Tristen Nelson was 19 when he tried heroin for the first time. A sternman on a lobster fishing boat in rural Maine, he was making good money and quickly learned the opiate wasn't hard to come by.
And as long as he showed up ready to work, his developing addiction went unmentioned.
"I had one or two captains that knew, and they would see it and not say anything," Nelson says. "If I went to work and I was sick, and said 'I don't know if I can work today… I'm having withdrawals,' he'd say, 'Well here's a hundred bucks. I'll see you in an hour.'"
Nelson's story is not an anomaly in Machias, Maine.
Opioids were involved in more than 33,000 deaths in the United States in 2015 alone. In Maine, there was an average of one overdose death per day in 2016, the vast majority of which involved at least one opiate. Nowhere is the crisis more pronounced than in Washington County, where Machias is located. The sparsely populated area had the highest rate of drug overdose deaths in the state last year. It's also a hub for the state's largest export industry: lobster.
Maine's lobster fishing industry brought in $533.1 million last year alone, with a record 130 million pounds of the red nippers hauled ashore by fishermen like Tristen. It's a lucrative and world-renowned industry, but not one that's devoid of issues. According to Machias residents, opioid abuse is particularly pronounced among the town's lobster fishermen.
Nelson was 16 when he first got on a fishing boat. He spent a winter pulling scallops, but quickly noticed a more profitable path lay in lobster fishing. When he was offered a position on a lobster boat the following season, he took it. "I made more in that summer than I had any other year," he says. But by then he was already abusing the prescription opioid Oxycontin and other drugs, and he ended the season broke.
"I'd put gas in my car, I'd buy something to eat, and then I'd spend the rest of it on drugs," Nelson says. "Probably for every addict that's on the water, every single one of them is broke when the season ends."
Nelson believes the long hours, the physical labor involved in throwing around 90-pound traps, and the availability of heroin among his fellow lobstermen exacerbated his drug problem. The drug is often sought as a cheap alternative to prescription pain medication, and working on a lobster boat takes a toll on the body.
"A straight person might come home [from work] and say, "I think I'm going to take a couple Advil and lie down." I was a junkie on the boat and I would say, "Well when I'm out of work I'm going to go shoot some heroin."
For those who are addicted, Machias can be a pretty hard—and expensive—place to find help. Washington County is more than 2,500 square miles, about the size of Delaware, and home to around 30,000 people. The county is settled for the most part along the coast and the county's rivers, making it an elongated, sparsely populated area. "The jail is the only detox centre," Nelson says. "If you get arrested and you're on the inside, you can't get anything."
There are no detox beds in the county, so a night in the cells or the emergency room are among the only options for people seeking immediate help. A faith-based, abstinence non-profit program, Arise Addiction Recovery, is the only treatment centre in town, with beds for 18 men and 8 women, but it doesn't offer a detox facility. In 2016, the year that Arise Addiction Recovery was founded, program staff drove 23 people from Machias to Portland, where the state's only true detox center is located. The drive can take up to four hours. This dearth of treatment options is not something that has escaped the attention of town officials.
"There's definitely a need for help," says town manager Christine Therrien, but Machias is home to a little more than 2,000 people, and resources are scarce. They don't have the staff or training to manage a detox centre, Therrien says.
"We can get the representatives to the table. We can say there's a need for it, we can sign a grant application saying we need funding to get it going," she says. "[But] who's going to operate it? Who's got the expertise? Who's going to cover the hours when somebody's there?"
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The only methadone clinic in the county is a 45-minute drive from Machias and it's not cheap, at upwards of $95 a week. Methadone treatment programs are often not successful if done for less than three months; one year is considered the minimum for effective maintenance. Another option, a Suboxone treatment program available in a few nearby towns, is slightly cheaper and requires fewer visits.
But, as Nelson found, with fewer visits comes less supervision. "I filled my script, I went home. For a month or so, I took it like I was supposed to and I did well, and after that I would fill my script, go home, sell it, and buy what I wanted," he says. "I was an addict, I needed more supervision of my prescription."
Policymakers are searching for solutions. Rep. Anne Perry is a member of Maine's House of Representatives, and a working nurse practitioner. Perry says programs like the prescription-monitoring program (an electronic database of substances dispensed within a state, aimed at reducing prescription opioid abuse) were so successful in reducing the availability of prescription opiates that they opened the gates for heroin and fentanyl abuse in Washington County.
"We may have [shrunk] a source, but how do we help those who are addicted get back into treatment? Especially when they're ready for it," Perry says. "That's really, really difficult in a rural area where resources are not abundant."
Rep. Perry is on the Health and Human Services Committee, and is leading a group to work on a bill aimed at curbing addiction in Washington County. The bill aims to fund training for law enforcement and emergency personnel, create more detox beds in the county, and provide treatment services to those without insurance. Perry wants to create a network of services to get help to addicts when they need it.
"If you don't get them when they say they're ready you've lost them again. We need something that gets them where they're at, so if they go to their primary care provider and they say I need help, we've got that Washington county network that says, "Okay. Let's start here."
It's a sentiment echoed by Machias's town manager. "When somebody gets to the point that they want to quit this addiction, and they're ready right then, that night, and they pick up the phone and they call someone… there's nothing available," Therrien says. "If they get off that phone, the next day may not be the same. They might say they're fine and the next day keep on using, so you miss the opportunity."
The scarcity of treatment options close to home and a "boys don't cry" mentality common to many lobster fishermen, according to Nelson, means that many addicts in Machias are not getting the treatment they need. He thinks that a methadone clinic in Machias would be full within a week.
"I've almost got to be on my deathbed before I go to the doctor. It's just the mindset of somebody in Washington County—and especially somebody that works on a boat is a 'I can work through it' type," he says.
Nelson has been clean for a little more than a year now, an achievement he credits to Machias's Arise Addiction Recovery. While local and state policymakers work to create a web of treatment options that increase medical access for addicts across the county—solutions like telemedicine and further training for local doctors—Nelson is focused on reducing the stigma around addiction in Washington County.
"It's something that nobody ever wanted to talk about, it was shameful. Nobody wanted to be associated even with the word addiction," he says. "But people now are willing to say that. Just get the word out, you can find help."
Inspired in part by reporting in the Portland Press Herald.
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