‘It is so critical that we draw a line around our youth’

Clay Stamp is Maryland’s point man in the war against opioids. He was appointed by Gov. Larry Hogan in early 2017 to the post of executive director of the state’s Opioid Operational Command Center.

He sat down with The Daily Record to discuss the status of the opioid epidemic in Maryland – how it’s evolving, what data the state is now collecting and where progress is being made. This interview was edited for clarity and length.

What is the state’s plan to curb the epidemic?

In order to effectively manage this crisis, we have a three-pronged approach. We know that across the country the priority for treatment services for people that have substance abuse disorder are marginal at best, so the expansion of an infrastructure for treatment with recovery services is one of the prongs.

The second piece is enforcement. There has been a paradigm shift where law enforcement recognizes that we can’t arrest our way out of this. Low-end users are people that have substance abuse disorder who are better off in treatment than in jail. But this enforcement piece is important because we have to go after these drug trafficking organizations.

The third is prevention, and that is where we are going to make the biggest difference. The United States is a capitalistic society — we always meet demand in this country, and until we really remove it, the supply will always be there. That is why it is so critical that we draw a line around our youth and protect our children to create a culture of not wanting to do this.

What data is the state collecting and how do you believe it gives the state a better understanding of the problem?

There are three layers of data that we use.

There was a bill that went through this year, that allows for data sharing to use what’s called the overdose or “OD map”. That is where we use near real time information from EMS reports — not patient specific, but geographically specific – to populate a map and show us where overdoses are happening at any given time. This is what we call the tactical layer.

The second layer is information that tells us the total number of deaths and non-fatal overdoses that are occurring and where. In addition, we have a whole set of metrics that we use around state and local programs and efforts to see if they’re effective. Those are our impact indicators.

The final layer is more of a research layer where we are trying to use predictive analysis. A bill that went through this last session, compels state agencies to share data so we can do more of that kind of research.

How has this crisis evolved since it began?

What we are seeing is something that is really interesting — we still have a lot of people dying every day, but the type of death is different.

We believe that this crisis initially started from prescription opioids, where people became addicted to a pain medication that was not supposed to be addictive. In many cases it was not the fault of the person — they were prescribed this medication and so we saw that the numbers of addiction really spike, and then we saw the deaths associated with that spike.

In the last year, what we are seeing is a reduction in the number of deaths associated with prescribed opioids and a reduction in the number of prescriptions being written. This means that doctors are getting the message and we are starting to see that reduction, and if it weren’t for illicit fentanyl the number of overdose deaths would be dropping.

What began as a prescriber-based epidemic is now shifting to an illicit drug crisis. We can’t let our foot off of the gas pedal as far as holding people accountable for properly prescribing these medications, but now we have this illicit fentanyl that is flooding our streets and it is being combined with virtually every other illicit drug out there — killing an alarming rate of people across Maryland and across the country.

Upwards of 70 percent of opioid-related deaths in 2017 are going to be because of this illicit fentanyl.

What are the pros and cons behind the new statewide standing order allowing pharmacists to dispense naloxone to anyone who may be at risk for an overdose? Could this affect the overdose data the state is collecting?

The standing order for naloxone is all about getting life-saving medicine and making it available everywhere we can. The theory is that you need to save a life before you can help somebody get into treatment. If you don’t save that life, the life is gone.

Our position has been to try to get naloxone in the hands of as many people as we can so they can save a life. That’s a noble thing to do and that’s an important thing to do and though we try to measure that the best we can though it is very difficult.

Then the unintended consequence is that you’ve now put naloxone in the hands of people who have an addiction. So they potentially use that to enable their ability to continue using.

How does the state gauge progress other than through overdose numbers?

The ultimate measure is reducing the loss of human life. We all know that we need to reduce the number of people who are dying or having non-fatal overdoses, and we need to reduce the number of instances of hepatitis and HIV that can be picked up through addiction.

To do that we have to launch programs and establish determinants that measure whether a program is successful.

Especially in the area of prevention, it is often a long period of time before you see any results. For example we believe that rolling out drug awareness programs in schools will have a positive effect down the road, but immediately it is very difficult to measure.

Every agency has different measures that we watch. In school systems we measure drug awareness curriculum which they are now required to have by law between third through twelfth grade — so we can watch that gap close.

When we talk about measuring the amount of drug interdictions that occur, there are metrics to determine how well we are doing to stop the flow — whether we are taking in more or not.

Once Maryland starts to fully participate in the OD map, you can see plumes of overdoses come down from New York to New Jersey towards you. This allows us to warn people that they might have a deadly batch of something moving into an area. It helps us guide our prevention efforts, our awareness efforts and our short-term alerting efforts.

The OD map exists today and in part, Anne Arundel County is already starting to use it. We plan to roll EMS data across the state into the map to more effectively capture real time overdoses, instead of depending on people to input that data manually.

We also monitor for neonatal abstinence syndrome — babies that are born addicted—and for Hepatitis C and HIV — diseases that can be picked up secondary to addiction.

Where has the most progress been made this far in curbing the problem?

Stigma.

There are a lot of people out there that think that life is just tough and that when you grow up you teach your kids not to grab the bleach from under the sink and drink it because if you do you’re going to die. If you walk in front of a bus you’re going to die. If you take drugs you’re going to die. Well that doesn’t answer the doctor that prescribes an opioid to you and you get addicted.

A lot of people have a very callous view, and frankly this stigma gives people a hardened view towards those who have addiction, or view a family that has an addicted member as having a moral failure.

Across Maryland there is a huge cadre of beautiful people called advocates. They help others who have found themselves in the middle of this crisis — they could be someone who has had addiction themselves, or are the parents of an addict. We work with them a lot and what they will say to you is that it’s easier to speak about the disease of addiction today than it was 365 days ago.

That means that the environment is more conducive for people to raise their hand and say that they have a problem or say, “I don’t know what to do and I need help.”

This article is part of The Daily Record's special edition examining Maryland's response to the opioid crisis

Read articles in the series:
Attorney addiction | Local government litigation | Outpatient treatment | County programs | A mother's message | For-profit treatment | When to prosecute? | When to prescribe? | Employers' best practices | Rural communities' response | Opioid chief interview

Read commentary:
Maryland's courts | MSBA Lawyer Assistance Program | Using data | The good, the bad and the ugly