VALID MEASURE OF A WORSENING OPIOID CRISIS IN “MODEL” TREATMENT STATE MAINE: SURGE IN INJECTION-RELATED HIV CASES
If recent dramatic drops in opioid deaths were due to effective treatments reducing high-risk use, we wouldn’t be reading about opioid injection-related HIV surges
by Clark Miller
Published September 12, 2025
From a Maine Public Radio news piece appearing July of this year –
The Maine Center for Disease Control has identified two more positive HIV cases in Penobscot County, bringing the total cases to 26 since an outbreak was identified more than a year ago. But providers say the actual number may be much higher. And other areas of the state are grappling with the same issues that contributed to the outbreak. …
With the ongoing HIV outbreak in Penobscot County, there’s more awareness in the Bangor area, where Taraschi said people are more likely to specifically come to request a test.
The Maine CDC has identified 26 cases here — an area that historically sees 2 cases a year. And providers said there are likely more people with HIV who are unaware, because the disease is often asymptomatic.
And from a separate news report in March, 2025 –
BANGOR, Maine – Testing has confirmed 22 different cases of HIV in Penobscot County since October of 2023, many of which are concentrated in the Bangor area. Officials are expecting that number to rise as more testing is completed.
All of the cases reported using injected drugs within one year of their diagnosis. …
Maine CDC says it is working with community partners to provide care for individuals that are diagnosed. They are also hoping to prevent further spread by increasing testing, offering syringe services and pre-exposure prophylaxis (PrEP). …
“The populations impacted by this HIV cluster are populations who struggle with substance use disorder, with mental health challenges, with housing instability,” Gunderman said. “Every one of those factors creates stigma.”
The report does not make explicit the salient point – that the individuals testing positive for HIV were engaging in high-risk opioid and other drug use, moderation of high-risk opioid use the single means by which gold standard medical and standard “addiction treatment” programming can provide alleged benefit.
Explained here and here, and here, and in numerous other posts at A Critical Discourse and Illness and Cure, incidence, trends, and differences in fatal opioid overdose are NOT valid measures of the effectiveness of treatments or of severity of the crisis, because numbers of fatal overdoses have always been confounded by changes and differences in rates of reversals of potentially fatal ODs by naloxone and other reversal agents. Until recently, numbers and trends in nonfatal overdoses – comprising high-risk opioid use – served as valid measures, but no longer as those reversals are increasingly occurring in community and private locations, by laypersons, and without ever being reported or not recorded in ways that result in their being parts of any database accessible for study, research, or news reports.
Incidence of opioid injection-related infectious disease is different, as considered in some detail in this previous post (scroll down to “Another direct measure of high-risk use of opioids”) –
It’s critical to understand the importance of this type of evidence
The more deaths mount, the more pressure mounts to divert public healthcare resources to the unvalidated medical model provision of addictive, diverted and abused substitute opioids. Perversely, tragically, and criminally, it seems, because it has been established that provision of American Medicine’s fix for American Medicine’s opioid crisis predicts, rather than harm reduction or saved lives, worsening of increasingly lethal epidemics.
That’s established partly because trends in opioid-related overdose deaths are not a meaningful measure of effectiveness of OST (MAT).
For reasons discussed in this post and additional posts – each post with detailed explanation linking to primary research and other sources.
There is no body of evidence with results that control for the most likely of confounding explanations for any slowing of mortality – increased availability and use of the OD death-reversing drug naloxone.
On analysis of the evidence, naloxone use – its reduction of deaths acting and measured directly, unlike presumed benefit from OST – directly accounts for all apparent changes (= decreases) in opioid-related overdose deaths. This result holds when results are available on a local level (e.g. here, here, here, and here) and when national data are examined.
Attributing benefit to OST requires evidence of reduced high-risk use of opioids.
As described in detail in this, this, and other posts, that is the mechanism by which OST could possibly provide benefit.
When outcomes are critically analyzed, the evidence points consistently to provision of the medical model fix or “treatment” for problem opioid use worsening, not protective for, high-risk use and associated harms including opioid-related mortality. Because high-risk use, measured as non-lethal overdose incidence (eliminating the confounding, established effects of expanding naloxone use and campaigns) has increased nationally and consistently in multiple locales where data are available as dose of the medical cure increases.
As explained and established by multiple lines of evidence in this new post, emergence over past years of the potent opioid fentanyl in street economies of illicit opioid use does not qualify those invalidating results – fentanyl cannot explain away the failure of increased provision of the medical “treatment” to reduce high-risk opioid use
Another direct measure of high-risk use of opioids
is incidence of opioid injection-related infective disease, like endocarditis.
Think about it – incidence of infective diseases caused by injection of opioids. That use of opioids is high-risk. If OST provides benefit to at-risk users, the mechanism is by reducing risk and associated problems related to opioid use.
Trends of decreased incidence of an injection-related infectious disease could be attributed to a variety of factors including: changes in public health, prevention, or medical interventions; decrease in high-risk opioid use including use by injection; clean needle exchanges; behavioral health treatments; others. Identifying the factor(s) any decreases could be confidently attributed to would require that multiple congruent, well-designed studies and other lines of evidence point to those factors and not others.
