Screening, Brief Intervention and Referral to Treatment (SBIRT) Program Expands to Six Detention Centers and Five Additional Hospitals

Evidence-based tool helps identify patients who are at risk of substance use disorder

ANNAPOLIS, MD — 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 (OOCC) has been working with state agencies and local jurisdictions to address the epidemic, which is ravaging communities across the state. Today, the Maryland Department of Health released its overdose death report for the third quarter of 2017, which shows that, while the largest increases in overdose deaths continue to be related to fentanyl and from cocaine use combined with opioids, there has been a slight decline in the overall number of heroin-related and prescription opioid-related deaths when comparing third quarter data for 2016 and 2017.

"As the opioid epidemic continues to claim Marylanders’ lives, we must not tire in our resolve in combating this crisis," said Clay Stamp, executive director of the OOCC. "Over the past year we have seen the development and expansion of prevention, enforcement, and treatment efforts, which serve as a critical foundation for our fight against this ever-evolving threat."

Funding in Governor Hogan’s Fiscal Year 2018 budget enabled the administration to expand innovative prevention, treatment, and enforcement efforts, including the Screening, Brief Intervention, and Referral to Treatment (SBIRT) program, and the other initiatives detailed below.

“Third quarter data continues to show steep increase in fentanyl-related overdose deaths in Maryland,” said Department of Health Secretary, Robert R. Neall. “Through programs like SBIRT and with the standing naloxone order, we’re trying to connect individuals touched by substance use disorders with resources that will potentially save their lives.”

Screening, Brief Intervention, and Referral to Treatment (SBIRT)
Funding announced in July includes $2.6 million to expand SBIRT to hospitals and parole, probation, and correctional facilities. The SBIRT program has traditionally proven effective in hospital and other medical settings.

In detention center settings, SBIRT involves identifying persons with a substance use disorder, connecting them to available treatment while in the facility, and also referring them to treatment upon release. SBIRT, including peer support, will expand to the following detention centers – Allegany County, Anne Arundel County, Dorchester County, Queen Anne's County, Talbot County, and Wicomico County.

Howard County was the first detention center in Maryland to pilot SBIRT through a grant from the federal Substance Abuse and Mental Health Services Administration to the Maryland Department of Health's Behavioral Health Administration. For the first time in a detention center, the grant, awarded for one year, will allow for trained staff to screen inmates, provide advice to at-risk individuals, and offer referrals to treatment. Corrections will partner with existing Howard County Health Department staff providing mental health and addiction services at the detention center. The program officially launched in November of 2017.

“We’re committed to implementing innovative programs like this to combat the opioid epidemic,” said Howard County Executive Allan H. Kittleman. “In addition to the detention center, we will be using SBIRT at our crisis intervention center. This method – Screening, Brief Intervention and Referral to Treatment – will identify individuals at risk, connect them to treatment services, and help remove barriers to treatment and recovery.”

Through the Maryland Department of Health, SBIRT will expand to Greater Baltimore Medical Center (Baltimore County), Meritus Medical Center (Washington County), Northwest Hospital Center (Baltimore County), St. Agnes Hospital (Baltimore City), and University of Maryland Upper Chesapeake Medical Center (Harford County).

Already in existence in 10 hospitals — Bon Secours Hospital, Johns Hopkins Bayview Medical Center, MedStar Franklin Square Medical Center, MedStar Good Samaritan Hospital, MedStar Harbor Hospital, MedStar Montgomery Medical Center, MedStar Union Memorial Hospital, Mercy Medical Center, University of Maryland Medical Center, and University of Maryland Medical Center Midtown Campus – the department and command center also are working to implement peer recovery support in all 15 hospitals.

SBIRT is an evidence-based tool designed to help physicians identify patients who are at risk of substance abuse and to provide appropriate intervention. It has been implemented for adult patients in approximately 22 primary care locations, across 36 sites, and throughout 10 jurisdictions including Baltimore City, Baltimore County, Prince George’s County, Montgomery County, Carroll County, Anne Arundel County, Harford County, Howard County, St. Mary’s County, and Worcester County. More than 210,500 patients have been screened through the program, exceeding the five-year goal of 90,000 screenings. Of those, more than 3,000 individuals have been referred to treatment, with 377 individuals successfully linked to treatment.

Overdose Survivors Outreach Project
The Overdose Survivors Outreach Project (OSOP) connects overdose survivors in hospital emergency departments to community peer recovery specialists, who assist them in enrolling in substance-use disorder treatment and obtaining support services. To date, the majority of all individuals referred to an OSOP peer recovery specialist engaged with the peer in the community and more than half of those referred to treatment are admitted.

Increasing Access to Naloxone
The Maryland Department of Health’s Behavioral Health Administration, OOCC, and Maryland Institute for Emergency Medical Services Systems are partnering to provide financial relief to Emergency Medical Services Operational Programs (EMSOPs) that are currently carrying the increased burden of providing naloxone without reimbursement from the patient or insurance providers.

Additionally, the OOCC, Maryland Institute for Emergency Medical Services Systems, and the Behavioral Health Administration have worked with the Maryland Department of General Services to allow jurisdictions to purchase naloxone in bulk pricing from a State of Maryland contract. This has the potential for significant cost savings across the state. Any state or local partner who is eligible to buy off of a statewide contract is eligible.

Mobile Treatment Services
The Maryland Department of Health and OOCC support a creative partnership between the University of Maryland School of Nursing and the Anne Arundel County Department of Health to use the Governor's Wellmobile to deliver medication-assisted treatment to one of the areas of Anne Arundel County most affected by the heroin and opioid crisis.

“The University of Maryland, Baltimore (UMB) is committed to leveraging its expertise in fighting the addiction crisis,” says UMB president Jay A. Perman, MD. “I am delighted that our School of Nursing is partnering with Governor Hogan and Anne Arundel County to provide health professionals and the Governor's Wellmobile in this critical public health initiative.”

"The Wellmobile is an innovative tool that will give us the rapid flexibility needed to effectively address the opioid crisis," said Anne Arundel County Executive Steve Schuh. "We thank Governor Hogan and the School of Nursing for partnering with Anne Arundel County as we seek to turn the tide against addiction."

In July, the OOCC, Department of Health, and the Governor’s Office of Crime Control & Prevention announced more than $22 million to fight the heroin and opioid epidemic. 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. The governor’s recently-released Fiscal Year 2019 budget continues to demonstrate a strong commitment to combating the crisis. In addition to $159 million dedicated to non-Medicaid substance use disorder and addiction programs, it includes: $13.7 million in new state funding; $3 million in grant funding for local boards of education to implement prevention and education programs; $1.2 million to expand treatment programs and job readiness training for the Maryland Department of Public Safety and Corrections’ pre-release population; and funding for 15 new positions at the Maryland Department of Health to assist pre-release inmates in applying for Medicaid eligibility.

Before It’s Too Late is the state’s effort to bring awareness to the heroin and opioid epidemic-and to mobilize resources for effective prevention, treatment, and recovery. Marylanders grappling with a substance use disorder can find help at BeforeItsTooLateMD.org and 1-800-422-0009, the state crisis hotline.