ANNAPOLIS, MD — Today, the Maryland Department of Health released its Unintentional Drug And Alcohol-Related Intoxication Death Report for the entirety of 2017 and the first quarter of 2018. Following Governor Larry Hogan declaring a State of Emergency to combat the heroin and opioid crisis in March 2017, Maryland’s Opioid Operational Command Center has been working with state agencies and local jurisdictions to address the epidemic.
“Maryland, like other surrounding states, saw overdose fatalities increase in 2017,” said Clay Stamp, executive director of the Opioid Operational Command Center. “Every day, the state and its federal and local partners are working hard to save the lives of the Marylanders caught in the grips of addiction. We’ve made progress in expanding access to treatment and recovery services, disrupting and dismantling drug trafficking organizations, and beginning to re-educate our youth on the dangers of drug use – but there is still work to be done in fighting this destructive crisis that is evolving daily.”
In June 2018, the Hogan-Rutherford administration announced $40 million in new funding to fight the heroin and opioid epidemic. The funding for Fiscal Year 2019 includes $29.4 million from the Hogan-Rutherford administration, $10 million from the federal 21st Century Cures Act, and $1.2 million from the Governor’s Office of Crime Control and Prevention.
This week, Maryland was awarded a $1,975,085 grant from the U.S. Department of Labor to provide reemployment services for individuals impacted by the health and economic effects of widespread opioid use, addiction, and overdose. Five other states received this National Health Emergency Dislocated Worker Demonstration Grant funding.
“Maryland is one of six states that received funding to develop programs within the state to directly address the opioid epidemic. Skills training for peer recovery specialists is critical to the ongoing care necessary for a full recovery, as well as reemployment efforts for those looking to reenter the workforce,” said Secretary Kelly M. Schulz, Maryland Department of Labor, Licensing and Regulation. “This is an example of how Maryland is engaging the business community to offer opportunities for those in recovery to re-renter the workplace, which is key to their continued recovery.”
“During 2017 and the first quarter of 2018, fentanyl-related deaths in Maryland have continued to rise at an alarming rate,” said Maryland Department of Health Secretary Robert R. Neall. “In the first three months of 2018 alone, 500 Marylanders lost their lives due to fentanyl. In addition to often being mixed with heroin, this incredibly dangerous drug is now finding its way into other substances, especially cocaine, resulting in even more overdose deaths.”
Maryland’s opioid crisis is evolving as fentanyl, typically combined with cocaine or heroin, is driving the increase in overall overdoses in 2017 and in the first quarter of 2018 – and so is the state’s response to it, which includes addressing the epidemic from every possible angle. Education and prevention go hand-in-hand with treatment and recovery, and enforcement – all are essential components of the state’s efforts to turn the tide of this epidemic.
EXPANSION OF TREATMENT AND RECOVERY SERVICES
Hospital Emergency Department Overdose Response – The Maryland Hospital Association (MHA) surveyed the discharge protocols for all Maryland hospitals and developed consensus recommendations on four core components that should be provided to patients who were treated for a drug overdose or were identified as having a substance use disorder. Recommended emergency department protocol components include universal screening, linkage with a peer recovery specialist, access to naloxone upon discharge, and a warm hand-off to a treatment program and/or the first dose of medication-assisted treatment, as appropriate.
Through state and federal funding, 15 hospitals in Maryland now offer Screening, Brief Intervention and Referral to Treatment (SBIRT), to patients in their emergency departments, as well as additional services from peer support specialists to ensure that high-risk individuals are able to access treatment upon release. Work continues with other hospitals to expand this program.
Correctional Facility Screening and Treatment – State and federal funding has expanded SBIRT to six detention centers, with a focus on pre-trial treatment coordination and case management. Five detention centers received funding to provide medication-assisted treatment and care coordination to individuals upon release. Twenty detention centers provide substance use treatment services in their facilities, many coordinated through their local health department offices.
The Medicaid State Plan also has been amended to expand health care and treatment coverage for individuals leaving jail or prison. The Maryland Department of Health (MDH) and Department of Public Safety and Correctional Services are working together to enroll exiting inmates for services, through Medicaid’s expansion under the Affordable Care Act, prior to their release. In 2017, local health departments established a pre-and post-release Medicaid enrollment processes in 22 detention centers. The local health departments also initiated a referral process with six parole and probation sites to assist applicants to enroll in Medicaid.
