordham Institute, a New York agency that monitors health care, education and income. The institute gave Maine a "D" for its efforts in its November annual report. Rural police feel overwhelmed Police in small towns, lacking the resources of cities, struggle with the state's rising drug problems. Some don't have drug investigators. "I only have six full-time deputies for a county of 35,000 people," says Hancock County Sheriff William Clark. "I can't afford to have someone exclusively assigned to drug investigations, and the dealers out there know it." Clark and other police departments in Hancock County are pushing for a three-member drug investigative unit at a cost of $200,000 annually to the county. "We've got to do something," says Clark. "When we're losing 20-year-olds . . . to overdoses, we're losing future generations." The Maine Drug Enforcement Agency also is strapped for resources. Since 1992, its budget has been cut in half to $1 million. "I've been sounding the alarm (since) 1995, telling people prescription drugs are a real threat," says Sgt. Darrell Crandell with Maine's DEA. "But no one in state government is listening. Until this July, we only had one agent covering 2,600 square miles in Washington County. "Now we've got two agents covering an area with a tremendous, tremendous drug problem. The resources are a joke." Painful start for babies The babies lie in darkened rooms, screaming, flailing, sweating. Every week there are one, two and sometimes five baby addicts born in Maine. Within 48 to 72 hours of their birth, the babies begin to have withdrawal symptoms, craving the drug they ingested in their mother's womb. Some only have minor irritations while doctors slowly wean them. Others suffer severe complications. They are difficult to soothe. They scream for hours. They have trouble eating. They are restless. Their tiny hands and feet flail constantly, creating sores on their limbs. "The nurses have to hold them, rock them, swaddle them quite a bit," says Tina Gist, head nurse at Eastern Maine Med's neonatal intensive care unit. "Weaning the babies off drugs is very slow and heart-wrenching at times. You see these babies go through withdrawal and you can only imagine how they feel." This year, 65 babies were born drug-addicted in Maine - at Portland's Maine Medical Center and Bangor's Eastern Maine Medical Center. The hospitals offer the state's two intensive care units for newborns. Eastern Maine Med, which serves the tiny towns of Down East Maine, has treated nearly 100 babies with "neonatal abstinence syndrome" in the past five years. It is a statistic that startles the nurses and doctors working there. "I worked on the neonatal unit in the Dallas-Fort Worth area of Texas and we'd sporadically see drug-addicted babies," Gist says. "When I moved to Maine 2 1/2 years ago, I thought Maine is such a rural area, there won't be as many drugs. I had no idea they'd be so prevalent. The number of babies we see here with drug dependency is very surprising." One week last June, there were five babies born drug-dependent at the Bangor hospital. "That was a tough week," Franzek says. Most of the mothers giving birth to these babies are taking controlled doses of methadone, which helps wean them off OxyContin, heroin or other opiates. Many are women from rural Maine, seeking help at a methadone clinic. "We had more than 15 moms pregnant at our clinic this summer, which is a lot," says Bonnie Plowman, a nurse at Discovery House in South Portland. "Most of them were on heroin and OxyContin. Usually they come to the clinic when they find out they're pregnant and they want to stop using." Many users start young It's not unusual for Plowman to see pregnant teenagers who say they began using drugs when they were 14. "Usually the kids who start using so young are from the small towns," Plowman says. "It's rare that I see a young teenage mom from an urban city." Most often, the young mothers grew up impoverished or disadvantaged, Franzek says. "A lot of the moms don't come from stable environments. Some have a track record of being in and out of jail or problems with the law," she says. Many of the mothers are victims themselves. "They've usually been abused in relationships or had something very sad that's happened" to them, says Dr. Brenda Judkins, a pediatric doctor working at Maine Medical Center. Once the pregnant women begin taking methadone, their doctors are usually informed. In some cases, Maine's Department of Human Services is also alerted. "Most of these women are clear (that) they want to be monitored on methadone instead of using heroin and not getting proper health care," says Mary Kennedy, who runs a support group for pregnant mothers at Discovery House. Once the babies are born, doctors carefully monitor their withdrawals from methadone. On average, the infants stay in the hospital a few weeks. Babies with more complications may stay up to two months. Their medical costs may be double those of an infant born healthy. Most often, hospital administrators say, the bill for the drug-dependent babies is paid by Medicaid. "It's a high cost because they have to be monitored in the intensive care unit," Franzek says. Two and sometimes three electrical wires connect the babies to machines, which check their heart, pulse, breathing rates. If the babies are born premature, they are fed through intravenous tubes or syringes. To help wean them off the methadone, they're given small doses of the barbiturate phenobarbital. If that isn't enough to reduce the withdrawal symptoms, they get small doses of opium. Every three hours they're evaluated by nurses and doctors to gauge the intensity of discomfort. "They require constant care, and sometimes it can be pretty unnerving," Gist says. "We try to help them, but sometimes no matter what you do, it's not enough. You can't get them to stop crying. The nurse techs walk them around for hours trying to get them to settle down."
Staff researcher Julia McCue contributed to this story. Staff Writer Barbara Walsh can be contacted at 791-6355 or at: bwalsh@pressherald.com
|
||||||||||
The five-part series