AUGUSTA — Maine’s next governor will inherit a host of challenges – including a graying population, struggling paper mills and underfunded schools – that have vexed Blaine House occupants for decades.

None of those predecessors has entered office at a time when opioid addiction is claiming so many lives in Maine, however.

Maine has failed to reverse or significantly slow the opioid addiction crisis that killed a record number of people last year. While part of that failure is attributable to the immense difficulty and cost of addressing what has become a nationwide epidemic, political dysfunction in Augusta as well as differing opinions on strategies have contributed to the problem.

The 11 Democrats and Republicans hoping to be Maine’s next governor all agree on the need for expanded treatment but differ on how to pay for it as well as the level of state involvement and the role of law enforcement.

Here’s where they stand:

THE DEMOCRATS

All seven Democrats – Adam Cote, Donna Dion, Mark Dion, Mark Eves, Janet Mills, Diane Russell and Betsy Sweet – insist that expanding Medicaid is a critical component of addressing the heroin and prescription opiate crisis.

Eves, a licensed counselor and family therapist from North Berwick, said the state needs to rebuild a public health system that he said has been “decimated” by the LePage administration. Rebuilding the Fund for a Healthy Maine programs funded through legal settlements with tobacco companies can assist prevention programs.

“My first look would be toward any federal money that is left on the table, and this administration’s legacy is leaving a lot of money on the table,” Eves said when asked how he would pay for expanded treatment. Eves estimated that LePage is leaving about $500 million on the table between Medicaid and other federal funding sources. If additional funding is needed for opioid-related programs, he would potentially tap into the revenue generated from his plans to eliminate corporate tax loopholes, increase taxes on wealthier Mainers and broaden the sales tax.

Russell called for creation of state-run treatment centers in regions throughout the state hardest hit by the epidemic because it is unrealistic to expect someone struggling with addiction in Machias to travel to Bangor.

A former state lawmaker from Portland who helped lead the marijuana legalization fight, Russell said the state should recognize the potential role of medical marijuana in helping ease people off opioids, and establish safe-injection sites and needle exchanges as part of a more humane approach to addiction.

All of these programs could easily be funded with tax revenues from marijuana legalization, Russell said.

Sweet said Maine needs to expand behavioral health services – in addition to conventional drug treatment programs – because there is such a strong link between substance abuse and behavioral health.

An advocate and lobbyist for nonprofit organizations, Sweet said the state needs to reinvest in early education programs for children, young families and new mothers.

She said the LePage administration has caused an erosion to Maine Department of Health and Human Services programs. As a result, Sweet said, the ranks of experienced and knowledgeable staffers at DHHS who have relationships with the state’s health care provider community have been depleted.

Mills, the attorney general, pointed out that overdose reversal drug kits distributed by her office to police departments statewide have been credited with nearly 450 “saves” to date. But Mills said the state needs a comprehensive, statewide strategy for the crisis, including more drug courts and lifting the two-year limit on Medicaid participants receiving methadone treatment. She also pointed to “triage systems” adopted by other states, including Massachusetts, where overdose victims are connected with other services before they are discharged from the emergency room

“We should have a recovery coach on call at every emergency room and Suboxone, or medication-assisted treatment, in every emergency room,” Mills said. “We don’t have that now.”

But some of Mills’ opponents criticized her for pushing to keep simple heroin possession a felony offense in Maine. Mills said at the time that the threat of a felony stain on their record is often enough to push people to commit to treatment in exchange for a lesser conviction.

“They make a life-and-death decision each time they inject,” said Mark Dion, a former Cumberland County sheriff. “They know they can die, but the physical compulsion to have the drug overwhelms that kind of thinking. Bringing the concept of a felony (threat) to them is alien and irrational.”

Dion said the next governor must also recognize that there is a law enforcement component to the opiate crisis. He said he would direct the law enforcement leaders in his administration to work closer with Massachusetts and New Hampshire on interdiction efforts to stop the flow of drugs into Maine.

Dion also pledged to work with municipal officials to ensure that local zoning rules allow for recovery houses across the state that provide people safe, stable and supportive environments among peers. And he said the governor needs to play a major role in destigmatizing drug addiction.