Removing Barriers to Treatment Coverage – The Maryland Medicaid expansion, through MDH, has greatly increased access to substance use disorder treatment, with more than 9,000 individuals receiving residential treatment services paid for by Medicaid and state-funded programs in FY 2018.
The Maryland Insurance Administration (MIA) continues to help individuals with substance use disorder navigate the private insurance system with resource materials for consumers and providers, webinars, and events across the state.
Recovery and Academic Support for Students – In May, Lt. Governor Boyd Rutherford joined Karen Salmon, Maryland State Superintendent of Schools; Michael Durso, president of Montgomery County Board of Education; and Jack Smith, superintendent of Montgomery County Public Schools to announce a recovery and academic program. Partnering with Family Services, Inc., this academic program supports students who are in substance use recovery and are committed to maintaining sobriety. The program is located at The Landing, part of Family Services, Inc., in Gaithersburg. This pilot program will be monitored for possible expansion if successful.
Disrupting Trafficking of Illicit Opioids – Law enforcement partners continue to work together to dismantle and disrupt drug trafficking organizations. Federal, state, and local law enforcement agencies supported by the Washington/Baltimore HIDTA (High Intensity Drug Trafficking Areas) seized 119 kg of heroin and 35 kg of fentanyl in Maryland in 2017.
As a component, the Maryland Criminal Intelligence Network (MCIN), led by the Governor’s Office of Crime Control and Prevention (GOCCP), was established to develop a state network of criminal justice agencies focused on identifying, disrupting, and dismantling criminal networks through collaboration and comprehensive data sharing, both locally and statewide. This is a key element of Maryland’s public safety strategy which provides the basis for data-driven decision-making.
“MCIN is an integral part of our fight to reduce overdose deaths in the state and a commitment by Governor Hogan,” said Glenn Fueston, executive director of GOCCP. “From the Heroin Coordinator Program – where data is funneled into a central location to help identify those who need help and those trafficking heroin into our communities – to programs that are increasing our understanding of the flow of drugs from source cities overseas into our neighborhoods, all of these components are helping us to stop these criminals who are bringing this poison into our communities.”
Crime Reduction – GOCCP provides funding to the Baltimore City Police Department for the Law Enforcement Assisted Diversion (LEAD) program, an evidence-based crime reduction strategy which diverts low-level offenders to treatment and support services, rather than the criminal justice system. MDH is partnering with GOCCP to expand the LEAD program to other Maryland jurisdictions in FY 2019.
Reducing Dangerous Prescribing Practices – As of July 1, 2018, all controlled dangerous substance prescribers in Maryland are required to access Prescription Drug Monitoring Program (PDMP) data before prescribing opioid and benzodiazepine medications in many clinical situations. Prescribers were required to register with the PDMP starting July 1, 2017. This effort was designed to ensure providers utilize this important clinical tool in making prescribing and other treatment decisions with patients. More than 31,000 prescribers in Maryland are now registered in this program. In addition to this, MDH’s Office of Controlled Substances Administration engaged in more than 1,000 regulatory inspections in FY 2018.
Proper Disposal of Prescription Drugs – From July 2017 to June 2018, Maryland State Police collected more than 11,300 pounds of old and unused prescription drugs.
PREVENTION AND EDUCATION
College and Universities – The Maryland Higher Education Commission (MHEC) met with colleges and universities in Maryland who made a commitment to address the opioid epidemic through education and outreach. Many campuses have implemented initiatives to educate both their student body and the future workforce. Additionally, campuses have naloxone training and have policies in the use of the overdose-reversing medication. MHEC also partnered with system, Maryland Independent Colleges and Universities, Maryland Association of Community Colleges, Morgan State University, and St. Mary’s College of Maryland to promote a public service campaign video to educate residents to take unused, unwanted, or out of date drugs to a secure location in an effort to stop opioid abuse for National Drug Take Back Day in April.
