Teams Engaged in Prevention, Enforcement, and Treatment Efforts to Fight Maryland’s Heroin and Opioid Epidemic
In the months since Governor Larry Hogan declared a State of Emergency to combat the heroin and opioid crisis, Maryland’s Opioid Operational Command Center 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 second quarter of 2017, which shows that opioid-related deaths continue to climb, including an increase in those related to the deadly additives fentanyl and carfentanil.
In July, the Opioid Operational Command Center, Department of Health, and the Governor’s Office of Crime Control & Prevention announced more than $22 million to fight the epidemic in Fiscal Year 2018, with 80 percent going to Maryland’s 24 local jurisdictions and service providers to fund prevention, enforcement, and treatment efforts throughout the state.
“Working closely with the Opioid Operational Command Center allows us to collaboratively share information and use real-time intelligence on the ground to enhance services provided by the Department of Health,” said Maryland Department of Health Secretary Dennis R. Schrader. “We continue to work with local jurisdictions to expand resources for prevention, treatment and recovery to combat this crisis at every level.”
Screening, Brief Intervention and Referral to Treatment (SBIRT) Program
Through the Maryland Department of Health, access to the Screening, Brief Intervention and Referral to Treatment (SBIRT) program, 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 — will expand to a total of 15 hospitals, five of which are being funded through the Opioid Operational Command Center. The department and command center also are working to implement peer recovery support in all 15 of the 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 Fatality Review Teams
The Maryland Department of Health is also working with local jurisdictions to expand drug Overdose Fatality Review teams in Frederick County and Worchester County through one-year supplemental funding from the Centers for Disease Control and Prevention. Baltimore County and Carroll County both received funding for their respective programs earlier this year through a Harold Rogers 2016 grant issued by the department.
Overdose Fatality Review teams conduct confidential reviews of resident drug and alcohol overdose deaths to identify opportunities to improve member agency and system-level operations in a way that will prevent future similar deaths. The Department of Health’s role is to provide oversight, data, and guidance to the local program teams. The funding will allow Frederick and Worchester Counties to improve the ability of Overdose Fatality Review teams to identify and conduct direct outreach and engagement with individuals connected to overdose decedents, particularly healthcare providers and family members.
Recovery Residences
In addition, the Maryland Department of Health’s Behavioral Health Administration, pursuant to House Bill 1411 of 2016, has issued certificates of compliance to 152 recovery residences across Maryland. Recovery residences, which provide alcohol-free and illicit drug-free housing for individuals with substance-use-disorder or addictive-disorder, must adhere to the quality standards developed by the National Alliance of Recovery Residences. Certificates of compliance for additional recovery residences will be issued on a rolling basis. The list of recovery residences will be available on the department’s website starting Nov. 1, 2017.
Start Talking Maryland Act Workgroup
The Maryland State Department of Education convened its final meeting of the Start Talking Maryland Act workgroup in September. The workgroup reviewed 52 programs that provide behavioral and substance use disorder services in public schools identified throughout Maryland. To create curricular materials for each of the grade bands addressed in the Start Talking Maryland Act, the department is developing a workgroup comprised of teachers and other school staff.
The department released an updated Opioid Abuse and Prevention website, which includes an updated toolkit for educators and parents, as well as a video that outlines both the opioid problem and the steps educators can take to prevent drug use and abuse.
Additionally, the Opioid Operational Command Center granted $200,000 to the Maryland State Department of Education to explore options for a regional recovery school/program in Montgomery County.
Heroin Coordinator Grant Program
In support of enforcement, the heroin coordinator grant program, which was recommended in the administration’s Heroin & Opioid Emergency Task Force Final Report, promotes a coordinated law enforcement and investigative strategy to battle the opioid epidemic through cooperation and data sharing.
Heroin coordinators work with each jurisdiction’s Drug Task Force and partner with the federal High Intensity Drug Trafficking Areas (HIDTA) program in the dissemination of all drug-related intelligence. The coordinators also act as the local Opioid Intervention Team (OIT) point of contact on overdose trends, and manage the jurisdictions’ drug intelligence. This year, the program has identified at least 1,042 nonfatal overdose victims for outreach and referral to treatment, identified 33 opioid trafficking organizations, and assisted with investigations that seized nearly $1 million in assets.
“We are fully committed to supporting Governor Hogan’s initiatives to reduce the threat of opioids in the state. Through innovative strategies and funding programs targeted at identifying, disrupting, and dismantling drug trafficking networks we are taking bold steps towards making Maryland a safer place,” said Glenn Fueston, executive director, Governor’s Office of Crime Control & Prevention.
Opioid Intervention Team (OIT) Plans
At the local level, OITs are set up in each of Maryland’s 24 jurisdictions and led by the emergency manager and health officer. They are multi-agency coordination bodies that coordinate with the community, and complement and integrate with the statewide opioid response effort. A total of $4 million in FY 2018 was distributed to the OITs to use for opioid-fighting strategies at the local level. OITs were asked to submit plans for use of the funds and all plans been approved at this time.
“Over half of our funds are going to help individuals needing recovery housing or help in getting into safe housing,” said Fredia S. Wadley, MD, health officer, Talbot County Health Department. “Priority groups are those discharged after detoxification, released detention center inmates who have undergone treatment and are returning to the community, and individuals involved with the Problem Solving Court needing recovery or safe housing. We are also using a portion to reimburse ambulatory providers that have claims for the uninsured clients denied by Beacon.”
