BALTIMORE — The Department of Health and Mental Hygiene has posted to its website the third-quarter 2016 data report of fatal overdoses. According to preliminary data, from January to September, Maryland saw 1,468 deaths related to overdoses. The report is posted at https://goo.gl/oNlvlz.
“This epidemic continues to cut across all demographics and communities,” said Secretary Dennis R. Schrader. “All Marylanders need to know they can find treatment options for substance use disorders at MdDestinationRecovery.org. To not seek help for a drug problem now is to risk death. Please seek help now.”
The data show how fentanyl and heroin continue to drive the overdose scourge — whether Marylanders are taking only those opioids or are mixing them with other substances. Some users think they are buying heroin, long known for its fatal-overdose risk, and are actually buying even deadlier fentanyl, which is several times more potent. In January 2016, Health and Mental Hygiene issued a warning about such fentanyl consumption driving the overdose trend. The department continues to repeat that warning.
Fighting substance-use disorder and the opioid epidemic in Maryland has been a major priority of Maryland Gov. Larry Hogan’s administration. Earlier this year, Health and Mental Hygiene released the annual report of fatal overdoses from 2015. That report logged a total of 1,259 overdose deaths in Maryland in 2015. The number of intoxication deaths had nearly doubled since 2010.
Naloxone access expanded
Health and Mental Hygiene has been collaborating with federal, state and local partners to try to reduce the number of overdoses and has been combating and responding to the increase in overdose deaths. With support from Governor Hogan, the department has expanded access to naloxone, a life-saving drug that can reverse opioid-related overdoses.
In December 2015, a standing order under Deputy Secretary Dr. Howard Haft was issued. The order allows all Maryland-licensed pharmacists to dispense naloxone without a prescription to anyone trained and certified under the Department’s Overdose Response Program. Health and Mental Hygiene has authorized 55 organizations to conduct naloxone trainings and to issue certificates, including local health departments, substance-use treatment programs, community organizations and law enforcement agencies.
As of this month, more than 39,000 people have been trained by these organizations since the program was established in March 2014.
The Maryland Good Samaritan Law was established in 2009 and amended in 2013 and 2015. The Good Samaritan Law protects people assisting in an emergency overdose situation from arrest, as well as from prosecution in certain crimes. It also protects a person from violation of a condition of pretrial release, probation or parole if the evidence of the violation was obtained solely as a result of a person seeking, providing or assisting with medical help to save a life. In an effort to educate the public about the Good Samaritan Law, the department has established an ambassador program with representatives from the advocacy community to reach out to each jurisdiction and to educate stakeholders about the law. Signage is being made available to all local health departments, local addiction authorities, law enforcement, courts, juvenile centers and other stakeholders. A public service announcement will debut soon on local TV stations and theaters.
Scope of Pain
Because opioid addiction often has its roots in prescribed medication, Health and Mental Hygiene last year co-sponsored Scope of Pain, a prescriber-education seminar that trained providers in managing their patients’ chronic pain but in ways to avoid facilitating addiction to opioids. Clinical provider education and resources continue to be a critical focus of the department’s addiction-prevention strategy, being achieved through Continuing Medical Education and the Prescription Drug Monitoring Program (PDMP). Maryland’s PDMP allows providers and pharmacists access to their patients’ history of such prescribed controlled dangerous substances (CDS) as prescribed opioids. Prescribers of CDS and pharmacists will be required to register with the PDMP by July 2017 and obtaining a permit to prescribe CDS in the future will be dependent on prior PDMP registration to obtain a Controlled Dangerous Substance permit.
The Department is also expanding access to Screening, Brief Intervention and Referral to Treatment (SBIRT). SBIRT is an evidence-based tool designed to identify individuals who have the potential for substance abuse and to provide medical intervention. It has been implemented for adult patients in 22 primary care locations throughout seven jurisdictions in Maryland (Baltimore City, Baltimore County, Prince George’s County, Montgomery County, Carroll County, Anne Arundel County and Harford County). The Department is implementing SBIRT in the emergency departments of three Baltimore-region MedStar hospitals (Good Samaritan, Franklin Square and Union Memorial). The goal of this five-year project is to conduct 90,000 screenings; more than 81,000 patients have been screened.
Survivors Outreach Program
Because people who die from overdoses often have histories of hospitalization for nonfatal overdoses, the department also has been working to intervene in Marylanders’ lives after they survive an overdose. The Overdose Survivors Outreach Program is an initiative to improve health outcomes for overdose survivors or those at risk for overdose by collaborating with hospitals and local health departments to facilitate interventions by Peer Recovery Specialists in the emergency department. If a patient has overdosed, or is at risk for overdose, the peer will work with the patient to assist them in enrolling in treatment or support services. If she or he is not interested in treatment, the peer will obtain consent to refer them to an outreach peer at the local health department, who will contact them via phone or field call a day or two after presenting in the emergency department, and will periodically check in to assess their needs and willingness to enter treatment. As of December 2016, four hospitals in Baltimore City and two in northern Anne Arundel County are participating in the program, with plans to expand post-discharge outreach services for multiple other hospitals in the coming months.
Maryland Medicaid’s waiver renewal has just been approved by the federal Centers for Medicare and Medicaid Services. The waiver will allow Maryland Medicaid to reimburse for residential substance use treatment services delivered in large facilities, known as Institutes for Mental Diseases. Maryland Medicaid also is instituting an initiative that will prioritize the role of counseling to Marylanders by facilities that provide Medicine Assisted Treatment. The process would change the Medicaid reimbursement amounts to MAT providers.
Medicaid also has implemented a Corrective Managed Care program to identify participants who may be utilizing excessive quantities of controlled substances, especially when multiple prescribers and pharmacies are involved. Each month, specific participants are identified, their drug and diagnosis histories are reviewed and a determination is made whether an educational intervention letter should be sent to all prescribers and pharmacies affiliated with those participants. If intervention letters are insufficient and drug utilization does not improve, Medicaid participants can be restricted to a single pharmacy to reduce possible misuse or diversion.
Marylanders who need help finding substance related disorder treatment resources should visit MdDestinationRecovery.org or call the Maryland Crisis Hotline, which provides 24/7 support, at 1-800-422-0009. For information on many of the policies currently implemented to fight substance related disorders and overdose in Maryland, see http://goo.gl/KvEzQw. If you know of someone who could use treatment for substance related disorders treatment facilities can be located by location and program characteristics on our page at http://goo.gl/rbGF6S.