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By Ron Cassie and Lauren LaRocca
Photography by BENJAMIN C. TANKERSLEY | July 2018
News & Community

Can H-Town Kick Its Habit?

The worst drug epidemic in U.S. history could be a fatal blow to Hagerstown (and other small towns like it).

By Ron Cassie and Lauren LaRocca.
Photography by Benjamin C. Tankersley | July 2018

seventy-five miles
west of Baltimore,

the sun has yet to rise over South Mountain, but already a line of cars is arriving at the Phoenix Health Center in Hagerstown. Saturday mornings are the busiest days of the week because the drug treatment clinic is closed on Sundays—meaning that several hundred people begin showing up at 5 a.m. to ensure that they can collect their extra day’s supply of methadone or buprenorphine.

The substance abuse treatment center sits across the street from an abandoned hospital parking garage (the hospital moved out of downtown like nearly everything else), and a seemingly endless stream of addicts in late-model cars, minivans, and pickup trucks come and go until the pharmacy closes at noon. A local taxi company sporadically drops people off. Others walk from nearby apartments. Some folks—a waitress with an apron tied around her waist, a guy in construction gear—are clearly stopping by on their way to a job. Others arrive in pajamas and sweatpants, barely awake, clutching telltale lockboxes for take-home doses. A handful, with newer haircuts and cars, might be professionals somewhere in this politically conservative county. For the lion’s share, however—a nearly all-white mix of solitary adults, young and middle-aged couples, teenagers, and parents dragging along children—it looks like life has been a struggle for a while. Maybe longer. There’s an unmistakable world-weariness written into their faces. Most aren’t even here to get clean but to get by.

Washington street leading east at the hagerstown public square in 1957.

Perhaps as many as three-quarters of those in local methadone programs, according to recovering addicts interviewed for this story, still get high, using coke, crack, ecstasy, Spice, or benzos like Xanax, which are particularly dangerous in combination with methadone. Others sell or trade their methadone or bupe (opioid medications used to suppress withdrawal symptoms) to buy the real thing, faking drug tests to game the system. “Maybe 10-15 percent don’t give you any problem and are trying to do the right thing,” says Lee Green, an addictions counselor who is also an active member of a 12-step program. “That’s how strong the grip of this addiction is.”

When a methadone clinic was first proposed at this site, two blocks from Hagerstown’s “main street,” in the spring of 2001, it was met with vehement opposition. For the past 44 years, since Valley Mall was built on the outskirts of town, shuttering the department stores, retail shops, restaurants, theaters, and five and dimes, there have been hopes of reviving Hagerstown’s once-thriving city center.  A methadone clinic was not a part of that vision. The mayor and City Council at the time didn’t want it. Neither did the Washington County health officer or then-Hagerstown Police Chief Arthur Smith, who questioned the wisdom of opening a methadone clinic in a city that, he claimed, did not have a heroin problem. It’s true that from the outside, the county seat of some 40,000 people still looks a bit like Mayberry, with its turn-of-the-century architecture, elegant City Park, church spires, tidy sidewalks, and walkable streets. The huge A&W Johnston clock, first built in 1836 and later refurbished, still stands four stories above the town square in a period brick building.

But the sad fact is that in 2018, Phoenix Health Center draws more people downtown than anything else on a Saturday. Two additional private methadone treatment centers have since opened in the area, not to mention the Washington County Health Department’s outpatient addiction program, which treated more than 11,000 patients between 2013 and its closing this spring due to state budget cuts.

It’s nearly impossible to find a family, including those among the Hagerstown Police Department and City Council, that has not been affected by the town’s still-escalating opioid epidemic. Kevin Simmers, a retired Hagerstown police officer, lost his 19-year-old daughter to an overdose and is now building a women’s recovery center, Brooke’s House. Thirty-two-year-old City Councilwoman Emily Keller, a go-getter single mom and insurance agent, lost her oldest friend to an overdose and ran for office specifically to lead the fight against the opioid epidemic. “There wasn’t a door that I knocked on when I was campaigning for City Council that people didn’t say heroin and the opioid crisis was the number one issue,” Keller says. “Everyone had a story.”

“Now it’s everywhere. It’s a phone call away.
They’ll deliver. Quicker than ordering a pizza.”

n its heyday, Hagerstown built the massive Fairchild transport planes that carried U.S. troops across the Pacific during the Korean War; post-war, they made Boeing jets. Hagerstown built automobiles, bottled Coca-Cola, made shoes, clothing, furniture, and Breyer’s ice cream, and was the world’s largest manufacturer of pipe organs. But today, while Frederick, just 25 miles east down I-70, is regularly named among the best places to live in the U.S., Hagerstown more closely resembles a microcosm of Baltimore—essentially a small town with big-city problems, continually in survival mode. In truth, Hagerstown has a higher poverty rate than Baltimore City, a higher percentage of people under 65 with a disability, lower home-ownership rates, and a lower percentage of its workforce with college degrees. (It also broke a record last year with eight homicides, sending its per capita murder rate past Philadelphia and Chicago.)

A Pedestrian on north Prospect Street.

Opioids may be the deadliest catastrophe to hit Hagerstown, but the current crisis follows a long string of blows to a city that never made the transition from a mechanical to a hi-tech economy. While the most pressing question confronting Hagerstown—and other resource-deprived towns in Maryland such as Frostburg, Cumberland, Cambridge, Snow Hill, Elkton, and Edgewood—may be how to get immediate help to those struggling with addiction, the broader question is more vexing: How does an isolated, blue-collar town recover from the worst drug epidemic in U.S. history on top of 45 years of deindustrialization? Economists studying national trends say people should simply vacate towns like Hagerstown—and seek work elsewhere.

“The epidemic has not peaked yet by any means,” says Mike Piercy, director of the Washington County Department of Social Services. “If we were somehow able to turn around the [addiction] numbers today, it would take another 20 years to shake off the damage.”

police investigating a burglary on West Franklin Street

o understand the DNA of Hagerstown, you have to go back to the 19th-century industrial boom. Situated near the Potomac River and what was once Western Maryland and West Virginia coal country, Hagerstown served as a vital gateway to the fertile Midwest. The National Road, Route 40, began carrying wagon trains through Hagerstown to the Ohio River Valley in 1818. The steel tracks of the Baltimore & Ohio Railroad started carrying locomotives from Baltimore in the same direction, straight through the heart of Hagerstown, two years after the end of the Civil War. The C&O (Chesapeake and Ohio) Canal, which passes through Washington County and primarily transported coal, was already in operation by then, having been completed in 1850.

But the current economic picture in Hagerstown stands in stark contrast to the days when it earned its Hub City nickname—when five major passenger and freight lines merged here in a way that resembled the spokes of a wheel. Consider, for example, that three of the four railroad properties on the Monopoly board were spokes in that Hagerstown hub, connecting the city to Richmond, Washington, Baltimore, Pittsburgh, Philadelphia, and New York.

In the first decades after World War II, during the early rumblings of the automobile age, Hagerstown continued to thrive, becoming a trucking hub as well a rail hub. Now, however, nearly all of the rails leading into downtown have been removed. After the public schools and hospital, the largest employers in Washington County today are the sprawling Citi and First Data call centers.

a view from the abandoned hospital parking garage across from the antietam street clinic.

Even as other Rust Belt towns decline—losing union jobs, community, status, and a general hope for a brighter future—the numbers in Hagerstown are startling when you step back and look at them. In a Brookings Institution study of 114 metropolitan areas that specialized in manufacturing from 1980-2005, the Hagerstown-Martinsburg (West Virginia) area had the second-highest percentage of industry job change in the U.S., a staggering 70 percent. Meanwhile, health care, housing, and education costs have skyrocketed over the ensuing decades, but wages, adjusted for inflation, have remained essentially flat in Hagerstown, growing just 5 percent in total over that 25-year span.

