Salisbury and Wicomico law enforcement, health officials and political leaders are stepping up to raise community awareness on opiates abuse and seeking ways to stem what is threatening to become a health and social epidemic.

A look at the numbers reveals that prescription-opioid abuse becomes a path to heroin use. Doctors have long prescribed opiates for various pain-relieving reasons. Tighter controls on opiates, however, forced an end to so-called “doctor shopping” practices, in which the addicted sought care from multiple physicians who didn’t know what their colleagues were already doing.

“When the source of their pills dried up,” said Lt. Tim Robinson of the county Sheriff's Office, “the addicts went to the streets.”

For anyone who’s developed an addiction prescription opioid abuse, heroin often provides an alternative.

“People can buy a pill for on the street for $35 or a bag of heroin for $7, said Beth Ohlsson, executive director of the Salisbury Substance Abuse Community Center. “Which do you think they’re more likely to do?”

Tighter controls have also prompted campaigns to educate folks about the dangers of using these drugs without a legitimate prescription.

Prescription-related deaths have declined, but deaths from street drugs are climbing.

For both 2013 and 2014, Wicomico's heroin death rate per capita was the second-highest in the state, with only Baltimore City having a higher per-person figure. In all of Maryland, according to the state Department of Health and Mental Hygiene, there was a 21 percent increase in the number of deaths in 2014 compared with 2013’s data.

DHMH’s annual reporting describes trends in the number of unintentional drug- and alcohol-related intoxication deaths, commonly referred to as fatal overdoses, occurring in Maryland during the period 2007-2014. Among the major findings:

A total of 1,039 overdose deaths occurred in Maryland in 2014. This also represented a 60 percent increase since 2010.

Exactly 887 (or 86 percent) of all overdose deaths in 2014 involved opioids – which include heroin and prescription drugs such as oxycodone, methadone, and fentanyl. Large increases in the number of deaths involving heroin and fentanyl were responsible for the overall increase in opioid-related deaths:

The number of fentanyl-related deaths more than tripled between 2013 and 2014, increasing from 58 in 2013 to 185 in 2014. The number of fentanyl-related deaths began increasing in late 2013 as a result of overdoses involving an illicit form of fentanyl that increasingly has been mixed with, or substituted for, heroin or other illicit substances.

There were 578 heroin-related deaths in 2014, a 25 percent increase over the number in 2013. Heroin-related deaths have more than doubled in Maryland between 2010 and 2014.

In Wicomico, the number of deaths associated with drug overdose has climbed dramatically. In 2014, 20 people died from drug overdoses, up from nine people in 2007.

That outpaces the number of homicide deaths during that same period.

State and local leaders have taken notice and vowed action.

Gov. Larry Hogan established the Heroin and Opioid Emergency Task Force and a separate Inter-Agency Coordinating Council. Both groups work and support efforts to address Maryland’s growing heroin and opioid crisis.

The task force, led by Lt. Gov. Boyd Rutherford, has regularly met -- a forum was held at St. Francis de Sales Catholic School in Salisbury -- and has sought input and guidance from a wide variety of sources throughout the state, including academicians, law enforcement and health care officials, and state residents affected by cycles of addiction.

DHMH has been collaborating with state and local partners to try to reduce overdoses, and has been actively combating and responding to the increase in overdose deaths. The department also has expanded access to Naloxone (also known as Narcan) statewide; in May, Hogan signed legislation that expands DHMH’s Overdose Response Program.

The program already has trained more than 5,500 individuals since March 2014, including more than 2,300 law enforcement officers.

In the city of Salisbury, officers are prepared to assist when an overdose occurs: More than 50 city Police Department officials have been trained in the use of Naloxone.

 Wicomico’s ‘Don’t Tag Alone’ campaign

 County health leaders recently began a new campaign to educate residents about the dangers of heroin and opioid abuse.

