Increased Exposure to Substance Use Is Shifting Drug Policy Attitudes in Maine

Driven by the opioid crisis and the increasing prevalence of powerful synthetic opioids like fentanyl, U.S. drug overdose deaths have more than tripled in the last ten years. 

Maine has been particularly hard hit, with the eighth highest overdose rate in the nation. Each of the 716 overdose deaths in 2022—a new state high for the third consecutive year—represented the heartrending loss of a family member, friend, or neighbor; in a tightly-knit state like Maine, it is now virtually impossible to find someone whose life has not been upended by substance use disorder, overdose, or a drug-related fatality. 

Besides causing grief and consternation, this exposure to substance use is powerfully changing perspectives on how to address the crisis. As our recent research on public attitudes shows, the more Mainers are personally affected by substance use, the more they increasingly support reforms that move away from arrest and criminalization, and instead rely on interventions grounded in public health and harm reduction.

Envisioning an Agenda for Drug Policy Reform

Roughly five years ago, the Maine Coalition for Sensible Drug Policy (MCSDP) collaborated on a set of broad-ranging policy suggestions cast as a holistic model of “compassionate care and radical humanism.” In 2019, the coalition put forth a report with 18 evidence-based policy recommendations across five dimensions of illicit substance use policy: primary prevention, harm reduction, treatment and care, support for those in recovery, criminal justice reform, and stigma and discrimination reduction. Since then, advocates have won several notable policy achievements: increased access to opioid reversal medication and safe injection supplies, the strongest “Good Samaritan” protections in the country, increased funding for harm reduction, and more. Yet proposals like the decriminalization of drug possession for personal use, greater access to medication assisted treatment (MAT), and the establishment of “safer consumption sites” remain aspirational. 

Statewide Public Attitudes 

As we began researching drug policy attitudes in Maine in 2020, advocates and lawmakers from all political backgrounds expressed wariness about public support for such bold reforms. Advocates were concerned that Mainers outside of recovery and harm reduction advocacy circles might balk at some proposed reforms, and even the most reform-minded state and municipal political officials feared the potential for constituent blowback. 

Working closely with drug policy advocates, organizations, and lawmakers, we crafted and launched a 2021 statewide survey in which we asked registered voters about their support for MCSDP policies. While there were clearly partisan divides (with Democrats trending more supportive of non-punitive reform than Republicans) and greater division on harm reduction recommendations such as safer consumption sites (35% support) or provision of safe injection equipment (49% support), survey data suggested that nearly all observers—including our research team—had underestimated Mainers’ appetite for policy reform: 

• Nearly 74% of survey respondents supported decriminalization of drugs for personal use (including 61% of Republican respondents). 
• Over 80% of respondents supported policies that would increase pathways to recovery from substance use disorder (such as access to treatment, medically assisted withdrawal, and recovery community centers). 

What was driving so many Mainers to hold positions fundamentally at odds with the punitive approach to substance use policy? We used the data to create a measure that captured one’s support (or lack of support) for a non-punitive approach to better understand which factors—political beliefs, demographics, attitudes, exposure to the crisis—were driving respondents’ attitudes, finding that: 

• Political party matters, but exposure to substance use matters more. Typically, political party identification can tell us a lot about one’s drug policy positions. It mattered here as well, but not as much as other variables—especially, if one had exposure to substance use disorder, either personally or with someone they know. 
• Notions of “superiority” matter most of all. We also asked about “social dominance orientation” (basically the extent to which people view the world with a sense that some are superior and some are inferior). This was the most robust factor driving policy attitudes; a stronger sense of superiority and inferiority went hand-in-hand with favoring punitive approaches over harm reduction.

Implications for Public Policy 

As we have seen in other countries that embarked on serious drug policy reform, the scope and urgency of the opioid crisis are shifting policy attitudes, making significant change possible. Policymakers often overestimate the public’s appetite for enforcement-oriented, punitive approaches to criminal justice issues; our results suggest that, at least in Maine, these policies do not accurately represent constituents’ desires. 

We suspect that our state is not alone in this trend. Simply put, it is hard to sustain stigmatizing rhetoric about people who struggle with substance use when those people are not abstractions, but one’s friends, family, and neighbors. Furthermore, the data suggest that individuals struggle to support enforcement-oriented approaches when they observe how these policies can fail in helping people they know on their path to recovery. While the substance use and overdose crisis has devastated communities across the country, the sheer number of those affected can be the basis for a new policy mindset, one receptive to investing in public health and harm reduction.