More than 80 percent of students at three Hagerstown public schools receive free or reduced-priced lunches.

And now, Hagerstown’s unique coordinates, once its greatest asset, play a leading role in enabling its public health crisis. Six years ago, at an I-81 coalition meeting of stakeholders, Western Maryland state police commander Lt. Mike Fluharty coined the phrase “Heroin Highway” to describe Hagerstown’s I-81/I-70 nexus. Stretching from New York to Tennessee and Baltimore to Utah respectively, I-81 and I-70 are two of the longest interstates in the U.S., and they intersect in Hagerstown. It’s these fast-rolling interstates that carry the deadly opioids, including heroin and fetanyl, flooding Maryland’s western counties.

The opioid trade has become so lucrative here that dealers from Baltimore and even New York travel to Hagerstown, and often farther into West Virginia, because they can earn up to $40 more a gram for heroin and a similarly higher profit margin for fake pills, like the counterfeit, fentanyl-laced “Vicodin” that killed Prince. “Dealers now have their own pill presses,” explains Drug Enforcement Administration agent Robert Grob at a recent Drug Take Back Day, a collaboration between the Hagerstown Police Department, county health department, and the DEA that encourages local residents to turn in leftover medication for safe disposal. “All it takes is a little fentanyl—or a microgram of carfentanyl, which is 100 times more potent. They buy the stuff to cut it, the right color dye, and press in a number or an initial, and it looks like the real thing—Percocet or whatever.”

Hagerstown Suns’ Municipal Stadium.

Kristie Lockhard, a 38-year-old recovering addict volunteering at the event, says when she first started using heroin in 1999, she would drive to Baltimore two or three times a day to buy it.

“Now it’s everywhere here,” she says. “It’s a phone call away. They’ll deliver. Quicker than ordering a pizza."  

More than 1,000 pounds of prescription medicine is collected in the first two hours of the event, which is held in an empty parking lot outside the county health offices. Two more telltale signs of Hagerstown’s plight are present here as well: The county’s storefront offices sit in an all-but-abandoned shopping center, and nearby is a Superfund site, less than a mile from three public schools, and still in need of remediation two decades after it was added to the EPA’s National Priorities List.

Add to all of this one more factor: Three prisons in Hagerstown, includings two state penitentiaries, have had a habit, according to local law enforcement officials, of leaving ex-offenders in town once they’re released. “It’s a problem,” says former Hagerstown police chief Victor Brito, who resigned in May to lead the Rockville force. “With the highways and economic factors, it’s all a perfect storm.”

a shuttered barber shop on Jonathan Street.

“People began to say, ‘Oh, if it can happen to that family, it can happen to my family.’”

y any definition, the epidemic in this part of Maryland, a state with one of the top five death rates from opioids in the country,­ is among the worst anywhere. Since the start of the addiction crisis, which now kills more in the U.S. than car accidents and gun violence combined, emergency rescue calls have tripled in Hagerstown. In 2016 (the most recent year available), an average of 113 prescriptions for opioids were written for every 100 Washington County residents—nearly twice the national average. At Meritus Medical Center outside of downtown Hagerstown, nearly three children a week are born addicted to opioids.

Home to one-fourth of the county’s population, Hagerstown accounts for the majority of those seeking treatment, as well as the majority of overdose fatalities, which included 21 city residents in the first four-and-a-half months of this year—a pace that would, if it continues, triple last year’s total. In a town with two traditional public high schools—North High and South High—it has become the norm for incoming generations to attend several funerals before seeing their first classmate get married. “I cannot count the number of friends who have died after I almost did,” says Katie Wetzel, 27, a recovering addict in Hagerstown who is now married with three kids. “A lot of them are just taking their normal dose and get hit with this new shit cut with fentanyl. They don’t stand a chance.”

The societal ripple effect of the opioid epidemic can’t be overstated, says Piercy, who doesn’t have to look any farther than outside his downtown Potomac Street office window to witness people nodding and passing out. The crisis, he says, is driving a dramatic increase in infant mortality rates, a bellwether for other social problems. “We had 13 infant deaths over the past two years, eight of whom were born substance exposed and later died at home because of neglect or some other cause,” Piercy says. “We have more kids living with their grandparents and a greater need for foster parents. The number of child abuse cases has gone up. I’m not in economic development, but you also can’t help but wonder, how do you build a workforce and attract new businesses—which we desperately need—when this is happening everywhere in your community?”

A sitting train and truck behind a lot along West Franklin Street.

he one place in Maryland that has had a long struggle with heroin use is Baltimore, of course. And for the past two-and-a-half decades, the city has taken a public health approach to addiction, offering methadone programs, needle exchanges, HIV testing, and inpatient treatment opportunities before the pharmaceutical industry dumped OxyContin and other opioids onto a naïve market. The rest of the state did not share that history, and Hagerstown and towns like it are dealing with something entirely new. These kinds of places are where non-college-educated, white working-class people have been dying in increasing numbers from what Princeton economists Anne Case and Angus Deaton referred to in their landmark 2015 paper as “deaths of despair”—suicide, drug poisoning, and liver disease—which are reversing the life expectancy progress that the U.S. has seen over the past 50 years. A mortality rate increase for any first-world demographic group had been virtually unheard of for decades, with the exception of Russian men after the collapse of the Soviet Union, a phenomenon blamed on soaring alcoholism rates. It is a cruel twist that Hagerstown, on the receiving end of so much heroin from Baltimore, has such a shortage of addiction specialists that the Wells House, one of the largest outpatient clinics here, utilizes Baltimore doctors via telemedicine to treat its clients.

Across the country, rural addiction rates have surpassed those in urban areas, yet there is still not a single inpatient drug treatment facility in Washington County.

“People often use the term ‘self-medicating’ to describe why people use drugs or alcohol,” says Ron Zuskin, a licensed clinical social worker and former University of Maryland faculty member who has worked in Western Maryland. “It’s not as conscious a decision as that. But there is often trauma, or simply the stress of living in poverty, that is putting them under intense pressure.”

“It’s not the white picket fence. you can’t find work, can’t pay your bills. who wants to think about that?”

A dog tied up behind Byers Market on North Burhans Boulevard. Men outside a Hammond Street garage.

osh Morningstar could be the poster boy for the use of prescription opioids gone awry. Ten years ago, the Hagerstown native started having seizures once or twice a week that left his muscles tense, his bones aching, and his head feeling like it might explode. Along with a prescription for the anti-seizure medication Topamax, his family doctor prescribed him Vicodin to be taken after each episode.

He liked the feeling the Vicodin gave him and began to sometimes take the pills just for that hydrocodone buzz. The seizures, and the refills, continued for about eight months, then ceased, but Morningstar found himself dependent on the narcotic—physically, mentally, and emotionally.

Over a period of about three years, he went from prescription Vicodin to shooting up heroin. Though extreme, the transition seemed gradual. When his Vicodin prescription ended, he started buying it on the street, until 5-milligram Vicodins weren’t enough. He moved on to 10-milligram Percocet, then 30-milligram. Then he went from eating it to snorting it. Before long, he was buying heroin because it was cheaper than pills, and he went from snorting to injecting it, simply to maintain the same high—and eventually just to function, if you could call it that.

Addictions counselor Lee Green.

