Combating an evolving epidemic

Gov. Hogan, Dorchester County leaders respond to increasing threat of opioids

CAMBRIDGE — For Gov. Larry Hogan, addressing the heroin and opioid epidemic in Maryland is a top priority. Since his campaign for governor began in January 2014, he has heard a cry for help from communities across the state, from the most urban to the most rural.
According to the governor, who spoke recently on heroin and opioids, a concentrated and cohesive effort is needed to combat the epidemic. This includes prevention, treatment, law enforcement, interdiction and education. Federal and state governments must work with communities throughout the country, faith-based institutions, volunteer groups and families to confront the scourge.

In Dorchester County, government leaders and community members are doing what they can to curb the epidemic. These community leaders and the governor agree that more efforts, funding and awareness are needed.

‘We have to attack it from every direction’

In a Jan. 24 news conference, Gov. Hogan and Lt. Gov. Boyd Rutherford announced the 2017 Heroin and Opioid Prevention, Treatment, and Enforcement Initiative — a multi-pronged and sweeping administrative and legislative effort intended to address the epidemic.

In introducing the initiative during the news conference at Anne Arundel Medical Center, Gov. Hogan said the heroin and opioid epidemic first became a priority three years ago at the beginning of his campaign for governor.

“I went into every small town and every county, whether it was a busy, bustling, urban county or a suburban area, or a small rural county,” The governor said Jan. 24. “Almost everywhere I went, I asked the local elected officials and some of the folks in the community, ‘What’s the No. 1 problem facing your community?’ And the answer was always the same. It was heroin. And I was a little bit shocked by that. …

“I knew heroin was a problem three years ago. When I first started looking at it, I had no idea how pervasive it had become,” Gov. Hogan said. “It was in our smallest county, our most rural town. It was in our suburban areas. It was in our cities. It was affecting every socioeconomic class — people everywhere. Families were being torn apart. Communities were being torn apart. It was killing people on our streets. …

“This was a crisis that nobody was paying attention to, not enough people were focused on,” Gov. Hogan said.

“It seemed as if it was being swept under the rug, and nobody would talk about it, because it’s a really hard problem to solve, and maybe it’s easier if you just don’t talk about it. But we decided to shine a spotlight on it, and to focus on it, and to try to save lives in our communities.”

The governor backed his campaign promise to take a hard look at heroin and opioids, and in 2015, he signed an executive order to create the Heroin and Opioid Emergency Task Force, chaired by Lt. Gov. Rutherford. The task force held summits across the state, including the Lower Shore Regional Summit held in June 2015 in Salisbury. The task force then developed 33 recommendations to address the opioid and heroin crisis. The recommendations focused on prevention, treatment and enforcement.

Gov. Hogan said during the Jan. 24 news conference that all 33 recommendations are being implemented to aggressively combat the epidemic, but still, more is needed.

Since 2014, overdose deaths related to heroin and opioids, as recorded by the Maryland Department of Health and Mental Hygiene, have risen sharply, even in Dorchester County. This is despite the governor’s efforts backed by an increase in state funding to curb the epidemic.

“We have to attack it from every direction,” The governor said Jan. 24. “It’s a crisis that is nearly doubling every single year, and it’s getting more and more dangerous, and it’s evolving as a crisis. The shift, recently, has been to fentanyl, and it’s a hundred times more powerful than heroin, and it’s killing people left and right — sometimes the first time they ever get exposed to it. The crisis is continuing to evolve and continuing to grow no matter what.”

Dorchester Banner/Executive Office of the Governor of Maryland
Gov. Larry Hogan signs an executive order to establish the Opioid Operational Command Center during a Jan. 24 news conference at Anne Arundel Medical Center. Behind the governor is Anne Arundel County Executive Steve Schuh.

As the crisis grows, so must the response, Gov. Hogan said. During the news conference, the governor signed an executive order to establish the Opioid Operational Command Center.  According to a Jan. 24 release from the governor’s office that followed the conference, “The center will facilitate greater collaboration between state and local public health, human services, education, and public safety entities to reduce the harmful impacts of opioid addiction on Maryland communities. As a direct result from increased collaboration, the center will collect and collate data — data that will be used to save lives.”

