Opioid-related deaths in Maryland, which have quadrupled since 2010, climbed again in 2018.

Overall, there were 2,385 total unintentional intoxication deaths last year in Maryland, an increase of 4.5 percent from 2017 Of that total, 2,114 deaths were opioid-related, an increase of 5.2 percent from 2017, according to data released Thursday from the state’s Opioid Operational Command Center (OOCC).

Maryland is among the top five states with the highest rates of opioid-related overdose deaths.

The crisis continues to be acutely felt in Baltimore City, where opioid-related intoxication deaths jumped more than 15 percent, with 798 unintentional deaths, in 2018.

The fatal overdose epidemic continues to be driven by fentanyl—a synthetic opioid that is 80 to 100 times more potent than morphine. A deadly substitute for heroin and prescription opioids, fentanyl-related deaths in Maryland last jumped to 1,866—an increase of 17 percent.

“We haven’t seen the peak of this, yet,” said Mona Rock, Baltimore City Health Department’s public information officer. “Right now, fentanyl is having a devastating effect in our community and we don’t know when it is going to end.”

Rock added that addressing the opioid epidemic remains a “top priority” for the Health Department under new Commissioner of Health Dr. Letitia Dzirasa, who was appointed in March after former commissioner Dr. Leana Wen was named president of Planned Parenthood Federation of America.

Adrienne Breidenstine, vice president of policy at the Baltimore Behavioral Health System, which works closely with the Health Department, said her agency and the city has begun receiving more state and federal dollars in the past two years.

She adds, however, it will take time to see the impact of new outreach, prevention, and treatment programs. “I think it will still take a couple of more years before we start seeing those numbers [overdose fatalities] turnaround,” said Breidenstine, adding that building safe, healthy communities in the city remains the best long-term preventive measure in addressing Baltimore’s heroin and opioid epidemic.

Opioids, now including fentanyl, are sometimes used in combination with cocaine, and fentanyl is also now pushing a dramatic increase in the number of cocaine-related deaths in Maryland. Cocaine-related deaths jumped 28 percent to a total of 784 in 2018, marking the third straight year of significant increases in cocaine-related fatalities. Approximately 89 percent of all cocaine-related fatalities in 2018 were in combination with fentanyl.

Washington County, driven largely by the opioid epidemic in Hagerstown, its economically struggling county seat of 40,000, saw the second largest increase in unintentional opioid-related intoxication deaths in the state. Opioid-related fatalities in Washington County jumped from 51 to 80 in 2018—a 58 percent increase.

In terms of the per-capita death rate for unintentional opioid-related intoxication deaths, Baltimore County, which saw an increase in overdose deaths from 323 to 348 last year, now ranks fifth among reporting Maryland jurisdictions.

If there’s good news in the report, it’s that several large Maryland counties, including Montgomery, Prince Georges, and Howard, saw decreases in unintentional opioid-related intoxication deaths.

Former Anne Arundel County Executive Steve Schuh, executive director of OOCC, praised Gov. Larry Hogan’s response to the epidemic.

“Since Governor Hogan declared a state of emergency in response to the opioid crisis in March 2017, Maryland has made tremendous progress in implementing prevention and educational programs, stepping up enforcement, and expanding treatment and recovery programs throughout the state,” said Steve Schuh, executive director of Opioid Operational Command Center.

Anne Arundel County saw a 10 percent increase in unintentional opioid-related intoxication deaths with 217 fatal overdoses last year.

In a statement, Schuh added that state officials are “encouraged that the epidemic is starting to plateau.” “2018 was the second year in a row that fatalities increased by less than 10 percent,” Schuh said.

Mike Gimbel, the former “drug czar” of Baltimore County, cautioned about leaning too much on fatal overdose figures in gauging the opioid-addiction crisis. With widespread use of Naloxone, a medication that can quickly reverse the effects of opioids in overdose situations, more people are surviving overdoses. More users are also likely becoming familiar with deadly fentanyl and better managing its use, said Gimbel, a proponent of on-demand, long-term treatment

“We don’t need more billboards and hotlines,” Gimbel said Thursday while at the opening of Awakenings Recovery Center, a 50-bed, residential treatment facility in downtown Hagerstown. “Everyone knows about the crisis now. We need more beds. This place accepts Medicaid and we could use 500 more like it across the state.”

On Monday morning, Mayor Catherine Pugh and Baltimore City Health Commissioner Dr. Leana Wen announced a new initiative to combat the opioid epidemic in the city. The Levels of Care initiative involves identifying best practices for responding to the opioid epidemic and will be based in 11 Baltimore hospitals included Bon Secours, Mercy Medical Center, St. Agnes, University of Maryland, and Johns Hopkins Bayview. 

“Among Baltimore’s greatest assets is Baltimore’s unparalleled hospital system which, arguably, is the finest in the world,” Pugh said in a statement. “I am calling on the leaders and medical professionals of our hospitals to join us in fighting the opioid crisis, which continues to claim far too many lives not only in our community, but across our nation. This is a national health crisis and it needs to be treated with the advanced medical resources that we know can be effective and which for sure will save lives.”

The levels of care were developed with input from hospital administrators and will be based on criteria like a hospitals’ ability to provide treatment to patients who screen positive for addiction, distribute overdose medication naloxone to patients, connect patients with peers or other support services, and educate how doctors prescribe opioids. The levels will range from one to three—with one being the highest—to rate a hospital’s comprehensive response to opioid treatment. Currently, the levels of care are open to the public for comment until May 31 and will be finalized this summer.

“We are in the midst of the deadliest drug epidemic in American history,” Wen said in a press conference. “And Baltimore City—with the highest age-adjusted overdose fatality rate of any metropolitan county in the United States—is one of its epicenters.”

The initiative is based on a similar program in Rhode Island, one of the only places in the country where overdose deaths decreased last year. Dr. Wen and the health department have been approaching the opioid crisis in Baltimore aggressively since the number of opioid-related deaths have increased each year. As of June 1, 2017, legislators enacted a standing order for a blanket prescription of naloxone at all pharmacies in the city.

In the spring of 2019, the Baltimore City health department will also open the state’s first-ever Stabilization Center for those under the influence of drugs to receive short-term medical and social interventions as part of the city’s plan to create a 24/7 behavioral health emergency department. Services provided will include medical screening and monitoring, connections to behavioral health and social services, and buprenorphine induction to treat opioid addiction. The Stabilization Center will be located in the Coppin Heights/Rosemont community.

“We are leading the nation to provide evidence-based treatment for the disease of addiction,” Wen said. “The only way to combat it is to ensure that resources and treatment are available.”

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.”