He couldn’t hold down a job for more than a month or two, he says, and bounced around from one employer to the next: cleaning bathrooms, painting houses, waiting tables, making pizza.

“October of 2011, I woke up one day and thought, this is the day you die or the day you get clean. I legitimately thought about that for five or six hours that day. I was gonna overdose and kill myself.”

Instead, he sought help by way of Suboxone (the commercial name for a combination of buprenorphine and naloxone), which he considers a miracle. Methadone, he argues, “is a drug just like heroin.” He found an opiate specialist doctor and took Suboxone for about a year, then safely weaned off.

“Life is great now,” he says. He’s married with children and living his dream of being a full-time musician, touring his original folk-country songs across the U.S. But he moved his family to Pennsylvania a couple years ago, leaving Hagerstown behind.

“It’s low-income, and I think it’s hard for people to find and keep employment there,” he says. “It’s not the white picket fence. When you can’t find work, can’t pay your bills—who wants to think about that? Instead, you go get high and forget about it for a while.”

Forty-year-old Brooks Zombro, who has lived in Hagerstown his whole life, puts it another way: “Hagerstown is a manufacturing town, then we lost all those factory jobs our parents and grandparents had, [and] it has become a playground for big box retail that has all but eliminated and destroyed our downtown’s small business district. We kind of got shit pie handed to us.”

Source: Maryland Vital Statistics Administration

HAGERSTOWN MORE CLOSELY RESEMBLES A MICROCOSM OF BALTIMORE—ESSENTIALLY A SMALL TOWN WITH BIG-CITY PROBLEMS, CONTINUALLY IN SURVIVAL MODE.

s the former managing editor of Hagerstown’s daily newspaper, The Herald-Mail, Dave Elliott witnessed firsthand the city’s downward spiral. He blames forces beyond the city’s reach, as well as futile and often misguided leadership. Plainspoken but good-natured, and a well-respected journalist, Elliott started at The Herald-Mail in 1970. He moved to The Frederick News-Post in 1989 but lived in Hagerstown until 2000.

Big out-of-town industries such as Fairchild Aircraft, which once employed 10,000 people and closed its plant in ’83, and Mack Trucks, which arrived in 1961 (and still makes trucks here, although it employs fewer people), were controlled from a distance and had no stake in the community, Elliott asserts.

Those kind of manufacturing jobs generally pulled up stakes for cheaper labor in the South or overseas, a trend that has continued.

Politically, Washington County has always tilted right. George Wallace campaigned here in 1968 and 1972. President Donald Trump spoke to a packed hangar at Hagerstown Regional Airport during his campaign in 2016 and won the county vote by a 2-1 margin.

councilwoman emily keller.

Herman Mills, a Republican mayor from 1965-1973 who owned several gas stations and stores, was a “sort of kingpin of the local ruling class,” as Elliott puts it—and the last in a long line of businessmen and factory owners investing in Hagerstown. “From the early 1970s onward, there was a vacuum—economically, socially, politically, culturally. There were a few people dedicated to establishing a Maryland orchestra, a few people trying to revive the Maryland Theatre. There were things going on, but no cohesiveness at the top.”

One (seemingly) solid mayor, Republican Donald Frush, who served from 1981-1985 and was known as “the Father of Planning” in Washington County, disappeared during his campaign for a second term and was found by a reporter at a Johns Hopkins psych ward.

Mayor Richard Trump (no relation to the president), who ran for office on a slate that promised to return God to City Hall, abruptly resigned without explanation after nine months in office in 2006.

One of the biggest mistakes city officials made was failing to sufficiantly upgrade Municipal Stadium, the nearly 90-year-old home of the minor league Hagerstown Suns, or build a new ballpark downtown. The team lost its Orioles affiliation in the 1980s when the O’s said goodbye to Hagerstown and hello to nearby Frederick. (Currently affiliated with the Nationals, the Suns draw a South Atlantic league-low 896 fans per game; Frederick led the Carolina League in attendance from 2012-2016, attracting nearly 5,000 fans a game.)

For a century, Hagerstown had been the dominant city, and Frederick a little cow town. In recent decades, they’ve swapped roles. Frederick, which seems worlds away rather than a mere 20 minutes, has benefitted from its MARC train station, which has grown the town into a bedroom community of D.C. It’s also close enough to Baltimore that people make the I-70 commute. Because of that, its residents have more money and higher expectations, and a strong restaurant base and downtown arts and culture district has grown there, sustained by its community. “Hagerstown is still a meat and potatoes kind of place,” says Elliott.

But after 50 years of decline, Elliott and others say downtown is finally showing signs of recovery, even if it is a long road ahead.

The rear of North and Locust Food Mart. A Hagerstown pawn shop.

orking with Philadelphia-based Urban Partners, the city has put together a 10-year City Center Plan, which began in 2014, to enhance the town’s quality of life and attract new developers, investors, and businesses. With a projected $125 million in investments needed to fully develop the proposal—a big if—the project, according to city officials, has the potential to create 875 jobs. Eight planned downtown catalyst projects include an expanded City Farmers Market and the creation of a cultural trail, part of which has already been implemented. A huge component of this initiative includes a $40-million effort, started in 2017, which will expand three key institutions—the University System of Maryland at Hagerstown, the Maryland Theatre, and Barbara Ingram School for the Arts—with a slated completion date of spring of 2020.

When the University System of Maryland satellite campus at University Plaza was established in the city center in 2005, it was the first time anything like that had moved into town in decades: something big, with money behind it and staying power. A block away, two restaurants that would become staples—Jone and Don Bowman’s Bulls and Bears and E. Jay Zuspan III’s 28 South—soon opened. In 2009, an old theater was transformed into BISFA, a magnet arts high school.

As the former Supervisor of Visual and Performing Arts for Washington County Public Schools, Rob Hovermale was involved in conversations as early as 2000 about opening a public arts high school in Hagerstown—talks that were largely dismissed at the time.

“Had we not gotten this building donated, it never would’ve happened,” says Hovermale, who’s lived in Hagerstown most of his life and now serves as principal of BISFA.

Recovering opioid user Katie Wetzel.

The school started with 85 students but this year surpassed 300, even though that meant holding classes in hallways and stairwells. They’re bringing in students from nearby counties and occasionally out of state. “We have a long way to go, but the school has brought life downtown,” Hovermale says. “It’s a huge step forward.”  A block away, the City of Hagerstown opened the artist-run Engine Room Art Space and four artist apartments above it in 2015, which also breathes some life into the city.

“You’ll see people dressed up nice to see a play or film, and you have addicts walking around,” says Matthew Hast, a sculptor who lives at Engine Room. Daily, he watches people, mostly in their 30s, 40s, and 50s, selling and scoring drugs in the city’s central parking lot behind the gallery.

Another resident artist, Anthony Jones Jr., is a recovering cocaine addict and alcoholic who credits art—and Engine Room—as part of his salvation, giving him a sense of purpose and allowing him to be creative rather than self-destructive. “This place is a blessing. We get to engage and feel like we’re being a positive influence on the city.”

These ongoing efforts build on one of Hagerstown’s legacy assets, the lush City Park, utilized year-round, as well as the Washington County Museum of Fine Arts therein, where the new Cultural Trail begins before it winds toward downtown.

“Having beautiful open spaces is important, and it’s important to have a connection to your community,” says city engineer Rodney Tissue, who moved to Hagerstown in 1986 and raised his two daughters here. The trail, which he helped develop, is primarily for economic development but also gives residents a sense of place and pride in their community.

