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Cleaning Up: Attacking the Heroin Epidemic

Jul 03, 2015 09:00AM ● Published by Cate Reynolds

By Mark R. Smith

Just a few short years ago, the use of heroin in Anne Arundel County and the surrounding area wasn’t noted on the news, part of the conversation in coffee houses, or discussed much among families and friends.

Use of the opioid heroin had always been an expensive nightmare, an addiction most often found among heavy drug users, junkies turned thieves, and other thrillseekers who took the chance on glowing in its high while avoiding smack’s often deadly grip.

Then, a few years ago, a not-so-funny thing happened on the way to the prescription counter: the cost of prescription opioids rose, even for generics; around that time, a more potent version of heroin hit the street. And not only was this new cut much more potent, it was less expensive.

Suddenly, people who had been addicted to prescription opioids had an alternative. It was illegal and it was off the street, thus of varying quality; but getting a fix for maybe less than a quarter of the cost of a prescription drug was too big of an opportunity for an addict to ignore.

The results were predictable. Today, heroin use has skyrocketed to an epidemic level, and around Annapolis and Anne Arundel County use of the drug is killing about one person per week.

The Street Today

Owen McEvoy, spokesman for Anne Arundel County Executive Steve Schuh, says evidence of heroin abuse surfaced during Schuh’s campaign, as the new executive began repeatedly hearing tales of heroin’s carnage.

“People were approaching Steve, with tears in their eyes, with stories about how the epidemic has affected them and their families,” says McEvoy, pointing to the county’s most recent numbers, with 291 overdoses recorded in 2014, 48 fatal.

With those numbers in hand, Schuh declared a public health emergency on January 27th, making Anne Arundel the first county in Maryland to do so.

“In 2013, [Anne Arundel County] outpaced Montgomery and Prince George’s counties, each of which have 400,000 more residents than we do,” McEvoy says. “We think Anne Arundel County is standing out, since we’re intertwined in the Baltimore-Washington highway network.”

Upon declaring the state of emergency, Schuh called for the formation of a task force, asking decision makers from various sectors of the community what action they were taking, and requested recommendations. “We’re tackling this problem from every angle,” McEvoy says.

While Schuh acted upon the stories he heard on the campaign trail, the uptick in heroin use “probably began in 2010 or 2011,” McEvoy suggests, during which time federal, state, and local authorities began cracking down on prescription opiate users.

“What that did was make prescription drugs more expensive. At the same time, the price of heroin dropped, and it was plentiful. In addition, not as much of it is coming from traditional sources, like poppy fields in Southeast Asia,” he says. “Now, it’s coming from Central America, which makes transport easier.”

As for the price, it runs approximately $10 per hit (dose) and is available in pill and powder form, as well as liquid. “When you compare that to your regular garden variety prescription opiate being $80 per hit, it’s easy to see what’s happening.”

How Fast It Happened

While people on the street have noted that Edgewater has seemed to be a hub of heroin abuse, the Anne Arundel County Police Department (AACPD) hasn’t especially found any certain area to be a key location, according to Lieutenant T.J. Smith, a police spokesman. He noted the total number of heroin overdoses for calendar 2014 was 291, with other opioids (like Oxycodiene and Fentanyl) accounting for 67 more.

“We started to see more people in Annapolis and South County, in general, contributing to the spike about 18 months ago,” Smith says. “As for [mostly rural] South County, the users often come more from Calvert County or the Eastern Shore. And we have noticed that some sort of production is going on around Annapolis, so users don’t have to go to Baltimore or D.C.

“There absolutely is a lot of heroin in the county, and particularly in Annapolis,” says Annapolis Mayor Mike Pantelides, a member of the county’s task force, “but I wouldn’t say there’s more here than elsewhere. Drug abuse knows no boundaries.”

Smith added that “The [AACPD] map really shows [heroin abuse] more spread out along the Route 97 Corridor.”

To attack the problem, the AACPD has initiated Operation HOPE (for Heroin Overdose Prevention and Eradication), which is something that Smith never dreamt would be necessary during his 12 years on the street in West Anne Arundel County, which includes the notoriously drug-infested and crime-addled areas of Meade Village, Still Meadow, and Pioneer City.

“I could count the heroin cases on one hand from that decade-plus,” he says. “That’s how fast this all happened.”

Smith also pointed out another angle of the trend that many people are stealing items from citizen’s cars and homes, including copper wire, sometimes resorting to shoplifting and robbery—to sell them for a fix.

“It’s a huge issue from a social perspective,” he says. “Who robs a 7-11 at midnight when all they can get is $20? But all the addict wants to buy is one pill to get high. And with $20, they can.”

Smith stressed that parents need to be nosy and aware, now more than ever. “Know that, if your child is using prescription pills a bit longer than they need to, they are a prime candidate to become a heroin addict,” he says.

Smith also noted that the department was the first crime organization in the state to arm its force with Narcan, a drug that reverses the effects of a heroin.

