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Counties’ challenge: Stop one drug, another pops up

Combating prescription opioids can end up with a jump in use of heroin

In early 2012, Wicomico County started to address the challenges of opioid addiction and overdoses when the rural Eastern Shore county experienced an increase in home invasions, burglaries and pharmacy robberies after the state removed the registration of a local pain management physician who was treating about 4,000 patients.

The county formed a prescription drug task force to create a plan to deal with the issue, expanded education efforts for doctors about prescribing opioids and tried to spread the word about the dangers through local media. But like many treatments, it had a side effect.

“As the opiate arrests decreased, as well as the prescription drug deaths decreased, we saw the heroin [use] rise,” said Lori Brewster, Wicomico County health officer.

Wicomico County isn’t the only jurisdiction dealing with this issue. In fact, prescription opioid abuse and the associated rise in the popularity of heroin is so common the Maryland Association of Counties summer conference will include two workshops on the issue. The two sessions will be dedicated to examining how counties can deal with the crisis as public health and public safety issues.

In June, Gov. Martin O’Malley announced he had established an Overdose Prevention Council with the goal of driving down drug and alcohol overdose deaths by 20 percent next year. According to the Maryland Department of Health and Mental Hygiene’s 2013 annual report on drug- and alcohol-related intoxication deaths, the number of state residents who died from overdoses increased by 7 percent from 2012.

Much of that increase was attributed to an 18 percent increase in heroin-related overdose deaths, which increased from 392 in 2012 to 464 in 2013. During that same time, prescription opioid-related overdoses have fallen from a high of 342 in 2011 to 316 in 2013.

Overdose deaths for drugs such as cocaine and benzodiazepine remained flat or decreased. But 60 percent of cocaine overdose deaths involved heroin or prescription opioids, and two-thirds of benzodiazepine deaths also involved prescription opioids.

As a result, counties throughout the state are taking measures to try to curtail the abuse, even jurisdictions that haven’t experienced a dramatic increase in addiction and overdoses. In January 2013, St. Mary’s County started an overdose prevention work group that consisted of individuals that worked in fields such as law enforcement, hospitals and social services to create a local strategic plan to combat opioid and heroin abuse. The county even put together a drug summit for parents that was attended by about 600 people and expanded addiction treatment for female inmates who were under-served.

“The things that we’re tracking right now we anticipate it’s going to be a few years before we see a marked difference in some of the data. We’ve been looking at treatment admissions that are related to opiates and prescription drugs and heroin. We’ve been seeing a gradual increase over the last couple of years,” said Matthew Reisdorph, St. Mary’s County substance abuse prevention and treatment coordinator. “But it’s really tricky, because when you go after the prescription drugs, people start turning to heroin.”

Counties are also turning to law enforcement to help stop growing problems with addiction and overdoses.

Lt. T.J. Smith, a spokesman for the Anne Arundel County Police Department, said late last year the executive command staff was alarmed by the amount of people dying in the county because of heroin and prescription opioid overdoses. As a result, the department launched what it called operation HOPE, or Heroin Overdose Prevention and Eradication.

The program involved a two-prong approach. The first focused on targeting people who were selling heroin. Another leg of the plan involved becoming the first police department in the state to allow officers to carry naloxone, an “opioid antagonist” that stops overdoses. Officers have been carry the drug since early this year spring and have so far used it to prevent eight overdose deaths.

“We’re not going to stand by and watch people die,” Smith said.

Kathleen Rebbert-Franklin, division director of population-based behavioral health at the Maryland Department of Health and Mental Hygiene, said if the state is going to effectively address heroin and opioid addiction, it’s going to need local jurisdictions to make a concerted effort.

“The state can’t do it on its own. The jurisdictions can’t do it on their own. We can only do this by working together. They have a level of involvement with the community, and the state has a role to play that’s different from the jurisdictions,” Rebbert-Franklin said. “But together we have a lot of strength.”

Meanwhile, jurisdictions like Wicomico County continue to try address local problems. One of the methods Wicomico is using is participating in a pilot program with Baltimore city and Cecil County that involves conducting a local fatality overdose review to see if the jurisdiction missed an opportunity to intervene. Wicomico County has also started dispensing naloxone to law enforcement in the county, and the county executive is looking to put together a roundtable to address heroin addiction.

“You have to consider that every time you plug a hole, you need to look for another one, so to speak, in the dike,” Brewster said.