Sean Kennedy: The good, the bad and the ugly on the opioid front

First the bad.

Four times as many Marylanders died of opioid overdoses (2,044) than died in traffic accidents in 2016 (505). Almost 90 percent of all drug and alcohol poisonings in Maryland were opioid-related.

That grim toll might climb further 2017 and beyond. (Preliminary state data shows at least 167 opioid-related deaths per month in Maryland.)

In addition to the lives claimed in 2015, opioids-related expenses cost each Marylander $3,337 when accounting for criminal justice, health care and work productivity losses.

Fortunately, under the leadership of Gov. Larry Hogan and Lt. Gov. Boyd Rutherford, who heads Hogan’s Heroin and Opioid Emergency Task Force, the state of Maryland is doing much to tackle the scourge that is ravaging lives across the Old Line State.

Drug markets – like any good or service – follow the laws of supply and demand. As prescriptions climbed for legal painkillers like Vicodin and OxyContin over the past two decades, inappropriate use spiked as the market was flooded with cheap, high-quality opioids generously prescribed to real patients, many of them in real pain.

At the opioid frenzy peak in 2011, Maryland doctors were writing enough prescriptions of the painkillers for 73 out of 100 people. Fortunately, that figure has fallen, along with the number of total pills, to 59 prescriptions per 100 Marylanders in 2016.

Recent prescription limits proposed and later signed by Hogan in May 2017 will help by reducing the legal painkillers’ supply even further..

Next, the ugly

While controlling access to legally acquired prescription opioids and their diversion to the streets remains a challenge, the real killer of Maryland residents is not being distributed at pharmacies but smuggled over the border from Mexico, Canada, and China – fentanyl.

The synthetic opioid, often cut with street drugs, especially heroin, or mixed into counterfeit prescription pills, took 1,119 Marylanders’ lives in 2016.

In its pure form, fentanyl and its synthetic analogues are 50 to 100 times as potent as morphine and 30 to 50 times as strong as pure heroin.

Across the state, bad batches of fentanyl-laced heroin have resulted in mass overdose deaths. Since the drug is an easy and cheaper substitute for heroin due to its extreme potency, drug pushers and traffickers prefer to dilute their supply with it. Most drug addicts are unaware they are using the strong substance.

Disturbingly, the highly effective opioid overdose reversal drug, naloxone, is significantly less likely to work on a fentanyl-related OD than heroin or prescription opioids.

That means – even with the great strides made by Maryland officials to increase the availability of the overdose remedy in pharmacies (without a prescription) and put it in the hands of all first responders – overdose deaths might continue to climb as fentanyl’s usage spreads.

China – the ultimate supplier of fentanyl – has over 177,000 laboratories pumping out the poison. It is then trafficked through the mail, or over our land and sea borders via Mexico and Canada. Just one recent seizure of illegal fentanyl (118 pounds) last month could have killed every Marylander five times over.

Fully tackling the supply side of the opioid equation will require massive federal, state, local, and international cooperation to stem the flow of the toxic street drugs.

Now for some good news

Any progress against this scourge will be slow and painful but necessary. Opioid education campaigns, initiated by the Hogan-Rutherford administration, can prevent would-be drug abusers from ever starting, and scare straight those already on the path of addiction, hopefully toward treatment and recovery.

Medically assisted treatment (MAT) like methadone and buprenorphine can help ease abusers off street opioids, under a doctor’s care, while rehab and other treatments options can (though too infrequently, for most) return Marylanders to lives of purpose and sobriety.

The opioid epidemic did not start overnight, and it won’t be solved that quickly, either. It took years for the oversupply of opioids to produce the hundreds of thousands of addicts that walk Maryland’s streets and just as long for the public, our officials, and the media to notice the harm being wrought by the painkillers and their street drug equivalents.

It may take even longer to return addicts to their full and productive selves, but that does not mean we should stop trying. It’s promising that the Hogan-Rutherford Administration and its allies in Annapolis have invested more $600 million toward an “all of the above” approach to the opioid crisis, including improving agency cooperation, prevention, enforcement and education efforts.

But they must continue to push for solutions, even if the crisis gets worse before it gets better.

The real challenge for the Old Line State’s leaders is to be compassionate without condoning or sanctioning behavior that destroys lives, families, and the economy.

Campaigns that directly or indirectly tolerate illegal and dangerous drug use like “safe injection” sites, reducing consequences for drug possession and dealing, and even encouraging social “de-stigmatization” of addiction, are not going to save lives as much as trap future generations in despair and drug dependency.

Sean Kennedy is a visiting fellow at the Maryland Public Policy Institute.