Maine expands detox options to address ongoing overdose crisis

In-patient detox capacity in Portland will nearly double on May 13, when Milestone Recovery’s expanded substance use disorder treatment program is scheduled to open its doors. 

Executive director Thomas Doherty said everyday nurses and counselors have to turn away roughly 70% of people who are seeking and qualify for detox services because of a lack of space currently. 

“This project is going to allow us to say yes to a lot more of those people,” Doherty said on Thursday, during an opening celebration for the new facility, located on Andover Road off the peninsula. 

The Milestone expansion comes as the overdose crisis has hit Maine hard over the last few years. In 2023, there were 607 confirmed or suspected overdose deaths. Although that represented a 16% drop from the year before, advocates and lawmakers say the state is still in the midst of a serious crisis. 

Milestone’s medically-monitored withdrawal program is currently located in downtown Portland and offers 16 beds. Those beds along with 14 others will be housed in the new space, increasing capacity to 30. Outpatient services will also move to the facility, which attending psychiatrist Cameron Bonney said will also see an increased capacity to about 150-200 slots, compared with the fewer than 100 he currently serves. 

Those who work for the program were joined by Gov. Janet Mills, U.S. Attorney for the District of Maine Darcie McElwee, city officials and law enforcement on Thursday, demonstrating the multi-pronged approach needed to help people on a path to recovery, including preventing drugs from entering the state, prevention education in schools, and to treat substance use issues when they can’t be prevented.

“Detoxing from substance use disorder can be difficult,” Mills said. “Finding a safe place to start your recovery shouldn’t be difficult.”

In addition to capacity, another barrier to accessing detox services is insurance. Few facilities accept MaineCare and even fewer accept the uninsured, said Sam Heck, director of development and community relations for Milestone. 

Milestone is one of two facilities in the state that accept people who are uninsured, the other being located in Bangor. 

“The window in which people are willing and able to seek help for substance use disorders is so narrow that if you’re in that little window and you have to say no there’s no telling when that window is going to open up again,” Heck said.

The detox program

Providing people with the resources and autonomy needed to make the decision to enter recovery is a key component of long-term success, said Christine Cook, Milestone’s detox director.  

Potential patients initially undergo a phone screening to determine their eligibility. If they have other medical complications, such as needing dialysis for example, they may not be eligible because the program is in-patient but not a hospital facility. 

When patients arrive, they’re given clean clothes and assigned a bedroom, which are largely single or double rooms, compared to the downtown location that offered dorm-style rooms with three to five beds.

The stay is from three to five days, during which patients receive medical care, meaning physical treatment for the symptoms of withdrawal, but they’re also meeting with counselors and making a post-discharge plan.  

“We’re really trying to connect them to what that next step looks like,” Cook said, whether that be entering sober living, going into a longer-term treatment facility or accessing outpatient services.  

Bonney, who is a part of the outpatient team, said the idea is that people can begin their recovery journey in the detox facility, become familiar with the staff and then continue services as needed without having to transfer providers. 

“The relational aspect, I think, is often overlooked when organizations are designing systems,” Bonney said. “It’s really the relationship that carries the treatment.” 

Service expansion state-wide 

Maine’s statewide system of treatment services has been growing and is continuing to expand.

The supplemental state budget passed last month included $4 million to expand medication-assisted treatment in county jails and $5 million to start crisis receiving centers in Kennebec, Androscoggin, Aroostook and Penobscot counties. 

Also this legislative session, advocates celebrated the Legislature funding a bill creating a sustainable revenue source for the more than 20 recovery community centers in the state. Recovery community centers are independent nonprofits led by local community members that provide non-clinical, peer-support services for people with substance use disorder.

Last June, the Maine Office of Behavioral Health allocated $6 million to providers for renovation and startup costs for residential withdrawal and substance use disorder treatment services, creating beds in rural and urban communities.

Using separate funding from the American Rescue Plan Act, York County has plans to become the first county to operate a recovery center in the state, which will use the same contractor as the Milestone expansion, LandryFrench.  

Kevin Freeman, director of business development for LandryFrench, said the Milestone facility was completed in a span of 12 weeks, recognizing that the urgent need to expand capacity. LandryFrench plans to break ground on construction for the York County Recovery Center later this year, Freeman said.

In addition to building capacity, $750,000 in existing state funding this year went toward adding nine recovery coaches, and $1.25 million in federal funds went toward boosting the distribution of naloxone, which rapidly reverses opioid overdoses. Mills said the addition of emergency housing options has also prevented fatal overdoses, as shelter staff can identify people who are overdosing and administer naloxone. 

January marked the first month in two and a half years without a fatal overdose in Portland, Mills said.  

“It’s good news,” Mills said, “but we’re not at all complacent.” 

More work still needed

Despite recent advancements, those in the recovery community have said more needs to be done. 

This year, advocates pushed for a bill to decriminalize possession of illegal drugs and establish at least one center in each county to provide urgent 24/7 services for those having a substance use or mental health crisis. Proponents argued that instead of criminalizing drugs, the state should view addiction as a public health issue.

But amid opposition from Mills, the measure was turned into a study of drug decriminalization currently awaiting funding by the Legislature. The Legislative Council voted to fund a handful of studies during a meeting on Tuesday but took no action on the drug decriminalization study, likely positioning it to be killed.  

The recovery community has also urged the state to allow overdose prevention centers — sites where people can administer previously obtained drugs under medical supervision as a way to prevent overdoses. Mills signed a bill last year to study the use of such centers.

Editor’s Note: Reporter Evan Popp also contributed to this story.