Although the city has seen little interest from developers for the empty lots along the trail, Tissue says several nearby buildings have been purchased and rehabbed. “I’ve seen growth in investor confidence,” says Director of Community & Economic Development Jill Frick Thompson, attributing it to the city’s 10-year plan.

Whether these efforts, which remain largely public investment—schools, libraries, parks—can spark enough commercial interest to compete with the Valley Mall, the two Walmart Supercenters, and the Premium Outlets remains to be determined. If effective, they will be a start in rebuilding Hagerstown’s economy and, ultimately, its quality of life. Indirectly, they could have a hand at reversing the public health crises in the long run, civic leaders say.

icki Sterling, director of the Washington County Health Department’s Division of Behavorial Health Services, says the turning point for the county in addressing the opioid epidemic was the death of former Hagerstown police sergeant Kevin Simmers’ daughter, Brooke, who overdosed on heroin 10 days after she had been released from a four-month prison stay. “People began to say, ‘Oh, if it can happen to that family, it can happen to my family,’” Sterling says. “This was a normal kid, the daughter of a respected ex-city cop. My daughter went to school with her.” Up until that point, most people in Washington County viewed addiction as a criminal justice issue. Including Brooke’s father.

Christina Trenton Nee, COO, and Charlie Mooneyhan, CEO, of Wells House.

Simmers, an outgoing, thick-shouldered 53-year-old, joined the military out of high school in the early 1980s with the intention of going into law enforcement. “I fully bought into the War on Drugs and what Reagan was doing,” he says. “I wanted to be in narcotics. I wanted to knock down doors and haul bad guys off to jail, and that’s what I did for 30 years.”

Since his daughter’s death, Simmers and Brooke's stepmother, Dana, have been very public about sharing their experience, sparing none of their family’s worst moments and pain. Their daughter, who grew up playing soccer and basketball, became hooked on pills by 18 and then turned to heroin. She tried treatment and rehab several times, and even laid down on the family’s lawn once, begging her father to shoot her to put her out of her misery. “You can imagine as a police officer and a father how I felt,” Simmers says. “It’s like watching a slow train crash coming that you don’t know how to stop.”

For the past three years, the Simmerses have been working to build Brooke’s House in Washington County. The 16-bed treatment project for women is partly to honor their daughter, who once shared her wish of getting off drugs and opening such a center with her parents, but it is also borne of frustration, as the family repeatedly struggled to get the help their daughter needed. Brooke died while waiting for insurance approval for a $700 monthly shot of Vivitrol, which reduces cravings and withdrawal symptoms.

According to a 2016 report from the U.S. surgeon general, only one in 10 people with an addiction problem receives treatment.

“I’ve been a right-wing Republican all my life,” Simmers says. “But how many people do you know that have been attacked by a terrorist? Or an illegal immigrant? Nobody I know. Now, how many families do you know that have been affected by addiction? That’s everyone I know. This isn’t political. This is across the board—and I’ll be the first to agree that attitudes are changing because more white people are dying—that’s totally fair. I was on the other side, and I get it, and people have every right to make that point.”

Kevin and Dana Simmers at the future site of Brooke's House.

Earlier this spring, Keller, the city councilwoman who lost her best friend to an overdose, announced that the city would be joining several hundred municipalities, counties, and states in pursuing legal action against the nation’s largest drugmakers, alleging that they played a key role in launching the opioid epidemic. She highlighted not just the personal toll of the opioid epidemic on families but decreasing property values, its effect on businesses and workforce participation rates, and the immense strain placed on the city’s police, EMS, and fire department budgets. The City Council will likely be forced to raise property taxes again this year.

In an emotional press conference, she pointed the finger directly at the pharmaceutical companies, including Purdue Pharma, which hired hundreds of sales representatives to promote their product and has been accused of using misleading information to hide the drug’s addiction potential.

“This epidemic, largely caused by the pharmaceutical industry’s complete lack of accountability or care about anyone or anything other than their pockets, has wreaked havoc on my city,” Keller said. (In 2007, three Purdue executives pleaded guilty to federal charges related to the misbranding of OxyContin and paid $34.5 million in fines, while the company agreed to pay $600 million to resolve a Department of Justice investigation.) The first three municipality lawsuits against drugmakers—all Ohio cases—are scheduled to be heard in U.S. District Court in Cleveland early next year. Still, they are something of a Hail Mary pass for municipalities. It's hard to imagine Hagerstown and similar cities receiving restitution anywhere near the true cost of the opioid epidemic and officials acknowledge that.

Later, outside a Rotary Club meeting, Keller talks more optimistically about the city’s current efforts to tackle the crisis.

She mentions the increased training for Narcan, a medication that can prevent fatal overdoses, across the city. She also cites the new safe needle program implemented by the county health department—albeit over the objection of a couple of state delegates—to combat Hepatitis C and HIV infections. She discusses plans for the rollout of a new awareness program, Washington Goes Purple, a symbolic color adopted by opioid prevention advocates, geared toward steering youth away from substance abuse.

She talks enthusiastically—and genuinely—about the $40-million downtown revitalization effort and Hagerstown’s future. “To me, the urban improvement project is huge. We’ve been struggling for decades and hopefully this will get the ball rolling,” she says. “We need to maintain a sense of hope. It’s hope or heroin out here.”

Source

]]> Opioid Overdose Medication Naloxone on Short Supply in Baltimore https://www.baltimoremagazine.com/section/community/opioid-overdose-medication-naloxone-on-short-supply-in-baltimore/ Wed, 05 Jul 2017 12:17:00 +0000 https://www.baltimoremagazine.com/?p=29157

Every day at least two people die from opioid overdose in Baltimore City, according to health commissioner Dr. Leana Wen. There are only 4,000 doses remaining of the life-saving drug, naloxone, to last until July 2018 with no set date for replenishment.

“If we didn’t ration it, we would use it up in the next two weeks,” said Wen. “Right now, we are making the decision every day about who are the most vulnerable people, and rationing it accordingly.”

Naloxone, or more specifically Narcan, is a medication­ administered as a nasal spray or injection that reverses the effects of opioids during an overdose. Since 2015, residents administering Narcan to victims of overdose saved over 950 lives in Baltimore.

As of June 1, legislators enacted a standing order for a blanket prescription of Narcan at all pharmacies in the city. Unfortunately, the Baltimore City Health Department has run out of funds to purchase the medicine, and has been relying on the generosity of drug companies for donations.

“It’s very safe and effective. It’s got no side effects to someone who is not using opioids,” Wen said. “It’s not addictive—this is a life saving antidote that should be available to every single person.”

Back in March, Governor Larry Hogan declared a state of emergency for the opioid epidemic in Maryland. He also announced a supplemental budget of $50 million in new funding over five years for opioid overdose prevention and treatment.

Katie Kuehn, communications director for the Opioid Operational Command Center, said that as part of the first $10 million in the budget, funding would be available “soon” to local jurisdictions to purchase more naloxone.

“Recognizing the urgency of providing additional naloxone to Baltimore, Behavioral Health System Baltimore requested . . . that a portion of its current budget be allocated to purchase more naloxone to be used by the end of this fiscal year,” she said in an email. “Behavioral Health System Baltimore and the Department of Health and Mental Hygiene’s Behavioral Health Administration worked together to determine that $150,000 was needed, and it was approved the same day.”

According to Wen, Baltimore City has over one-third of all overdoses in the state, so she believes that Baltimore should receive at least one-third of that $10 million.

“We need Narcan, but we also definitely need treatment,” Wen said. “It’s important to save someone’s life if they’re overdosing, but we also need to get them into long-term treatment. That’s what will help them get their lives back.”

