Gordon H. Smith, Esq. was appointed by Governor Janet Mills as Director of Opioid Response in January 2019. He is responsible for coordinating and directing Maine’s response to the opioid crisis, including prescriber education and reduction of opioid prescribing, prevention and treatment of substance use disorder, and harm reduction strategies. He stepped down as the Executive Vice President (EVP) of the Maine Medical Association in January 2019, where he had served as its EVP since September 1993 and where he began as General Counsel in 1981. He graduated from the University of Maine with the highest distinction in 1973 and from the Boston College Law School, magna cum laude, in 1976. He is a past Chairman of the American Society of State Medical Association Counsel, a nation-wide group of 140 attorneys representing medical associations. Mr. Smith has also served as Chairman of the American Medical Association/State Medical Society Litigation Center, the Maine Health Data Organization and the Advocacy Resource Center of the American Medical Association. He is a former board member and chair of Quality Counts, a former board member of the Daniel Hanley Center for Health Leadership, and the Maine Association of Area Agencies on Aging. Mr. Smith is a frequent lecturer to medical groups on various medical legal subjects.
What influenced your decision to step into the role of Maine’s first Director of Opioid Response?
I accepted the position because the governor asked me to and because it was an opportunity to save lives and make a difference in one of the state’s greatest challenges. Having worked around the State House as an advocate primarily for doctors for 39 years at that point, I thought it would be a great opportunity to be right in the governor’s office on the inside, so to speak, and see government from that perspective. I’d already announced my retirement from the medical society. They already had their process in place to pick my successor, so I left about 11 months earlier than anticipated. I was excited about the governor’s election, and I started working with the governor in early February 2019. I thought focusing on one thing would be really interesting. So that’s why I did it.
Looking back over the past 7.5 years, what accomplishments are you most proud of?
I think in terms of what we’ve accomplished, there are several things that we’re very proud of, but we also try to be modest in our realization that you don’t do this alone. I give the governor a lot of credit for prioritizing the issue. Executive Order One was Medicaid expansion, and it is the single most important thing that the governor has done to help people with substance use disorder. Expanding Medicaid has allowed well over 100,000 people, many of them men between the ages of 18 and 50 to have insurance and access treatment. Roughly at least 25,000 people have filed claims for substance use disorder since the expansion took effect. Executive Order Two was the order to implement responses to Maine’s opioid epidemic that got us started. We said we’d do four things immediately, and it established my position and underscores much of the work we do.
I’ll tick off five or six things that I think have been the most important. Some of those were right in Executive Order Two. But I will start with the fact that all of these things that we’re going to talk about have, in some small way, changed the narrative around addiction in Maine. More and more people have come to realize that people addicted to drugs are not bad people. They are people who have a very complicated disease. It’s an illness that people deserve to be treated for in every way possible. What I’ve learned, which I probably did not fully know or appreciate until I took the position, is just how much addiction comes from trauma, adverse childhood events, children and family issues, intergenerational issues, and mental health. Certainly, genetics is a part of that as well. Changing that narrative and reducing the stigma have been really important, and failure to do that makes all the other things that I’m going to talk about so much more difficult.
We put together a strategic plan based on the 10 points we released during the 2018 campaign, built around the four primary pillars of prevention, harm reduction, treatment, and recovery support. We now talk about two additional pillars: public safety and the work public safety does to reduce the supply, as well as the infrastructure necessary to succeed in the other five pillars.
The plan itself, from creating it to developing support for it and keeping it up to date, has nine focused areas and 35 different strategies. Some of the 35 strategies we have been successful with are done, and some are unfinished or haven’t started. In some cases, we’ve had to set the work aside for various reasons and will pass those along to the next Administration.
In terms of being more specific within each pillar, we’ve been particularly active and successful in the recovery support pillar. We’ve got 19 recovery community centers. We’ve got 125 certified Recovery residences (as of the time of this interview). We have trained well over 2000 recovery coaches, many of whom are now certified and securing paid positions as recovery coaches. We have our recovery-friendly workplace initiative to secure vocational access for people as they get into a long, sustained, successful recovery. We’re very proud of all those initiatives.