Carroll County is pairing its funding from the Opioid Operational Command Center with other sources of funding to initiate 24-hours crisis response services. “These services will be available to first responders, Carroll Hospital Center, and other partners in the community to provide the professional support of qualified social workers and peer support specialists to assist with people who are in behavioral health crises. The team will have the capability of de-escalating situations and linking people with behavioral health treatment resources,” said Ed Singer, health officer, Carroll County Health Department.
“Baltimore City faces a disproportionate burden of the disease of addiction with one out of three overdoses in Maryland occurring in our city and two of our residents dying every day from overdose,” said Baltimore City Health Commissioner Dr. Leana Wen. “We thank our partners at the state for heeding Baltimore’s calls for help. The resources provided are an important first step, and we look forward to working with Director Stamp and our partners on Governor Hogan’s team to secure the additional funding that we need to battle this public health epidemic and to save lives from overdose.”
“The OITs’ efforts demonstrate a comprehensive and balanced approach across the state to combat this crisis, which is vital to turning the tide,” said Stamp.
| Jurisdiction (Total Award) | Project |
| Allegany County
$115,956 |
Educate patients and prescribers |
| Reduce illicit supply of opioids | |
| Increase community supply of naloxone | |
| Increase youth understanding of opioid addiction | |
| Anne Arundel County/ Annapolis City
$286,859 |
Augment mobile crisis response |
| Sustain existing and develop new public information outreach campaigns | |
| Increase capacity of peer support services in emergency departments | |
| Baltimore City
$1,240,429 |
Expand medication-assisted treatment |
| Distribute naloxone to first responders and community | |
| Baltimore County
$469,738 |
Expand peer recovery support services during non-traditional hours and in non-traditional settings |
| Develop media campaign on public health issues related to opioid epidemic | |
| Calvert County
$101,676 |
Expand access to clinical services and medication-assisted treatment funding |
| Establish peer recovery support specialist program | |
| Work with Calvert Memorial Hospital to provide outreach and prescriber education | |
| Develop opioid abuse awareness and health promotion campaign | |
| Caroline County
$78,183 |
Collect data on opioid epidemic |
| Decrease opioid growth | |
| Enhance opioid program and naloxone | |
| Carroll County
$138,068 |
Increase mobile crisis and crisis stabilization services |
| Cecil County
$123,327 |
Augment informational campaign |
| Increase youth knowledge of opioid risks | |
| Charles County
$108,125 |
Support Substance Use Services Clinic |
| Increase availability of naloxone for first responders | |
| Increase community knowledge surrounding opioids, overdoses, and available county resources | |
| Support peer recovery specialists services | |
| Dorchester County
$74,037 |
Promote use of Prescription Drug Monitoring Program (PDMP) |
| Establish on-call peer recovery support | |
| Develop outreach and promotion | |
| Support efforts to train members of Youth Action Council | |
| Expand medication-assisted treatment with Department of Corrections | |
| Support pre-release casework | |
| Collect, analyze, and distribute opioid epidemic data | |
| Frederick County
$162,022 |
Expand peer support |
| Garrett County
$71,273 |
Expand emergency room-based peer recovery support |
| Develop heroin and opioid education and prevention in public schools | |
| Support emergency room-based intervention for non-fatal overdoses, including overdose response and naloxone education | |
| Harford County
$170,314 |
Increase access to naloxone for first responders and other individuals at risk |
| Create Harford County’s Central Intake, Navigation and Recovery Team | |
| Howard County
$124,709 |
Augment substance use disorder screening and assessment portal |
| Kent County
$73,116 |
Develop information campaign on Opioid Community Intervention Project |
| Support peer specialist(s) for Opioid Community Intervention Project | |
| Montgomery County
$191,964 |
Expand Stop Triage Engage Educate Rehabilitate (STEER) |
| Host three community forums: Save a Life Montgomery: Opioid and Substance Abuse | |
| Expand public awareness campaign | |
| Increase police and community access to naloxone | |
| Prince George’s County
$189,661 |
Distribute naloxone |
| Promote educational and stigma reduction campaign | |
| Conduct community outreach | |
| Train staff | |
| Enhance opioid treatment | |
| Queen Anne’s County
$79,565 |
Develop family support program |
| Increase access to opioid dependence treatment | |
| Somerset County
$90,621 |
Promote Somerset County Opioid United Team (SCOUT) Initiative |
| Support peer recovery specialist(s) | |
| Expand law enforcement support | |
| St. Mary’s County
$74,958 |
Expand Level 3.5 treatment services for detention center |
| Encourage treatment for those who experience non-fatal opioid overdose | |
| Develop opioid public service announcement | |
| Train first responders and emergency department staff to address barriers to treatment services | |
| Talbot County
$79,565 |
Purchase care for uninsured |
| Supplement recovery beds and initial housing assistance | |
| Assist with urine testing – recovery houses | |
| Support student education | |
| Washington County
$158,797 |
Develop Community Overdose Response for Direct Service (CORDS) Crisis Response |
| Promote public awareness of CORDS and Safe Place Access | |
| Wicomico County
$115,956 |
Host and promote opioid forum |
| Increase access to naloxone | |
| Support for Opioid Intervention Team’s coordination | |
| Worcester County/Ocean City
$91,081 |
Distribute naloxone and place recovery specialists in hospital emergency department |
Before It’s Too Late is the state’s effort to bring awareness to this 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 24/7 State crisis hotline.