Kuehn said that more information about state funding would be announced in the coming days. Currently, the Baltimore City Health Department is awaiting a response from the state for the funding request, but Wen is being proactive with the fight against opioid abuse and overdose. Initiatives like the needle exchange program, which provides clean needles and substance abuse counseling, service about 3,500 people a year.

In addition, the Start Talking Act, which was passed this year, requires public schools to offer drug education as early as third grade, including the dangers of heroin and other opioids.

“Everyone has the ability to save a life. Unfortunately, in our community there are people dying who are mothers, fathers, siblings,” Wen said. “We strongly believe that everyone should have naloxone in their medicine cabinet.”

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]]> Cameo with ​Dr. Bernadette Solounias https://www.baltimoremagazine.com/section/health/cameo-with-dr-bernadette-solounias/ Thu, 29 Oct 2015 19:00:01 +0000 http://server2.local/BIT-SPRING/baltimoremagazine.com/html/?post_type=article&p=5931

As a leading addiction treatment center, does Father Martin’s Ashley have a typical patient?
No. We have people from all walks of life. We have 18-year-olds and 80-year-olds, men and women, professionals and college kids, married, divorced, never married, clergy, doctors, lawyers, nurses. The common thread is the addiction. About 50 percent have alcohol dependence as their primary disorder. Another 30 percent have opiate/opioid dependence as their primary disorder, but we treat all the drugs.

Do you use the 12-step program?
The co-founders [Father Joseph Martin and Mae Abraham] wanted to develop a program that would treat people very respectfully, as people having an illness rather than a disgraceful disorder. We are 12-step-based, but we’ve broadened that. We focus on a holistic approach. It looks at their whole life, including their mind, body, spirit and community.

Are there degrees of addiction? Can someone be a minor alcoholic?
Yeah, actually, the new diagnostic criteria have mild, moderate, and severe categories. And it’s not only the amount of drug or alcohol consumed, it’s how far out the negative ripples go in terms of the effect on their lives.

Why does one person become an addict and another doesn’t?
The biggest factor is our genetics. Fifty percent is determined by genetics. It is an illness that is transmitted in families genetically, but also socially; there are learned behaviors.

Are you able to identify who will succeed after treatment?
It’s often hard to predict. Sometimes there are people we think are going to be successful and we’re shocked that they relapse fairly quickly. Other times, we didn’t have confidence in somebody’s ability to stay in recovery and then were totally shocked that they’ve gotten themselves stable. Stable relationships and being able to maintain employment, those are good predictors of success.

Can you think of some improbable success stories you’ve seen?
One young man comes to mind. He came from a professional family and he went off to college and got addicted to heroin. He came to Ashley for treatment and he seemed to do well. Really pleasant young man. We discharged him, and he relapsed. He returned to Ashley for his second treatment and at this treatment he went to a halfway house when he left treatment and he’s done extremely well. He’s gone on to maintain a life of recovery. He’s gotten married. He has a baby. He’s doing well. He’s certainly a success story.

Another man, someone from our pain recovery program, had sustained a very severe injury at his job and was quite disabled. As a result of his injuries, he developed chronic pain, became addicted to his pain medicines, then got addicted to heroin. Then—this was a man who was employed—he ended up living on the street for several years as a heroin addict and was really plagued by the chronic pain as well. It just really didn’t get better. He came into our treatment program. His first admission lasted about 24 hours and he left; he was not happy. He left treatment and about four to six weeks later, he returned [to] our pain recovery program. He did extremely well. We were able to do a detoxification from the opiates. He was not pain-free, but he was far more comfortable. His socialization improved. His mood improved. He went onto a halfway house. We moved him to a climate that was more suitable for his chronic pain and he has done well in that setting and has been an example for other young men in that setting. He was really an inspiration.

How concerning is the rise of opioid addiction?
Opioid addiction is a huge concern because of the heroin-related emergency department visits. In Harford County [where Father Martin’s Ashley is located], heroin-related intoxication deaths have increased by 191 percent between 2007 and 2014. One of the motivations for Father Martin’s Ashley getting involved in our [new] outpatient program was concern in Harford County about the number of overdoses that presented to our local hospitals. There’s also an increase in the number of babies born in opioid withdrawal in the U.S. We also need to talk about alcohol. Alcohol is still a lethal drug. Alcohol-related intoxication deaths have increased by 266 percent in the county.

Really? That doesn’t get nearly as much attention in the media.
No, it doesn’t. There’s not this huge rise in alcohol use disorders that we see in opiates and opioids, but it’s still the most common drug of abuse out there. And it’s associated with so much trauma: traffic accidents, pedestrian accidents, boating accidents, domestic violence.

What’s your position on decriminalization?
Individuals who have a substance-use disorder should be able to get the treatment they need to be able to live a life in recovery. Addiction isn’t a moral failing. After years of research, the medical community has learned that it is a disease of the brain. It’s a public health issue. I don’t know if you remember Kurt Schmoke, but he was our first mayor who said we should be looking at addiction in the City of Baltimore as a public health problem, not as a legal problem.

Yeah, it’s an idea that’s been around, but it has recently gained more mainstream acceptance.
I think there has been a huge push to think about addiction as a chronic illness, a relapsing illness and de-stigmatizing addiction. It can be viewed more as a medical problem than a legal problem.

To that end, Father Martin’s Ashley started a pain recovery program, right?
It’s about three years old, and this is for people who have chronic pain who have become dependent on their prescription medications. Most of them have sustained some injury or have had chronic medical problems resulting in the chronic pain. Our goal for them is to increase their functioning, increase their activity, detox them from their pain medications because often the medicines are no longer effective, and improve their overall quality of life. That program is really quite separate from our main program with a focus on physical therapy, physical activity, really looking at pain and their dependence on drugs.

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]]> Baltimore County mother and lawyer Jill Swerdlin faces drug charges. https://www.baltimoremagazine.com/section/community/baltimore-mother-and-lawyer-jill-swerdlin-drug-charges-oxycodone/ Fri, 13 Jun 2014 09:30:00 +0000 http://server2.local/BIT-SPRING/baltimoremagazine.com/html/?post_type=article&p=8440

At 7:43 a.m., on a clear, otherwise picture-perfect morning, the first day of October, Baltimore County Vice Narcotics and Gang Enforcement Team officers—in full tactical gear with weapons drawn—begin yelling and pounding on the front door of a four-bedroom, two-and-a-half bath, two-and-a-quarter acre brick home on Manor Road in Phoenix. If they’re not up already, families in this bucolic neighborhood will be soon, trying to get their kids off to school. One next-door neighbor comes outside, concerned that there’s been some sort of medical emergency.

“Police with a search warrant!” the officers bellow. “Open the door! Police with a search warrant! Open the door!”

The home’s windows are open—it had been that kind of breezy, autumn sleeping weather the night before—but there’s no response from inside the house. And now the police, having announced their presence, break through the door with a battering ram. Just inside, standing in the living room near one of the two sofas, officers immediately identify 50-year-old commercial insurance broker Francis “Chip” Carnes. But initially, they are unable to locate the target of their search warrant—Carnes’s fiancée, attorney Jill Swerdlin—though they do locate her 8-year-old son in an upstairs bedroom.

Eventually, police discover Swerdlin in the basement of the $370,000 home, near a washbasin—there’s a Ziploc-type baggie with white residue atop the sink’s drain. Handcuffed and brought upstairs, Swerdlin, still in a long nightshirt, is told to sit in the living room across from Carnes, also in handcuffs, where both are read their rights per Miranda. That’s when Det. Douglas Kriete, a thickly built, goateed, ponytailed, 31-year police veteran, asks the couple if there is anything illegal in the house. Carnes, again, not the target named in the warrant, tells Kriete that there may be “some old smoking devices”—the words from the police report—meaning crack pipes, in the bedroom. Swerdlin concurs, according to the same police report, adding that there are guns in the basement inside a safe near where she was found by police.

