The Mills administration is taking the next steps to combat the opioid crisis, focusing its attention on what advocates say are key areas – increasing housing and residential treatment programs.

The administration’s initial actions in 2019 increased access to outpatient treatment, largely by expanding Medicaid. Under expansion, more than 5,700 Mainers are now receiving treatment for substance use disorder.

But Mainers continue to perish at near-record rates from the opioid crisis, with 354 overdose deaths in 2018 after there were a record 417 in 2017.

Now state officials are turning to housing, which is a key component to recovery, but a complex problem, experts say.

“You really can’t expect and hope that people who don’t have a roof over their head are going to be successful in their recovery,” said Gordon Smith, the director of opioid response for the Mills administration.

A new $1.7 million housing initiative will center on providing housing for 50 chronically homeless people who have opioid use disorder. Nonprofits have until Wednesday to submit bids, and the program is expected to start early next year.

The Maine DHHS also is requesting a federal waiver to boost residential treatment programs, and the state is providing incentives to independent recovery homes to allow residents to have medication-assisted treatment – usually Suboxone – in the homes.

Traditionally, many recovery homes bar residents from having Suboxone or similar medications at the homes, fearing that those pills will be diverted to street sales. Medication-assisted treatment is considered the “gold standard’ for opioid use disorder, and relapse rates are far higher in abstinence-based programs.

Rep. Drew Gattine, D-Westbrook, sponsored the bill that created the homeless pilot program. Gattine said that while the state allocated $1.7 million for the bill, getting homeless people into housing will save on other costs, such as the reduced use of emergency rooms and jails.

Gattine said the bill is designed to promote flexibility in how services are delivered, but there must be an urban and rural component. He expects that providers will offer housing vouchers combined with medication-assisted treatment, counseling and other supports.

Jane Drew, who was recently homeless for seven months and is now living in a 55-plus apartment complex in Portland, said she saw a lot of drug use near Portland’s Oxford Street homeless shelter.

“Housing is vital. If you want to be in recovery, Oxford Street is not the place to do it,” said Drew, 55, an advocate for the Homeless Voices for Justice group.

Drew said she did not have substance use disorder but saw many homeless people who were afflicted. Aside from the stability of housing, having your own place means you can control your space, so it’s easier to avoid being tempted by drug users and dealers, she said.

In another effort, the Maine Department of Health and Human Services is asking the federal government to lift a cap that limits nonprofits that offer residential treatment to 16 beds. Residential treatment is expensive, but some people need a more intense residential program.

The U.S. Centers for Medicare and Medicaid Services already has approved requests from 26 states to lift the cap on treatment beds, the Kaiser Family Foundation says.

The Maine DHHS estimates that, initially, federal approval would open up 30 additional residential treatment slots.

The cost would be about $1 million in federal and state tax dollars, but that would be offset be reduced emergency room visits for drug overdoses, possibly saving as much as $6 million in tax money per year, according to Maine’s application.

Cullen Ryan, executive director of Community Housing of Maine, a Portland-based nonprofit that develops, owns and maintains affordable housing, said momentum is building to increase housing opportunities for those with substance use disorder.

“The lack of affordable housing is a huge obstacle,” Ryan said. “But there’s now a lot of efforts underway. The action is finally occurring after waiting a long time for it.”

Ryan said housing the homeless “saves lives and money.”

The state also has asked the federal government to approve the use of Medicaid funding for an array of prevention programs, such as parenting education, and to permit those who have had their children removed to maintain their Medicaid eligibility while working toward family reunification. DHHS estimates that 400 parents could lose Medicaid eligibility if their children are removed from the home.

Jackie Farwell, Maine DHHS spokeswoman, said Maine hopes to gain federal approval for four pilot projects to support Medicaid-enrolled parents with substance use disorder who are involved or at risk of involvement with the state’s child protective services division.