Cote pointed to the Scarborough Police Department’s Operation HOPE program – in which police actively work to help place individuals in treatment programs – as well as peer-to-peer programs that link addicted persons with individuals successfully in recovery, as valuable programs. He has also said Maine should follow the lead of Arizona and other states that have declared a public health emergency.

“If there’s anything that we’ve learned about this addiction, it’s that it’s a range of treatments that need to be made available because different people respond in different ways,” Cote said. “It’s recognizing that we need to have a dynamic program that is flexible … and that’s really what the hub-and-spoke approach thinks about.”

Former Biddeford Mayor Donna Dion – no relation to Mark Dion – touted projects in cities such as hers that seek to get people into treatment and offer more comprehensive solutions, rather than put them in jail. But Dion said any solution needs to be “person-driven” because each person’s needs are so unique.

“No matter what you do, if there’s mental health or physical problems, outside influences or pressures, you have to look at each person separately. So the program has to be transitional. You have to have places where they can go for being clean and doing transitional meetings with the family.”

She also said the state needs to expand educational programs to address drug use.

THE REPUBLICANS

Unlike their Democratic counterparts, all four Republicans seeking their party’s nomination oppose Medicaid expansion. That position, which is consistent with LePage’s, means that fewer low-income, childless adults who do not have health insurance will likely have access to drug treatment services.

The four candidates – House Minority Leader Kenneth Fredette of Newport, Senate Majority Leader Garrett Mason of Lisbon Falls, former DHHS Commissioner Mary Mayhew of China and businessman Shawn Moody of Gorham – also called for expanded treatment. But they also put more emphasis on law enforcement than Democrats.

Moody said this is an example of government not being able to see a problem and respond before it reaches the crisis point. And part of that is putting more resources toward law enforcement.

“You know, when I was a kid I remember people smoking pot and selling a little on the side for their own habit or whatever. That’s not how it works today,” Moody said. “These are criminal organizations that come in and target our most vulnerable population. They are drug pushers. We need to resource the MDEA, state police, sheriffs, locals.”

Moody said more emphasis needs to be placed on education and prevention – especially in public schools – to teach young people that they could alter the course of their lives by making a bad decision at a party. On the issue of treatment, Moody said he would look to boost the programs that were effective by reallocating resources from those that were not.

Fredette indicated his approach would also be heavy on enforcement.

An attorney who is a lieutenant colonel and judge advocate general in the Maine Air National Guard, Fredette says Maine must treat the opioid crisis as a war on drugs and that, as governor, he would tap the National Guard for help.

National Guard troops involved in combating the crisis would not be armed or have the power to arrest people, as that’s prohibited under federal law, he said, but their expertise and equipment could be utilized in other ways.

“They can provide helicopters. They can provide drone surveillance. They can provide training for local law enforcement,” Fredette said. “Let’s bring those people into the fight.”

But Fredette also said the state needs a better-coordinated approach to the crisis.

“Until we have a coordinated program to deal with prevention, enforcement and treatment, we are going to continue to lose more and more lives,” Fredette said.

Mason said government can help with the opioid crisis, but it will not be able to solve it. He said the government’s role should be in making access to treatment available, coordinating services and “making sure the people who are hustling these drugs are taken care of – so criminal justice and the courts.”

Mason said there needs to be more recognition and support for faith-based treatment programs, which he said offer high success rates at little to no cost. He also doesn’t believe the state can spend its way out of the crisis.

“Money doesn’t always work,” Mason said, noting the Legislature has funded an increase in treatment beds in Maine but DHHS has yet to use the money to create the bed space. “Maybe we need to implement some of the things that we have instead of just letting it sit in an account somewhere.”

Mayhew said she would increase support for faith-based recovery centers and more residential treatment beds. She would also require that all methadone and Suboxone treatment have a counseling component and monitoring for concurrent abuse of heroin or other opioids.

In addition, Mayhew said she would continue LePage’s efforts to focus on law enforcement and close off Maine’s borders to drug dealers from out of state and to implement common-sense regulations on opioid painkiller prescriptions.

Kevin Miller can be contacted at 791-6312 or at:

kmiller@mainetoday.com

Twitter: KevinMillerPPH

Scott Thistle can be contacted at 713-6720 or at:

sthistle@pressherald.com

Twitter: thisdog