During the news conference, the governor announced that his proposed fiscal year 2018 budget includes $4 million in new funding to bolster the state’s efforts to support those struggling with heroin and opioid use. The proposed budget contains $1.3 billion for mental health and substance use disorders. New legislation including the Distribution of Opioids Resulting in Death Act, the Prescriber Limits Act, and Overdose Prevention Act, were also announced by the governor as part of the 2017 heroin and opioid initiative.

State’s attorney supports changes in Dorchester

While Mr. Hogan was surprised to learn of the rampant epidemic when he began his campaign, Dorchester County State’s Attorney William Jones was working hard to confront the problem. Mr. Jones said he began to see an increase in criminal heroin and opioid cases about five or six years ago, and he instructed his attorneys to give those cases special attention.

“Over the course of the last couple of years, Gov. Hogan has done a fantastic job of bringing this issue to the forefront,” the state’s attorney said in a Dec. 15 conversation with the Banner. “We already had it there (in Dorchester County). Certainly it was a priority to law enforcement already. It was a priority to me. It was a priority to the courts, but the governor really did a nice job with his task force that went around the state — hosted by the lieutenant governor — of making Marylanders aware of this issue.

“All of us knew. Law enforcement knew. I knew. The courts knew what a problem it was, but the public didn’t really know, and so I think that the governor’s task force, and the governor’s attention to this issue, has been instrumental in making sure that society within the state was aware of this issue.”

In response to Gov. Hogan’s heroin and opioid news conference, Mr. Jones released a Jan. 27 statement by email. In the email, Mr. Jones stated that he, “… applauds the announcement by Governor Hogan and Lt. Governor Rutherford regarding the 2017 Heroin and Opioid Prevention, Treatment, and Enforcement Initiative. These moves by the Governor and Lt. Governor are consistent with the beliefs of local law enforcement and public health professionals in Dorchester County, and will complement the efforts being taken locally.

“The State’s Attorney has stated publicly in the past that prescription drugs most commonly serve as the gateway to heroin and opioid addiction. Expansion of the Prescription Drug Monitoring Program by requiring mandatory registration by all providers, and requiring use of the system by certain providers, should have a real impact in terms of curtailing access to the prescription drugs that are abused and lead to the use and abuse of heroin and opioids. Reducing the access to these prescription drugs is a key component in our prevention efforts.”

Mr. Jones was already making a push in the county to better track the distribution of prescriptions. The state’s attorney testified during the June 2015 Lower Shore summit, and one of his key points was the need to reduce access to prescription opioids.

As part of the heroin and opioid initiative, the governor is hoping legislation to mandate a monitoring program will become law. In recent months, Mr. Jones has asked pharmacists in the county for voluntary participation.

“One of the things that does is that really allows the health care providers and the pharmacies to better monitor the doctor shopping, that sort of thing,” Mr. Jones said Dec. 15. “It also has the added benefit of keeping this issue at the front of the minds of the health care providers. We want them thinking about this. … Why give somebody a month’s worth if maybe a week’s worth will do? …
“Obviously, doctors do a great job of being on the lookout for that, but doctors see a lot of people during the course of a day. We want them thinking about that all the time, so I’m pushing hard on the Prescription Drug Monitoring Program because the quicker we see 100 percent participation, the better we will be in terms of reducing access as well.”

Mr. Jones also sees a need for criminal justice reform. In 2012, he was named by then-Gov. Martin O’Malley to a task force that studied laws and policies relating to criminals who could not afford an attorney. After meeting throughout 2012 and 2013, the task force made 16 recommendations. One recommendation was to implement a statewide system that employs risk-and-need-based supervision, referral and treatment options in all state counties. Another recommendation suggests that a pretrial services agency be created throughout the state.

Mr. Jones said that in some criminal cases involving substance users, six months can pass before they are ordered into treatment. A pretrial services agency, coupled with a supervised treatment referral program, could get people much needed help in a more timely manner. A pretrial services agency has been established in Washington, D.C., and it’s functioning well, according to the state’s attorney.

Right now in Maryland, Mr. Jones said in typical drug-use cases, “… by the time they get arrested, they wind through the system, maybe their case gets transferred to the circuit court, six months or more can go by before they’re ultimately sentenced, placed on probation, and then they have conditions of probation which include things like treatment.

