An Unintentional Director of Opioid Response
Gordon Smith, J.D., who became the state’s Director of Opioid Response when Gov. Janet Mills took office in 2019, knows he has a somewhat unusual background for the position.
“I am not in recovery, not in clinical work, and don’t come out of law enforcement,” he said. “What I do bring to the position is a sound knowledge of health care and health care law, and I know my way around Maine and the State House. But most importantly, I care deeply about my home state and the people who live here.”
Gordon had been involved in organized medicine for almost 40 years when the governor asked him to serve as director. His prior experience in the field involved serving as general counsel for the Maine Medical Association and then Executive Vice President of MMA for 30 years.
In 2018, along with three physicians, Gordon drafted a 10-point plan for candidate Mills to address the opioid crisis. “In many ways, it is still the basis for the current plan,” he said. The 10th point was a commitment to appoint an individual to direct opioid response activities from the governor’s office.
Gordon was getting ready to retire from the MMA when Mills asked him to draft executive orders to allow her to put his 10 action points immediately into place.
“Then, when she asked me to attend the annual PAARI (Police Assisted Addiction & Recovery Initiative) conference in Boston on her behalf, I began to think that perhaps the position would be something I might be interested in. So when I was asked to consider the position, I was ready and have never regretted that decision. I am very grateful for the opportunity Gov. Mills has given me to help my state and the people in it.
“In putting the strategic plan together in the early months of 2019, I looked at plans from many other states,” he said. “Our plan is 12 pages, with 10 priorities, and 33 strategies all built on five pillars:”
Provide strong state-level leadership and coordination among prevention, harm reduction, treatment and recovery strategies, such as the annual Opioid Response Summits that have attracted 1,000-1,500 participants each year.
The number of people lost to substance use in 2022 in Maine is sobering, and the solution starts with reaching youth. The older the age of first use profoundly reduces the risk that person will develop a severe substance use disorder. Young people often take drugs to escape lives that include trauma, poverty, homelessness, being removed from their family, loss of a family member and divorce. “If we don’t wrap ourselves around these kids, it will be very difficult to markedly improve the current situation.”
Treatment of all kinds. “We don’t support one treatment over others; we believe everyone has their own unique journey that works best for them.”
4. Harm reduction
“We’ve purchased over 300,000 doses of naloxone for distribution in communities, and we’ve been able to expand our syringe service providers (SSPs), particularly in the more rural areas. The SSPs also help with naloxone distribution. We’ve also supported media campaigns to raise public awareness of the importance of harm reduction activities.
5. Recovery support
“We have over 1,200 recovery coaches, 70 certified recovery residences and 18 Recovery Community Centers in the state. We have initiatives that support recovery friendly and recovery ready communities and campuses. In the early stages of recovery, people need quite a bit of support, so these activities are important to recovery success. We believe local, immediate, affordable, and best-fit recovery is the gold standard.
“In 2022, over 9,000 people survived an overdose,” Gordon said. “We don’t just focus on the people we lost, but also on people who survived. This is why the OPTIONS behavioral health liaisons are in place in each county – if anyone has survived a substance use related medical emergency, the liaison reaches out to the affected person and connects them with either harm reduction or a path to recovery, depending upon their willingness.”
Gordon said he has been most affected emotionally in this work by how incredibly resilient people are. “Millions of people have overcome the worst possible circumstances; many are recovering and recovering out loud. This keeps us going.”
He said the issues he’s dealing with are not quick-fix problems.
“We may not see positive results of our prevention activities for at least 10 years, but that’s OK. That is why we must go upstream and look at the reason people start using drugs. We need to look at protective measures, such as Universal Pre-Kindergarten; work on stigma among medical providers; work with our children, adolescents, and our families.
Gov. Mills recently announced some initiatives that address these issues and committed resources to strengthen families.”
Gordon noted that Mills has committed to having evidence-based prevention programs in every school in the state and every community through organizations such as Boys/ Girls Clubs, scouting and YMCAs.
In her recent State of the State address, Mills noted new strategies for addressing the opioid crisis, including increasing the amount of naloxone distribution by 25%; doubling the OPTIONS team; expanding substance use treatment beds; developing a Child Safety and Family Wellness plan to make sure children have healthy food, safe housing and quality childcare; and supporting parents with job training and education and mental health and substance use services.
Other new initiatives include supporting DHHS caseworkers by adding a substance use specialist to every child welfare office in Maine; creating a Recovery Coach Pilot Program to support parents; expanding family courts; and creating a path to ending chronic homelessness in Maine by expanding a Housing First model statewide.
“I am optimistic,” Gordon said. “My optimism comes from what I have seen in the recovery area. There are these amazing people who are in recovery – I can show you many people who are now living lives of joy, every day. While we acknowledge and grieve every loss, it is also fulfilling to know we are saving lives. There are now many people who will eventually be able to get into recovery; it won’t happen by just hoping – we all have to act, which increasingly means supporting our children and families.”