We’re also very proud to have increased the number of treatment beds across the continuum. We’re not done, and it’s very difficult to know how many beds we need. We now have more than 100 detox beds available each night, and there’s usually a bed available. They still need to be, frankly, more evenly spread across the state. We have our ASAM 3.1 and 3.5 residential care beds, and those beds have increased to over 600, though that may include detox beds as well. We still have more work to do on the residential treatment side. The opening of the York County substance use treatment facility in Alfred this fall, with 58 beds, will be a big addition, obviously. We haven’t had anything with 58 beds open, not for treatment, probably ever. It’s like building a small hospital.
In addition, there are more options available for medication for opioid use disorder, particularly buprenorphine, and we are moving to injectable buprenorphine. We also now have about 5,600 people in Maine getting a daily dose of methadone. As a lawyer, not a clinician, I have seen the medication over the past 50 years help people and save lives.
I think the second thing that’s the most impactful is requiring the prisons and the jails to treat, to offer every person with a substance use disorder treatment, particularly medication. And yes, there’s an expense associated with that, but the lives saved once they are released are worth it. There was an almost immediate 60% reduction in the number of overdoses following release in the Department of Corrections, and there’s been a similar experience in the jails. We look at that metric every week of the people who had a fatal overdose, how many had been incarcerated within the previous 30 days. It used to be one of the most dangerous, risky times. You see that data cited that people were a hundred times more likely to die leaving incarceration than other people. It’s very rare now. 1.6% of the people who had recently been incarcerated had a fatal overdose from 2023 to 2025. That is unbelievable. It’s rare now for three reasons. The primary one, in my opinion, is that people are now treated. We lead the nation in prescribing the injectable buprenorphine in carceral settings, and in prescribing buprenorphine in jails in general. The other reason, in addition to the medication and the treatment, is that we offer virtually everyone released naloxone, not because we think they’ll fail and need it. Still, it’s just an obvious way to help people. The third thing is that we have a lot of initiatives. The Department of Corrections’ Reentry 2030 and the Fair Chance Hiring initiatives. We’re doing a much better job of preparing people for release, making sure they have jobs, education, and training.
Now let’s move to harm reduction. There are two major initiatives there. One is obviously Naloxone, and we fought with LePage in 2016 and 2017. It took a couple of years even to be allowed to do this in Maine, but that’s why, in Executive Order Two, the first thing we said we would do is buy and distribute 35,000 doses of Naloxone. By the time I get done, we will be close to a million doses that we’ve purchased and distributed with state and federal funds. It’s remarkable. We created this Maine Naloxone Distribution Initiative. It’s just remarkable how well that system works. And over the past seven years, the price of a double-dose kit of Narcan, the nasal version, has dropped from $75 per kit to $25. What other product in America has dropped by that percentage in this time period?
The second initiative with respect to harm reduction, and equally important, is the syringe programs. Now, Maine’s had syringe programs for over 25 years, the first one in Portland in the late 1990s, but the state didn’t give them any money. The Prevention Treatment Fund was established 4 or 5 years ago, and it has contributed to what we’ve been able to do since. The Recovery Council has also made some helpful investments in syringe programs, which have allowed us to grow them. I would guess there must be, well, I think there’s nearly 20 that are probably certified, but not all may be operating today. We distribute between 2.5 and 3.5 million syringes annually, but that’s not what it’s all about. It’s about connecting people with harm reduction services, food, clothing, medication, and medical providers. The syringes are just one part of it. And now, fewer people are actually injecting, more people are smoking and ingesting their drugs in other ways, which can still be dangerous but is less likely to spread diseases like HIV. We know these programs have their critics, but they save lives and we are proud of the harm reduction work we do.
We also have the OPTIONS Program. We have 32 positions, two in each county, for people in the community on the ground, working with public safety, with the community provider, and with emergency rooms. It’s very hard work and supported by seven recovery coaches, connecting with people, keeping them safe, and supporting their entry into treatment. We’ve got four behavioral health organizations we contract with to hire and supervise those individuals, and we provide technical assistance to them through the MMA. I’m so proud of the work that my former organization is doing on the foundation of all that work.
I also want to mention the ME SUD Learning Community’s work. When I see the number of educational offerings, I think that it’s just unbelievable. You’re taking on really good subjects like the new novel substances that we see. It’s just really impressive.
We also created the Opioid Clinical Advisory Committee, which we started in 2019, with doctors Alane O’Connor and Lisa Letourneau as chairs. The fact that we get such a strong group of clinicians on that bimonthly call is just amazing to me. I’m very proud of the work of that group and the Guidance Documents they have produced.