“Our guys used it 12 times last year and it prevented 12 deaths,” he says. “It truly snaps people right out of their overdoses. It literally brings people back to life.”

Treatment Options

Of course, it’s preferable to treat an addict before a shot of Narcan becomes necessary, which is what Anne Arundel County is attempting to do via its recent deal with Gaudenzia Inc., a nonprofit drug treatment organization that is taking over the former Second Genesis site [the Phillips Building and the Phillips Annex]; and at Hope House, both of which are located on the old hospital grounds in Crownsville.

Gaudenzia, a Philadelphia area-based organization, is trying to recover from the rejection of a $200,000 state bond bill that called for Gaudenzia to add to an investment of the same amount.

However, an Anne Arundel County house delegation, which initially approved an only $100,000 infusion, saw that support scuttled when Senator Ed Reilly learned that Gaudenzia would be asked to pay only $1 per year in rent for the next five years (and possibly for up to 15 years) to operate from the approximately 70-year-old building.

All told, Gaudenzia officials said approximately $400,000 was needed for the first phase of the project, which calls for the renovation of 29,000 square feet of the 41,000-square-foot facility. Forward movement would address a big problem, which is a lack of treatment beds; it is still hoped that 120 new beds will boost the number at the facility to 400 by later this year.

“As we [continue to work], we’ll analyze the county’s needs,” says Greg Warren, regional director for Gaudenzia, noting that “its common practice” for nonprofits to pay just $1 year in rent, given the building rehab and job creation. “For instance, will the county need additional services for women, veterans, or other special populations? It’s too early to tell.”

Reilly noted that Gaudenzia signed a five-year lease on July 1, 2014, without any indication that a bond bill would be necessary. “The rent subsidy of more than $400,000 per year, or $2 million over five years, is an indication of the state’s commitment to futhering this program,” he said.

As for Hope House, the facility has 49 beds, but can only treat 16 clients at once due to Medicaid regulations “that had not been enforced before January 1st, but are being enforced now,” says CEO Peter D’Souza.

D’Souza discussed the demand for beds. “The irony is that Medicaid is now being implemented for ages 18-plus and it has stopped paying for all inpatient care, which costs $350 per day.”

Since January 1st, Hope House has offered outpatient detox treatment for $70 per day or $210 for six hours of outpatient programming. D’Souza said “that’s not enough money for the comprehensive treatment that is needed to treat addiction or mental illness,” and he’s trying to restructure the program.

McEvoy noted that the county is concerned about Hope House and is looking into offering assistance. However, “If nothing changes,” D’Souza says, “we will eventually have to close our doors.”

Continuum: The Key

Dr. Jinlene Chan, health officer for the Anne Arundel County Department of Health, which also works with the City of Annapolis, said that taking that broader approach is the correct way to address the epidemic. That point was cited by Pantelides, as well.

“Just throwing someone in jail for six months and having them get out and do the whole thing over again doesn’t work,” he says. “The focus has to be more on treatment.”

Chan concurred, saying that substance disorders “are, first and foremost, a health issue,” adding that the heroin problem is “crossing age ranges,” but primarily afflicts younger Caucasian males, ages 25–34.

She also expressed concern about the dangers of using drugs purchased on the street. “Its quality varies, since there is no standardization,” she says. “Then, when it’s combined with Fentanyl—which is potent on its own—it’s even more lethal. Its impact on your respiratory drive can shut down your respiratory central in your brain, so you stop breathing.

“That’s ultimately what causes death,” Chan says. “Without breathing, the other bodily functions shut down.”

What is really needed to stop the epidemic, she says, is a stronger continuum of care, including prevention, programs and services; screening and early intervention; treatment; then support for recovery services, “since this is a chronic condition from which patients often experience relapses.

“We need more treatment of all kinds,” she says. “[With in- and] outpatient treatment, with drugs like Narcan and Vivitrol, which is becoming a more prominent option.”

Chan thinks recent progress, like the proposed Gaudenzia expansion, “represent steps in the right direction,” she says. “It’s been a long time coming.”

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During Session '15

Maryland Gov. Larry Hogan issued two executive orders to address the heroin epidemic on February 24th: One marked the creation of the Heroin & Opioid Emergency Task Force, is chaired by Lt. Gov. Boyd Rutherford and is in the midst of holding regional summits; the other founded the Inter-Agency Opioid Coordinating Council, comprised of several state agencies that address addiction.

Later in the session, Bill 368, which was sponsored by Del. Pam Beidle at the request of County Executive Steve Schuh, passed (Senate 47-0; House 137-0, with two abstentions) and was ready for the governor’s signature at press time.

The bill provides immunity from civil liability for a specified person administering specified medications, like Narcan, or treatment in response to an apparent drug overdose. The person administering the drug must be licensed or certified as an emergency medical services provider by the State Emergency Medical Services Board, and authorized to administer the medications and treatment under specified protocols.

Basic heroin facts are available at ltgovernor.maryland.gov.

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