“In a jurisdiction with a pretrial services agency, they’ll sometimes, as soon as someone’s locked up, screen them in, understand that there’s an addictions issue there, and in pretrial, get those addiction services in place immediately. … Why wait? Why wait two months or six months to get somebody in treatment? If somebody needs treatment today, lets find a way to get it to them today.”

Expanding services at the health department

Donald Hall joined the local fight against heroin and opioids in April when he became director of the Addictions Program at the Dorchester County Health Department. In an October roundtable discussion with the Banner, Mr. Hall drew attention to a need for expanded services at the Dorchester County Detention Center — services that could someday be addressed through pretrial screening.

“… When I met with detention center personnel, they told me 80 percent of people who go into the detention center had to be detoxed,” Mr. Hall said in October. “They expressed a real willingness to work with us and I want to be clear about that.”

Following arrests in Dorchester County for any alleged offenses, those arrested often find themselves at the detention center. This is regardless of the alleged crime that is committed. According to Mr. Hall, most of the people who end up at the detention center are substance users.

In response to a need for treatment, Mr. Hall brought on a counselor to work at the detention center. He recently hired another counselor — one will work with men and the other will work with women at the detention center. The counselors offer individual and group therapy, and can help steer users toward more treatment.

Mr. Hall is also working to introduce Vivitrol treatment at the detention center. Vivitrol is a prescription, injectable medicine used to prevent relapse to opioid dependence after detox. It can be injected monthly and is also used to treat alcohol dependence. Vivitrol blocks opioid receptors in the brain to prevent someone from getting high. To be effective, Vivitrol must be coupled with other treatment including therapy.

“Vivitrol is not a narcotic and not addictive, but it is a very effective medication,” Mr. Hall said during a Jan. 19 interview. “To me, it was really important to get in the jail to strengthen what we do. …” Also, “I really want to create a situation where we have a network in the community that’s looking at what’s going on.”

Through the health department and the Dri-Dock Recovery and Wellness Center, Mr. Hall is expanding programs in the county.

He has hired two more peer support specialists who will work from the Dri-Dock. Peer support specialists are people who are in recovery from addiction, and are certified to offer an array of services to users and family members in need of help. Working in Dorchester County, the peers are doing everything they can to get users off drugs. Mr. Hall, through the peers, is trying to expand services to county residents on parole or probation.

He recently hired a Narcan trainer. Narcan is a potentially life-saving drug that reverses the effects of an opioid overdose. With limited side effects, Narcan is available to anyone in the public who is willing to be trained and certified to use it. Mr. Hall’s aim is to offer monthly Narcan certification classes throughout the county, even the more remote areas.

Mr. Hall is also seeking two new social workers to better address the need to combat substance use. He said the addictions program recently received grant funding to provide recovery housing for people who are being released from jail that are already working in a recovery program.

Of all the programs Mr. Hall aims to implement or expand, he still sees one major need in the county.

“If we don’t address the kids, they’re going to be the next group ending up in the detention center,” he said Jan. 19. “I don’t think we have a lot of adolescent services. To bring on a social worker to help with adolescent substance use, I think is going to be a really big help.”

Wrap up

Editors note: This is the final part of a series of six stories about opioids, heroin and related issues in Dorchester County. The series appeared in the five most recent Friday editions of the Dorchester Banner including today. The series touched on a number of subjects related to the epidemic:

• a drastic increase in overdose deaths in the county, state and nation;
• a need for the community to address and accept the problems that come with substance use, and to lessen stigma;
• law enforcement’s response to the growing epidemic including the use of Narcan;
• a perspective from a longtime user who is now in recovery and helping others to find treatment;
• how and where users and those concerned about them can find help and support;
• the governor’s and county’s response to a dynamic epidemic and the need for more services.

Of all the information shared in this series, the editors of the Banner would like to convey one clear message: If you or your loved ones need help dealing with substance use, reach out to the county health department or stop by the Dri-Dock.
The Dorchester County Health Department is open from 8 a.m. to 5 p.m., Monday through Friday, at 3 Cedar St., Cambridge, near the McDonald’s, 410-228-3223.
The Dri-Dock is open from 8 a.m. to 6 p.m., Monday through Friday, at 208 Sunburst Highway (Route 50), Cambridge, 410-228-3230.

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