Within the state, we have our Opioid Coordinating Council, which was also designed in 2019 and continues to meet monthly. Its work is to make sure the offices within DHHS are coordinated, that they know what each other is doing, to find where the money is being spent on opioid response, and to make sure that people are working together to follow the governor’s strategic plan. We also have an Opioid Data Sharing Committee. We have EMS, corrections, the Office of Behavioral Health, the Maine Health Data Organization, Public Safety, the Northeast Poison Control Center, and the Maine CDC. It’s not only interoffice, but also interdepartmental because a lot of the data spans departments. Not all of the data work is at the level we would like it to be, particularly with the treatment data. We’re focusing on it this year. So that’s another one of our challenges.
Finally, we have the Overdose Review Panel, which meets every two months for three hours and reviews particular cases in depth. That’s been very poignant work. We interview the families, and we’ve produced two public reports, and we have a third report that’s just about to come out once the attorney general approves it. I just got the final draft a couple of days ago.
All of this has contributed to the decline in mortality that’s continuing for the fourth straight year, so we’re losing half as many people as we were at the peak of the pandemic. Generally, that’s because of the availability of naloxone, our hard work, and changes in the drug supply.
Then it comes to prevention. I had my monthly meeting with the prevention network today, with our friends at the CDC, which receives 20% of federal block grants for prevention. The Maine Prevention Network has a prevention network provider in each public health district, and we are increasingly bringing them together with the Department of Education and youth development organizations. It’s still not where I’d like it to be. I mean, the governor announced about three or four years ago that by the end of her second term, she wanted an evidence-based prevention program in every school and every community. There are a hundred youth development organizations we’ve found that offer before-school and after-school programs, including YMCAs, scouting, and other programs that keep children occupied so they don’t have time, frankly, or the desire to seek illicit drugs. We’re very proud of our prevention efforts, and they never get their due, partly because you don’t see an immediate return. It will be generations before we see some of the positive outcomes of the work being done by Child and Family Services and the Children’s Behavioral Unit at OBH. The work is so essential and so gratifying when you can work with children who might be at high risk. I think those are the major accomplishments that I generally feel will be most impactful.
Some of this has been much harder than I thought it would be. But we have accomplished a lot; it is a legacy for me and, more so, for Governor Janet Mills. It has been a wonderful job for me and a labor of love.
As you think about what’s ahead, what should Maine keep front and center?
Where are we going? What I generally tell people is to keep everything going. The priority now is not to lose what we’ve built, not to go back to the times when it was just lock them up, arrest people, throw them in jail, don’t treat them. We could lose a lot.
Some of the activities, such as the Overdose Review Panel, are mandated by statute, and contracts cover many others, so they have some sustainability.
We’ve created a fair amount of infrastructure, but we need to keep focusing on how the activities show impact and effectiveness. They’re going to have to show that they’re making a difference. We need better data. We need to keep the Data Sharing Committee going and have a data strategic data plan, which is in our latest strategic plan.
As long as we continue to see declining overdoses, and it’s not the only metric, but it is one that people really pay attention to, particularly the fatal cases. The fact that we’ve now got three and a half years of declining deaths allows me to say our strategies are working. So, my ultimate goal in the next five months is to protect as much as we can of what we’ve done.
I think the state will face future issues, such as safe-use sites. We did a study on it. 12 people signed a unanimous report saying that if the state wants to do this and be the third place in the country to do so, these are the things you’d want to consider. Still, it doesn’t recommend it or recommend against it, which is why 12 people from a variety, everything from the most conservative sheriffs to the most progressive harm reduction people, signed. I’m very proud of what we did. We looked at sites in Canada, Portugal, and Amsterdam. I’m a lawyer. I can make a case for it, but it would be a heavy lift to deal with the legalities. Plus, we couldn’t have passed it, not with the governor’s opposition. But I say that is one issue the state may have to face in the future, depending on where a lot of this stuff goes.
Basically, we need people to pull out the strategic plan with the new administration, go through the 35 strategies, identify where we need to do more, and see what we’ve already accomplished. There aren’t a lot of new directions to go in, frankly; we need to keep doing what we’re doing. And as I say, start plugging some of these holes.
Could we do more? Sure. However, the most important thing is that we have not solved the problem of people’s insurance being sustainable, and the federal government’s threats to really harm MaineCare, which would be a big problem. Those are things to think about on the horizon.