The “Don’t Tag Along” campaign is designed to showcase just how dangerous heroin and other opioid drugs can be. Through a combined media campaign that includes billboards, radio, television and print ads, the Health Department is using state and federal grant funds to try and stem the body count that is destroying families.

“Saving people’s lives is our ultimate goal,” said Wicomico County Health Officer Lori Brewster. “Heroin and opioid abuse affects our entire community, from poverty and crime, to homelessness and health issues. We need to a multi-prong approach to this issue but it all starts with education and awareness.”

Treatment programs managed by the Wicomico County Health Department make it sixth in the state for heroin addiction at treatment facilities. The county has one of only two methadone clinics on the Eastern Shore and four years ago had 25 patients accessing the treatment program. Today, there are approximately 270 patients using the methadone treatment program.

“The profile of today’s heroin and opioid users is no longer the addict on the corner,” said Wicomico County Executive Bob Culver. “All levels of society have been impacted. This epidemic demands public and private commitments, resources and education. Heroin is cheap and accessible.”

Culver also identified the crime aspects that accompany the drug use.

“Rashes of crimes burden law enforcement, health and social services and family resources,” Culver said. “Wicomico County joins our community to combat this horrific epidemic that has invaded our homes, schools and communities.”

Sheriff Mike Lewis echoed those concerns.

"The opioid and heroin issues facing American families is of epidemic proportions, and unfortunately, no one is immune from its devastating consequences,” Lewis said. “However, through the partnerships of committed law enforcement and health care professionals here in Wicomico County, we are reclaiming lost lives, one day at a time."

No ‘wishing it away’

County health officials explain that many addicts may get started with a legitimate prescription for pain after an injury. It doesn’t take long for abuse of that drug to occur, and then patients scramble to find pills to take away pain.

When doctors no longer write prescriptions, patients turn to illegal drugs likes heroin which at one time had more of a stigma associated with it. Now that heroin is more readily available, and no longer requires a needle to shoot up, health officials say its abuse has become widespread.

“The real tragedy with heroin is how it takes complete control of a person’s life,” Brewster said.

“People are driven to commit crime to fund their drug habit. It destroys families. It destroys lives. But treatment is available and addicts need to reach out for help. You cannot kick heroin abuse simply by wishing it away.”

While individuals and families are suffering from heroin addiction, the community itself is battling the effects as well. About 10 percent of all babies in the neo-natal unit at PRMC are suffering from neonatal abstinence syndrome as a result of their mother’s drug addiction.

Shoplifting and theft is on the rise as a result of people trying to feed their drug habit.

“Most of our crime -- the overwhelming majority of our crime right now -- is property crime fueled by drug use, fueled by heroin addiction,” said Robinson of the Sheriff’s Office.

“They're looking to steal whatever they can steal to get cash for, and they’re either selling it on the street or they're taking it to pawn shops to get the cash.

“They’re not using (the cash) to pay the utility bills, they're not using it to pay their rent or their groceries -- they're using it to go get heroin,” he said. “If it's not nailed down, they will take it.

The county’s top prosecutor calls the situation unprecedented.

“We are in the midst of an epidemic the likes of which we have never experienced,” said State’s Attorney Matt Maciarello. “We are seeing overdoses skyrocket and we have attended the funerals of those who tragically succumbed to their addiction.

“It is clear that the best way to address this scourge is to get all hands on deck employing intervention and prevention strategies which will complement police efforts to disrupt and dismantle gangs and groups peddling this poison to our citizens,” he said.

As a  law enforcement officer, Robinson said his and his colleagues’ job is to arrest people who break the law. And, he said, an arrest is a sure-fire way to “get an addict’s attention.”

“Our responsibility to do something to end this cycle,” he said. “When we do initiate prosecution, that's actually in the best interest of these people. “Once we get them in the system, it opens up so many more doors that are available to assist an individual who has a heroin addiction -- it's a never ending cycle with some of these folks.”

But the SAC Center’s Ohlsson said the problem is too big for the police to solve.

“We can’t arrest our way out of this crisis,” she said.