Increases in incidence, like those we’re seeing, are different. If increases of significant magnitude occur over the same time period that an intervention, like the medical OST fix, hypothesized to be a “treatment” or protective factor has also increased, then that constitutes strong evidence against that intervention as beneficial in reducing high-risk use.
As we would predict from everything we know about problem substance use and the failure of medical approaches to provide benefit for that non-medical problem, those diseases are increasing in prevalence.
Back to our current post –
There may be potentially confounding factors to consider in attributing causality to surges in opioid injection-related infectious disease, for example if co-occurring in time there were identified factors that would have significantly changed the likelihood of positive disease cases being identified, factors that should be easy to rule in or out. What points instead toward the direct, expected connection between increasing high-risk (by injection) opioid use and increases in injection-related infectious disease as a valid measure are the many locales over which this has been occurring.
But in Maine! How does that make sense?
That the crisis could be worsening in the state designated and celebrated, as described in this post back in 2022, as the model for all other states to “replicate”?
But national leaders say the state’s data-driven focus and efforts to provide multi-pronged support to people in recovery helped shape its own policies and could help other states tackle the issue.
“And that leadership, what you’re seeing and living every single day here in Maine, is what we will want to try to replicate all over the country,” said Rahul Gupta, the director of the White House Office of National Drug Control Policy under President Joe Biden.
In an interview, Gupta said he was specifically struck by Maine’s tracking of nonfatal and fatal overdoses. It demonstrated the need to revamp how the country tracks overdoses, something he called for in an article in late June. He also highlighted the state’s mobile recovery team and treatment for incarcerated people, as well as efforts to provide housing, childcare, jobs and food security support that helped shape his office’s drug control strategy, he said.
Okay, there were some doubters, in a paper nobody outside of Maine has ever read.
And it’s not just the NY Times determining the actual validity of the remarkable success and promise of American expert gold standard treatments in Maine.
Here’s popular author turned treatment expert Sam Quinones, trotted out by Maine governor Janet Mills to add additional certainty to effectiveness of the opioid crisis treatment fix implemented in Maine.
If that weren’t enough, here, from Politico Magazine in 2023, is an investigative look at Maine’s remarkable recipe for turning the opioid crisis around, unironically headlined.
And oh where, where … where would we be! Without that lesson to the Nation on how to treat high-risk opioid use and turn a worsening epidemic around? Where?
With a persistently worsening crisis?
With persistent surges in infectious disease due to high-risk opioid use, in Maine and elsewhere?
Whatever’s going on in Maine, it’s not for lack of effort!
Maine has so leaned into expert gold standard treatments, it’s ridiculous!
And not just hooking up incarcerated high-risk opioid users pre-release with the substitute opioids that have been serving on the streets over decades as consumable, commodity, and currency in illicit economies of high-risk opioid use.
There’s more. Just as in Baltimore (Baltimore!), top experts and leaders have ensured that public healthcare funds have been used to support addiction medicine and traditional addiction treatment.
In Maine “treatment” expansion includes a new 70-bed facility noted in this report in 2024.
And reported back in 2023 –
“Part of the governor’s and my responsibility is to not give up and let people know recovery is possible, but they kind of have to meet us halfway,” Gordon Smith, who Mills appointed to lead the opioid epidemic response, said in an interview. “People have to decide that they want to get better, and then it’s on us.”
Gordon said a-half-dozen residential facilities have added 140 detox beds, and there are now 66 recovery residences, formerly known as sober houses, in Maine.
Gordon also said the number of methadone clinics has increased from 10 to 13.
He said, “We have doubled the number of prescribers of outpatient medication.”
This 2023 report includes an accurate and revelatory observation.
The Maine Attorney General’s Office released its latest report Thursday, tracking deaths from Jan. 1 through Dec. 31, 2022. In 2021, 631 residents died from an overdose and in 2020, the number was 502. Before 2014, the total had never gone above 200.
In all, 10,110 overdoses were reported in 2022, which means about 7 percent resulted in death. The death toll would certainly be even greater if not for the increased availability of Narcan, which can reverse the effects of an overdose if taken in time.
[emphasis added]
This is, the situation in Maine is no different than in all other locales consistently – dramatic, intensive, targeted, successful naloxone campaigns have covered, disguised the accurate picture of incrasing high-risk opioid use (= gold standard treatment failure).
But what about those expert treatment approaches that we can’t help but believe are about to end the opioid crisis, the “model’ for all states, perhaps getting a slower than expected start in Maine, yet evaluated for us by top experts and American media as effective? How could that be doubted?
It turns out, predictably, that there never has been a body of evidence to support that, not even some compelling evidence,
instead evidence that points in the opposite direction explained, for example,
here for a prison release population
and here also for a “statewide correctional MOUD program”
and here
and here
and here.
That’s why vulnerable Americans are trapped in a worsening opioid crisis, with no way out as long as those in power who created it and perpetuate it are allowed to continue.