None of this, however, is why the police are here.

A self-described “Jewish mother of two kids” from a prominent Baltimore County family of attorneys, Swerdlin, 47, was the focus of a five-month investigation and grand jury indictment, with prosecutors alleging that she was the center of a “hub and spoke” conspiracy to distribute illegal prescription drugs. The indictment alleges Swerdlin, a former public defender in private criminal defense practice for the past five years, provided legal services in exchange for illegal prescription drugs; possessed and distributed controlled substances, including oxycodone; conspired to distribute illegal prescription drugs; and—this was the kicker that sparked media attention when she was arrested—smuggled illegal prescription drugs into the Baltimore County Detention Center.

But while being questioned, Swerdlin initially refuses to talk about her role in obtaining or exchanging illegal prescription drugs, according to police. Only when Kriete threatens to end the interview and simply take her away, he testifies later, does Swerdlin open up to his more obliging, younger partner—the “good cop/bad cop” routine. Once her son has been fed breakfast and walked to the bus stop at the end of driveway, Swerdlin, who would certainly be expected to understand what’s she’s agreeing to do, appears to come clean.

This is what she wrote:

“In 2009 I was in a serious car accident and due to my injuries I was prescribed oxycodone. After approximately a year my dr. discontinued my prescription. I was still in pain and addicted to oxycodone so I purchased them from people who were selling them for money. I have given other people pills who needed them and I have asked other people close to me to get them for me. I am ashamed about my behavior especially because I am an officer of the court and have been a professional for 23 years.”

Then, potentially damaging, in terms of legal consequences—Swerdlin also participates in a written Q & A. In response to detectives’ questioning, she affirms, among other things, that she involved her 28-year-old legal assistant (charged with possession and intent to distribute) in oxycodone exchanges and that she brought, on one occasion, illegal prescription drugs to a client jailed at the Baltimore County Detention Center to increase her fee. She gives up the names of 11 people from whom she received oxycodone pills, including former clients with violent histories. And when detectives also ask if she provided oxycodone to her 20-year-old son Brett, who has pled guilty to one count of possession of a controlled and dangerous substance in an arrest related to the investigation, she writes, “Yes.”

MUGSHOT COURTESY OF BALTIMORE COUNTY POLICE DEPARTMENT.

TOWSON-BASED CRIMINAL DEFENSE ATTORNEY JILL SWERDLIN AFTER HER ARREST ON PRESCRIPTION DRUG DISTRIBUTION CHARGES

swerdlincourt
Swerdlin and her attorney leaving the Baltimore County Circuit Courthouse on May 16, 2014. - Photo by Ron Cassie

That would seem like case closed. Police take “green dot,” pre-paid debit cards from the house, confiscate a cellphone, planner, and receipt book as evidence—as well as a couple of pills, more baggies, vials, and paraphernalia. End of the story; except it’s not. Seven months later, in a Baltimore County Circuit Court criminal motions hearing this past May 16, Swerdlin—tall, slim, in a conservative black dress, sweater, and heels—claims her civil rights were violated by officers and that a quid pro quo offer was made by detectives.

Fidgeting, shooting glances back at Carnes (who was eventually charged with possession of cocaine and paraphernalia) from the defense table—and told at one point to “sit still” by Judge Timothy L. Martin—an understandably anxious Swerdlin and her attorney argue that her statement, particularly that less sympathetic Q & A, should be thrown out. In the meantime, the Attorney Grievance Commission of Maryland has sought an injunction to stop Swerdlin from practicing, alleging professional misconduct in a civil suit, including misleading clients about her ability to influence judges, and accepting money for legal services and then failing to provide those services. Swerdlin and Carnes also face a forfeiture suit regarding the shotguns (essentially Carnes’s hunting rifles) located in the Manor Road house because of the proximity to alleged illegal narcotics.

Then there are other personal things to contend with: Her Pikesville townhouse is in foreclosure; there are contract and tort claims being brought against her by two former clients; plus, family issues—her son Brett is living in a North Carolina recovery house, while his father, her first ex-husband, has stopped talking to her. Swerdlin, who agreed to be interviewed for this story even as she faces a plea hearing in mid-June, says she’s been clean and sober ever since her arrest and subsequent treatment, but it’s a lot for anyone deal with, let alone someone trying to recover from drug addiction.

But there’s still the broader question. How exactly does all this suddenly happen to a former St. Paul’s School mom with no previous criminal record? Why, for example, do Baltimore County police and addiction specialists say they aren’t surprised anymore that an upscale lawyer, following a doctor’s prescription for pain medication (at least initially), finds herself hustling pills from convicted drug dealers? Just how bad is the prescription painkiller problem in the suburbs?

If the stereotype persists that somehow this country’s drug problem is an inner city, “urban” crisis—read: low-income, poorly educated blacks or Latinos using crack cocaine or heroin—it’s time to put an end to that notion. And if the belief persists that soaring prescription opiate abuse in the U.S. is somehow relegated to Appalachia or some other poverty-stricken region where unemployed white people live—it’s time to put that notion to bed, too.

One good way to get a handle on the extent of the prescription drug problem is to look at the hard data on accidental overdoses.

In 2010, prescription drugs killed more than 22,100 people in the U.S.—triple the number from a decade ago, according to the Centers for Disease Control and Prevention (CDC)—and more than twice that of cocaine and heroin combined. What’s more, opiate pill addiction is now being blamed for reversing an earlier decline in heroin-related overdoses. Two years ago, the Maryland Department of Health reported that heroin-related overdoses had begun to spike again, and they linked the uptick to prescription opiate use that eventually becomes heroin use when the addict can no longer find or afford prescription opiates.

Most dramatically, recent studies show that for the first-time, more deaths are attributed to drug overdoses than car accidents or gun violence. But still think someone from Swerdlin’s demographic is an atypical drug addict or that it’s largely a teenage problem? According to the CDC, prescription drug overdose rates are highest, by far, among whites when compared to African-Americans or Latinos, and also highest among those aged 35-54—with both rates continuing to climb. Prescription overdose death rates among women, in particular, have reached unprecedented levels, increasing 400 percent from 1999 to 2010.

“This cuts across all boundaries, all levels of society,” says Mike Gimbel, Baltimore County’s former “drug czar” for 25 years. “And it is a huge problem in the private schools. But when teenagers start experimenting with pills today, they usually begin in their parents’ bathroom cabinet.”

And yet all of this is still a fairly recent development. It wasn’t that long ago, in 2006, that the Baltimore County Police Department first deemed it necessary to create a new narcotics unit, the pharmaceutical drug diversion team, specifically to tackle the crisis of the illegal distribution of prescription pills. That first unit only had two officers. Today, the unit is managed by a corporal and a sergeant, who oversee five detectives. In 2013, the unit made 305 arrests, including 168 for felonies, many including violent offenses, and they executed 52 search-and-seizure warrants like the one that brought them to Manor Road—far surpassing the numbers for any other illegal drugs.

Baltimore County police sergeant Bruce Vaughn notes this was all accomplished despite the unit’s having to overcome greater obstacles than other narcotic units, because they’re going after a black market for drugs that are legal when prescribed correctly. Also, HIPAA privacy laws can bog down background investigative work. “These can be complicated cases,” Sgt. Vaughn says. “Like investigating financial crimes.”

