Fentanyl-related deaths shows largest increase
Baltimore, MD – The Maryland Department of Health today released data for fatal overdoses in the first quarter of 2017. During this period, which encompasses January to March of 2017, there were 550 overdose-related deaths in the state, including 372 fentanyl-related deaths. The report is posted on the Department of Health website and can be accessed here.
“Fentanyl and synthetic drugs continue to claim the lives of Marylanders, many of whom are unknowingly consuming them,” said Health Secretary Dennis Schrader. “We implore Marylanders who are grappling with substance use disorder and are taking illicit substances to seek treatment immediately.”
Marylanders can find treatment resources at MdDestinationRecovery.org, BeforeItsTooLateMD.org, and the state crisis hotline, 1-800-422-0009.
The new quarterly data show how fentanyl, an additive that is often combined with other opioids, continues to drive the scourge of overdose deaths. Fentanyl and a related additive, carfentanil, are 50 and 100 times more potent than heroin, respectively. In 2016, Health issued a warning about such fentanyl consumption, later adding carfentanil to the list. Health continues to reinforce that warning.
“The number of Marylanders impacted by this crisis continues to drive our resolve to manage this epidemic as a statewide emergency,” said Clay Stamp, executive director of the state’s Opioid Operational Command Center. “In order for us to be successful, we must be united in this fight and steadfast in our commitment to partner with others in efforts to prevent, protect, and treat those in need.”
Fighting the heroin and opioid epidemic in Maryland has been a top priority of Governor Larry Hogan’s administration. Health, in partnership with other state agencies, continues to collaborate 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.
On July 1, 2017, three new initiatives to further combat the opioid epidemic went into effect:
1. Maryland Medicaid policies reforming the opioid-prescribing process went into effect, in partnership with all eight of Maryland Medicaid’s HealthChoice providers. The new policy requires prior authorization for all high-dose and long-acting opioids issued to Maryland Medicaid recipients. The policy changes were put in effect to reduce opioid misuse, dependence, overdose and death in both Medicaid fee-for-service and HealthChoice managed care programs.
2. Maryland’s Prescription Drug Monitoring Program (PDMP) allows providers and pharmacists access to their patients’ history of such prescribed controlled dangerous substances (CDS) as prescribed opioids. As of July 1, 2017, prescribers of CDS and pharmacists are required to register with the PDMP. In addition, prescribers are required, with some exceptions, to query and review their patient’s PDMP data prior to initially prescribing an opioid or benzodiazepine and at least every 90 days thereafter as long as the course of treatment continues to include prescribing an opioid or benzodiazepine. Pharmacists must query and review patient PDMP data prior to dispensing any CDS drug if they have a reasonable belief that a patient is seeking the drug for any purpose other than the treatment of an existing medical condition.
3. Maryland Medicaid began reimbursement for federally funded residential substance use treatment. Maryland was the third state in the nation to be granted a waiver from the federal Centers for Medicare and Medicaid Services to provide these services with federal Medicaid dollars. The expansion, solidified in the program’s federally approved waiver, enables providers to receive previously denied federal Medicaid reimbursement, an obstacle that contributed to the opioid crisis here. Maryland Medicaid – backed by Maryland Gov. Larry Hogan – applied for a waiver (or an exception) from that federal restriction, to be able to win treatment options for more Marylanders. The IMD Waiver expands Medicaid reimbursement to include adult residential substance use disorder treatment. Health is phasing in such additional services as residential substance-use disorder services for pregnant women with children, drug-exposed newborns, individuals involved with the child welfare system and 8-507 court ordered treatment services in January 2018; it will incorporate halfway houses in January 2019.
In addition to these new initiatives, Health continues to conduct a multi-pronged approach:
In July 2017, Health, the Opioid Operation Command Center, and the Governor’s Office of Crime Control & Prevention announced more than $22 million to fight the heroin and opioid epidemic. Eighty percent will go to Maryland’s 24 local jurisdictions and service providers to fund prevention, enforcement, and treatment efforts throughout the state. Health was awarded a $20 million grant under the 21st Century Cures Act from the U.S. Department of Health and Human Services, administered by the Substance Abuse and Mental Health Services Administration (SAMHSA), to be used for the prevention and treatment of opioid abuse over a two-year period. The funding for Fiscal Year 2018 includes the first $10 million of Governor Larry Hogan’s $50 million commitment to address the crisis announced in March 2017, the first $10 million from the federal 21st Century Cures Act, and $2.1 million from the Governor’s Office of Crime Control & Prevention.
Maryland has expanded access to naloxone, a life-saving drug that reverses opioid drug overdoses. On June 1, 2017, Health’s Public Health deputy secretary, Dr. Howard Haft, issued a standing order that allows pharmacies to dispense naloxone to individuals who may be at risk of an overdose or anyone who may be able to help someone who overdoses. This action is authorized through legislation signed by Governor Hogan. Naloxone safely and effectively reverses an overdose and has a low risk for adverse effects. This simplifies the previous process where it could be dispensed only to those trained and certified under the Maryland Overdose Response Program. Pharmacies play an important role in providing access to naloxone and counseling on how to recognize and respond to an opioid overdose. Fentanyl and carfentanil may require multiple doses of naloxone to be administered to help victims overdosing on those substances.
Medicaid implemented a payment policy for community-based Medication Assisted Treatment (MAT) – a clinical intervention that combines the use of medications and substance use disorder counseling. Maryland Medicaid will provide a re-bundled methadone reimbursement rate to include a $63 per-week-per-patient bundle for methadone maintenance, and the ability for Opioid Treatment Programs (OTP) to bill for outpatient counseling separately, as clinically necessary.
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, Health 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.
Health is also expanding access to Screening, Brief Intervention and Referral to Treatment (SBIRT). SBIRT is an evidence-based tool designed to identify individuals who are at risk of substance abuse and to provide appropriate 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). Health 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.
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 Anne Arundel County are participating in the program, with plans to expand post-discharge outreach services for multiple other hospitals in the coming months.
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.