Educating Maryland’s Youth – The Maryland State Department of Education (MSDE) provides support and resources to help school systems deliver best practices substance use prevention education in their classrooms. The Heroin and Opioid Awareness and Prevention Toolkit has been widely distributed, and embraced by several states as an effective weapon against substance abuse. MSDE is creating an online course module that will be available to those teaching drug addiction and prevention education. Additionally, MSDE provides clear and consistent guidance for school system partners on the safe storage and disposal of prescription drugs, and partners with law enforcement to support substance use disorder prevention efforts and drug take-back programs.
“In order to change the course of our future, we must draw a line around our youth in an effort to protect them and educate them on the serious dangers of drug use,” said Stamp.
Local Health Department and Community Police Outreach – “The Prince George’s County Health Department, along with health departments across the state, have an essential role in the battle against opioid addiction. Just in the last year, our training and distribution of more than 600 naloxone kits has been saving lives,” said Prince George’s County Health Officer Pamela B. Creekmur. “The Prince George’s County Health Department provides free trainings to community residents, school nurses, first responders and families. In addition, the Health Department has partnered with the Prince George’s County Police Department to conduct more than 200 follow-up visits to households where a 911 call came in for an overdose. County police officers, case managers and peer recovery specialists are working together so that our residents have the resources they need to defeat this deadly disease of opioid addiction.”
Those teams have provided educational flyers, treatment resources, and naloxone kits. Community police officers engaged first, then health department teams, including peer recovery specialists and case managers, provided follow-up support and services to those at risk for overdose.
Community Awareness and Education – Project Purple, a prevention and substance use awareness campaign which launched in Talbot County last year, included visits to schools, sporting events, civic organizations, homeowner associations, and business owners with educational messages related to prevention, early intervention, and recovery. A “promising practice” that the Opioid Operational Command Center identified and shared widely among jurisdictions, multiple Maryland jurisdictions have adopted it for this coming year.
“For our first year with Kent Goes Purple, we’re getting the message out that prescription painkillers are not safer than heroin, when used recreationally or other than as prescribed,” said John Price, Kent County Sheriff. “We invite you all to take a stand with us against substance abuse and ‘Go Purple’ this September. Let’s turn the tide of this epidemic, together.”
Washington County Health Department staff has been working with numerous law enforcement and mental health agencies to more successful implement the core principles of harm reduction by offering community outreach to combat the opioid epidemic. “We seek to meet people where they are physically, mentally, and spiritually,” said David A. Washington, program coordinator in the Division of Behavioral Health Services. “We’re out in the neighborhoods, and at the local library, in Hagerstown weekly, forming relationships, all with the goal of connecting those who desire substance use disorder treatment or resources and services.”
OPIOID INTERVENTION TEAMS
Opioid Intervention Teams (OITs) are set up in each of Maryland’s jurisdictions and led by the emergency manager and health officer. They are multi-agency coordination bodies that coordinate with the community, and complement and integrate with the statewide opioid response effort. Through the third quarter of FY 2018, OITs have reported the following notable accomplishments:
- Eleven OITs reported activities related to increasing access to naloxone in their jurisdictions.
- Nearly one million individuals have been exposed to opioid messaging and information campaigns through a variety of activities, such as public service announcements (PSAs), websites, social media, and mass mailings.
- Fourteen OITs have implemented a variety of education, training, and informational events, including naloxone training, for professionals and community members (health care providers, law enforcement, school personnel, students, and other stakeholders) on opioid misuse and prevention.
- OITs combined have hosted more than 100 educational or training events, and reached more than 5,000 individuals.
- Seventeen jurisdictions have implemented strategies to identify, refer, and link individuals to opioid use disorder treatment services, including medication assisted treatment, high intensity residential treatment, and crisis stabilization services.
- Thirteen OITs implemented recovery support strategies to improve access and enrollment to recovery support services and peer recovery support services.
“We are hopeful about the progress we’ve made in the battle against the opioid epidemic. While there is still work to do, we believe that initiatives and programs we have implemented in Howard County, such as expanding our community naloxone program and increasing service hours with Grassroots Crisis Intervention Center, are making a difference as evidenced by a reduction in fatal overdoses,” said Dr. Maura Rossman, health officer, Howard County.
Before It’s Too Late is the state’s effort to bring awareness to this epidemic—and to mobilize resources for effective prevention, treatment, and recovery. Marylanders grappling with a substance use disorder can find help at BeforeItsTooLateMD.org or by calling 211 and pressing 1.