According to law enforcement, prescription drugs have become a driver of criminal activity because so much money is involved. The going rate is now $30 for a single 30 mg pill, compared to, say, $10 for a small amount of heroin—and that, for all intents and purposes, prescription drugs have become street drugs. They’re often trafficked by the same people who sell heroin, coke, and marijuana, often violent offenders. The former client Swerdlin allegedly smuggled drugs to inside prison is there on armed robbery charges. He has also been charged with attempted murder in the past. In fact, a number of those initially charged in the indictment with Swerdlin have been found guilty of distributing other drugs previously. Four are former clients and a couple have faced armed robbery and firearm charges.

“We could use five more detectives,” Kriete says. “The prescription drugs take up more than triple [the time] of anything else we deal with.”

Gimbel, himself a longtime recovering heroin addict from Pikesville, calls prescription painkiller drugs like OxyContin “heroin in a bottle” and says that 80 percent of the calls he receives today from families seeking help for a loved one are related to prescription drug abuse. “It used to be 5 percent.” He says anyone taking these powerful pain medications every day for 30 days will begin to build a tolerance—inevitably suffer withdrawal symptoms—and that it should be protocol for every patient to go through a medically supervised detoxification program. “Look, this stuff isn’t coming from Central America, Columbia, Peru, or Southeast Asia,” Gimbel continues. “It’s doctors that are prescribing this stuff.”

Once addicted, he and other recovering addicts say, all bets are off.

“You cross every line that you think you’ll never cross,” says Linda Y., a former Johns Hopkins nurse who was fired for shooting up pain medication intended for patients in the bathroom at work. (She asked to remain anonymous in accordance with 12-step tradition.) The assumption is that a lawyer or nurse, or any suburban professional for that matter, lives two lives once they become an addict, but that’s not true, Linda says. “It’s one life,” she says. “It all revolves around getting what you need.”

She adds that the problem of prescription drug abuse is particularly acute in the world of health care providers given the access that doctors, nurses, pharmacists, and others have to medication—and notes that 12-step meetings in the Roland Park, Rodgers Forge, and Homewood areas are frequented by individuals in those industries. Linda went through a three-year, Maryland Board of Nursing discipline and rehabilitation program, including treatment and drug screens, to earn back full practicing credentials, adding, “I wish it had been five years like it is today. I needed it. It really helped me.”

Bob D., a 49-year-old lawyer who went through treatment for prescription drug addiction at Father Martin’s Ashley’s two-year pain recovery program in Havre de Grace, was initially prescribed medication for a rare neurological condition. But ultimately, the “cure” for his pain became worse than the underlying problem. He hid his addiction as long as possible, “doctor shopping” (going from one doctor to the next, hoping each would authorize a new prescription) and keeping the true number of pills he was taking from his neurologist and partner. “I was obsessed with my ’scripts,” he says. “I started with a pill every day like I was picking up my morning coffee. It was three or four years of a living hell.”

In fact, one of the things Bob says he learned at Father Martin’s Ashley was that drugs used to treat chronic pain, like oxycodone and hydrocodone, are not only addictive and potentially deadly—“my greatest fear was that I would forget how many I took and not wake up one morning”—but often don’t work long-term for chronic conditions. And these drugs can actually create a change in the neurological system where people develop hyperalgesia and become far more sensitive to pain than when they started out on these drugs. Today, Bob follows a routine he began at Father Martin’s Ashley that includes A.A. meetings, meditation, prayer, deep-stretching exercises, and some yoga to treat both his addiction and chronic pain. He reports he’s begun playing tennis again for the first time in years.

Ground up and snorted, or injected, which some abusers do, prescription pain pills can mimic the high of heroin, but even in pill form, opiates can create a false sense of euphoria and well-being, which is part of their insidious nature, says Dr. Carol Bowman, a Father Martin’s Ashley addiction specialist. “An injury sends a message to the brain. The medication, however, blocks the neuroreceptors and sends those signals away—but it also blocks all pain signals,” Bowman says. “It doesn’t distinguish if it’s anxiety, depression, or physical pain.” She adds that it doesn’t take long, either, for the drugs to confuse the brain’s normal “feel-good” chemical processes. “When they stop being taken, they suppress the brain’s natural production of dopamaine, our natural reward system, which also begins another downward spiral.”

Gimbel—who says he’s seen weekend warriors with knee and back injuries get hooked—believes there’s also a deeper societal component underlying the problem. “Everyone who gets admitted to the hospital today is asked to assess themselves for pain on a scale of zero to 10—that wasn’t always the case,” he says. “The target is always zero with the pharmaceutical companies pushing their products, so doctors try to get everyone down to zero. It’s like no one is supposed to experience pain anymore. It’s, ‘Here take a pill.’”

“And of course, all of this is just treating the symptoms,” Bowman adds, “not the actual causes of the original pain, which is what we should be examining.”

It’s this dual track—the physiological and psychological—that makes addiction, and treating addiction, tricky to fully understand, says Dr. Michael Fingerhood, director of the division of Chemical Dependency at Bayview Medical Center. There is a genetic component to addiction that makes some people more susceptible; there is a “phenomenological” component (i.e., stressful events or periods); and there’s the purely physiological aspect (the physical cravings)—particularly with the powerful round of painkiller drugs that were introduced en masse a little more than a decade ago.

“These are not your mother’s Valium or a drink after work: ‘Tough day, I think I’ll have a Percocet.’ But people think they are because they’re prescribed,” Fingerhood says. “I’m not surprised at all that people get to a place where they don’t know who they are anymore and can’t ask for help. Prescription drug addiction is the elephant in the room. It’s the epidemic no one talks about.”

A few days after her mid-May criminal motions hearing, outside a bustling Panera Bread cafe in the Hunt Valley Towne Centre shopping complex, Swerdlin—calmer than she appeared in court, dressed in a sleeveless white blouse, her hair colored a darker hue than in her smiling mug shot—recalls the car accident that ultimately led to her addiction, and to her journey from defense attorney to defendant. She’ll never forget the date; it was her 44th birthday, Jan. 6, 2009.

“I was leaving the Baltimore County courthouse, headed for Wabash Avenue, and it was raining. I was going about 5 mph on Allegheny [Avenue], trying to see, my view was obstructed, and I got T-boned,” she says. “My BMW was totaled, and I was taken to the hospital.” Police reports aren’t clear about who was at fault, but Swerdlin says the young driver of the other car was speeding. Her car did a 180-degree spin, and though she was wearing her seat belt, her face smashed against the empty passenger seat, badly damaging an eye socket and fracturing her cheek. “Of course, when I left the hospital,” she says, “I had the prescription for oxycodone.”

Her doctor cut off her prescription approximately a year later. But she says she needed oral surgery, which led to another prescription. She also says that she hit up friends and family members from time to time for pills, telling them that she didn’t feel well for one reason or another. “I didn’t go the doctor route [doctor shopping] and didn’t want to go through insurance,” she says, adding that she was “professionally, ethically, morally too proud” to have that on her medical records. Instead, she says, she found it easier to get what she needed from clients she was representing, who had been accused of drug dealing.

“Being a criminal defense attorney made it accessible,” Swerdlin says. “I started taking on clients who were drug clients. I started getting a good reputation from defending drug dealers, trying to get them into drug rehab and drug court, and I got to where I was making good money dealing with high-level people.”

She was eventually taking “five to seven” pills a day, starting first thing in the morning, then spread throughout the day, and “not eating lunch for years” while she hurried to track down pills, argue her cases, and make it to school to pick up her youngest son.

