As many of us know, our nation is in the midst of an opioid epidemic that has steadily gotten worse over the last 20 years. Opioids are a class of drug formulated to replicate the pain reducing properties of opium. These drugs include heroin and prescription pain relievers (i.e. oxycodone, morphine, fentanyl, etc.) According to a 2016 study by the American Society of Addiction Medicine, overdose death rates, sales and substance use disorder treatment admissions related to opioids all increased in parallel between 1999 and 2010. The overdose death rate in 2008 was nearly four times the rate in 1999; sales of prescription pain relievers in 2010 were four times higher than they were in 1999; and the substance use disorder treatment admission rate in 2009 was six times higher than it was in 1999.
A State of Emergency
Facts and figures for 2017 are still being compiled, but according to CNN there were more than 63,000 overdose deaths in the United States in 2016. Of these 63,000 deaths, 42,249 (or 66.4%) of these overdoses involved opioids; that’s an average of 115 opioid-related overdose deaths each day for the year in 2016. In the first half of 2017 (January through July), 1,029 opioid-related deaths were reported in Maryland, more than triple the number for the same period of time in 2012. The larger issue in Maryland seems to be fentanyl and carfentanil, synthetic opioids that are 50 and 100 times more powerful than heroin, respectively. While deaths from heroin and prescription opioids seemed to level off in the first half of 2017, Maryland saw a sharp spike in fentanyl-related deaths during that same period. In the first quarter alone, the state reported 372 fentanyl-related deaths; but by June that number had more than doubled to 799 deaths.
It was likely this uptick in deaths that lead Governor Larry Hogan to declare a State of Emergency in response to the epidemic, making him the first governor in the nation to do so. The declaration activated the Governor’s emergency management authority and enabled increased and more rapid coordination between state agencies and local jurisdictions. Governor Hogan and Lt. Governor Boyd Rutherford announced at the time $50 million in new funding to address the crisis and appointed the Governor’s senior emergency management advisor Clay Stamp to lead the state’s coordinated effort to combat the crisis. Stamp is the head of the Opioid Operational Command Center (OOCC), which is an effort to bring together state and local partners to support prevention, treatment and enforcement efforts combating the heroin and opioid crisis in Maryland.
2018 Plan of Action
In January of this year, the Hogan-Rutherford administration announced their 2018 Anti-Opioid initiatives. In short, the plan provided a go-ahead for Maryland Attorney General Brian Frosh to file a lawsuit against opioid manufactures; announced preliminary plans to convert the former Men’s Correctional Facility in Baltimore into a secure treatment facility; outlined enhancements for data sharing among first responders; and proposed to strengthen the volume dealer law to include fentanyl.
Filing Suit- The governor authorized Attorney General Brian Frosh to file suit against select opioid manufacturers and distributors on the grounds that they have misled the public and helped to create the addiction crisis not only in Maryland, but the nation. In his directive to Frosh, the governor stipulated that 100% of any proceeds recovered in the suit must be directed toward the development of opioid treatment, prevention and education programs. Four jurisdictions in Maryland, Anne Arundel, Prince George’s, and Montgomery counties and Baltimore City, have independently filed suit against specific opioid manufactures. Frosh has said that his office does not have the resources to file a separate suit at the governor’s request, but is involved in a 41-state investigation into opioid companies.
Treatment- the Hogan-Rutherford administration announced plans to conduct a feasibility study on converting a portion of the former Baltimore City Men’s Detention Center into a therapeutic detention facility for incarcerated individuals. According to a press release from the office of the governor, data shows that 60% of incarcerated individuals in Baltimore suffer from a substance abuse disorder. With regard to participant eligibility the administration has emphasized the distinction between high-level dealers who are responsible for trafficking these dangerous drugs into our neighborhoods and nonviolent users who are struggling with addiction by providing them with the support they need to become productive members of society.
Prevention- As part of the 2018 plan, Governor Hogan also introduced the Overdose Data Reporting Act to allow EMS providers and law enforcement to input and share data about opioid overdoses. With access to this kind of data, first responders will be able to track and respond to an extremely potent batch of opioid in specific areas, allow them to allocate resources (like naloxone), almost in real time. This piece of legislation will make Maryland one of 27 states to use this technology to inform its first responders, identify trends and ultimately prevent overdose deaths. Additionally, the Prescription Drug Monitoring Program (PDMP) mandate will go into effect on July 1, 2018. This mandate requires healthcare providers to check medication history via the online PDMP registry before prescribing opioids. Maryland joins 40 other states requiring PDMP checks as part of the prescribing process to ensure the safe and appropriate use of opioids.
Enforcement- Governor Hogan also outlined legislation to strengthen the state’s enforcement efforts by expanding the state’s Volume Dealer Law. The Volume Dealer Law allows for the prosecution of high-level drug traffickers who deal in large quantities of controlled substances, but it does not currently cover fentanyl or its equivalents. The legislation will also update the law to treat heroin consistent with its treatment of cocaine. The Hogan administration also introduced emergency legislation on the first day of its 2018 session that would allow prosecutors to work across jurisdictional lines to build cases and crack down on violent criminal gangs trafficking drugs into the state.
To get all of this done, the Fiscal Year 2019 budget includes $159 million to non-Medicaid substance use disorder and addiction programs, $13.7 million in new funding for the state’s response to the heroin and opioid epidemic, a $3 million grant to fund local boards of education to implement prevention and education programs and provides $1.2 million to expand treatment programs.
Before It’s Too Late
If you or someone you know is struggling with substance use disorder please know that there are resources out there to help you. The OOCC launched Before It’s Too Late, the state’s effort to bring awareness to the heroin and opioid epidemic. Before It’s Too Late also provides resources for effective prevention, treatment and recovery from substance use disorder. Marylanders who are grappling with a substance use disorder can find help at BeforeItsTooLateMD.org or can contact the state’s crisis hotline at 1-800-422-0009.