She also says that her addiction was “at low level for a long time, probably until six months to a year” before her arrest and “then it went from zero to 60 in a hurry.” She says that she was able to keep her use and behavior a secret from those closest to her, and that Carnes “had no idea” why the police broke into the house last fall.

Court records, police testimony, and allegations from other clients suggest life began getting unmanageable for Swerdlin before last fall, however. For starters, it was not long after her accident in 2009 that her name began to regularly appear as a defendant. Initially, it was for minor things. In 2010, there was a contempt charge that was dropped. Then there were a number of traffic violations, starting in 2011—driving with an expired tag, failing to produce a vehicle registration card, and later driving with a suspended license and other charges. Also, in 2011, her condo association sued for late fees. There’s the foreclosure that begins in 2011. And, Baltimore County police say she popped up on their “radar” in January 2012—a year before she says her addiction become serious—as part of a separate and still ongoing investigation (although Swerdlin is not accused of running any sort of major drug ring).

The first claims of professional misconduct, including that she took money in return for legal services not provided, date back to the fall of 2012. But most of the seven allegations, all of which Swerdlin denies, occurred more recently, in 2013. Baltimore County assistant state’s attorney Jason League, who is prosecuting the Swerdlin case, notes that she continued to represent drug clients even after her arrest until the Attorney Grievance Commission of Maryland filed an injunction.

Her testimony at her criminal motions hearing also differed substantially from that of the four police officers called to the witness stand. She testified that she believed her house was being robbed and under attack, possibly from a disgruntled former client, when police pounded on her door. She says she heard, “Get down, this is a robbery,” not “Police with a search warrant! Open the door!” She also says that she was in the basement near the washbasin when found by police because she was trying to run from the house to get help. Taken with her allegation that male officers helped her get dressed—and not the female officer who was called to the scene—and claims that a quid pro quo was offered (that police told her they would not arrest her fiancé and she’d receive a better deal if she agreed to the Q & A), Judge Martin said in court that he did not find her testimony “terribly credible.”

Of course, disputes in court over the facts aren’t uncommon. At the same time, Swerdlin seems to be walking what could look like a fine line to a jury at the moment: admitting to addiction and obtaining and using illegal prescription drugs while declaring herself not guilty of the most serious crimes of which she is accused.

“I’m an addict,” Swerdlin says. “But I’m not guilty with what they are charging me.”

She also says in the interview at Panera Bread that the Baltimore County police only found a single piece of paraphernalia, a spoon owned by her 20-year-old son, in the search of her and Carnes’s home. (Reached by phone, her son would not comment.) But, according to police reports, four burnt pipes were found, and it was Carnes who was charged with possession, not her oldest son—who lived in her Pikesville townhome at the time. Nonetheless, she suggests that charges against Carnes will be dismissed if she accepts a plea.

As far as the allegations that she took payments in return for legal services not provided—in one case a judge has already ruled in favor of the plaintiff—or other accusations that she implied that she could influence judges, Swerdlin says, “Once people found out what happened to me,” referring to her arrest, “they started coming out of the woodwork, looking for money.”

And finally, she also claims she is being unfairly targeted by law enforcement officials because of her “elevated status” as an attorney. “I’m not being treated like everyone else,” she says. “The state is trying to make an example of me.”

Meanwhile, even as Swerdlin maintains she’s being unfairly treated by law enforcement and prosecutors, she weaves 12-step lingo into the conversation, speaking about taking things “one day a time.”

After being bailed out of jail by Carnes, she entered the Kolmac Clinic’s intensive outpatient program on the campus of Sheppard Pratt. She’s says she goes to A.A. meetings on a daily basis and that it was her 12-step sponsor who was with her all day at her criminal motions hearing.

She says that she believes in God and that everything happens for a reason, and if she had to go through this to become an example for others—a cautionary tale, as it were—so be it.

She admits that her arrest has been “devastating,” but that she has also gotten a great deal of support, receiving, she says, more than 200 messages and e-mails from friends, family, and colleagues. She does admit that she “lied to judges, lied to people, and lied to people that could’ve probably helped me.”

And whatever the outcome of her legal case, successful recovery from addiction remains a fraught road for anyone, requiring life-long care, as with other chronic diseases, such as diabetes, to which addiction treatment and recovery is often compared. Studies show that the majority of those in recovery do relapse, often requiring additional treatment. Fingerhood, the Bayview addiction specialist, estimates that about half of those seeking treatment for opiate addiction and also receiving drugs such as buprenorphine or methadone to stave off cravings, are able to attain “sustainable abstinence”—defined as one year clean and sober. Without medication help, he says, “It’s about 10 percent.”

As her nearly two-hour interview is concluding, Swerdlin says her sponsor tells her that it will take the same length of time off drugs, as on them, before she will even begin to feel like her self again, and she acknowledges that jail is a possibility. “I’ve never been in trouble and hopefully the 43 years before my addiction [will] all be considered,” she says. “I’m happy that my two children have good fathers. If I have to go to jail and do time, then I will do what I have to do.”

She intimates, however, that plea negotiations are imminent, and that disbarment with the possibility of applying for reinstatement five or so years down the line is a more likely scenario than a prison sentence.

If necessary, she says, she will re-invent herself.

“Who knows?” she says. “Maybe I’ll write a book about this one day if I lose my license.”

EDITOR’S NOTE: This story will appear in our July 2014 issue, on newsstands later this month.

UPDATE (June 15, 5 p.m.):

Towson-based attorney Jill Swerdlin pled guilty to three charges this afternoon in Baltimore County Circuit Court related to the above story and faces jail time and disbarment, per her plea agreement with the Baltimore County State’s Attorney’s Office.

Swerdlin pled guilty to the distribution of buprenorphine, a drug used to treat opioid addiction, and the distribution of a controlled dangerous substance to a client incarcerated at the Baltimore County Detention Center. She also pled guilty to conspiracy to possess oxycodone.

The sentencing agreement, which will not be officially disposed until the end of July, calls for a maximum 5-year prison sentence for Swerdlin, with all but 18 months suspended. Swerdlin will not be eligible for home detention during her 18-month sentence, but will eligible for work release and may apply for parole. She also consented to disbarment as part of her plea.

Other plea agreement stipulations include three years of parole and probation, drug treatment, and random urinalysis.

Also as part of the deal, Swerdlin, a criminal defense attorney, agreed to meet with prosecutors and Baltimore County Detention Center officials to reveal everything she knows about drug smuggling efforts at the jail. Jason League, assistant state’s attorney for Baltimore County and lead prosecutor on the case, said changes have already been made since Swerdlin’s arrest to improve security at the jail.

According to the plea terms, Swerdlin may also seek to modify her sentence—essentially seek a probation before judgment final disposition—if she successfully completes all of her required stipulations, enabling her, potentially, to regain her law license down the road.

Three others indicted in the Swerdlin conspiracy case have already pled guilty and a fourth is expected to plea guilty next week, according to prosecutors. Six other people charged in the conspiracy still have their cases open.

“She’s different than just an addict because she had access to clients who were in a holding facility, and, as an officer of the court, she was abusing that access by smuggling drugs into prison,” League said afterwards. “Smuggling contraband into prison goes far beyond just that one client—many of the people there have drug problems and for them this is gold. So that becomes a huge problem and obviously, we have an obligation to uphold the integrity of our jails.”

League added that the broad prescription drug investigation that began in January of 2012, and led to Swerdlin’s arrest, remains ongoing.

–Illustration by Richard Mia

Update: This article has been updated to contain a sponsored link from recovery.org.

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