The nationwide problem of drug addiction continues to grow.
No neighborhood or area is immune, and Germantown has seen an increase in opioid-related problems, even as state and local elected leaders continue to discuss ways to combat the growing problem.
In the Germantown area calls for overdoses have increased since the first of the year, according to Montgomery County Fire Rescue Service run data obtained from DataMontgomery.com. While the data does not show if these overdose calls were related to specifically to opioids or patients making mistakes in dosage, the trend is alarming as two Germantown fire stations have already responded to more overdose calls in the first six months of 2017 than in the first six months of 2016.
According to DataMontgomery.com, in all of 2016 MCFRS responded to 1,098 overdose calls countywide. In the just the six months of 2017, MCFRS has already responded to 682 calls for overdoses countywide.
At the local level, Germantown Pulse looked at calls from Kingsview Fire Station 22, Germantown Volunteer Fire Station 29, Milestone Fire Station 34, and Clarksburg Fire Station 35. Those four fire stations responded to 133 overdose calls in 2015 and 134 overdose calls in 2016.
During the first six months of 2017, MCFRS in the Germantown area has responded to 77 overdose calls. That is one overdose call every 2.3 days in 2017 if that pace continues the Germantown area could have 154 overdose calls for the year just in Germantown.
In 2016 Fire Station 22 responded to 47 calls for an overdose. In the first six months of 2017, Station 22 has handled 14 calls.
In 2016 Fire Station 29 responded to 47 calls for an overdose. In the first six months of 2017, Station 29 has already handled 37 overdose calls. There were nine overdose calls for Station 29 in June alone.
In 2016 Fire Station 34 responded to 27 calls for an overdose. In the first six months of 2017, Station 34 has already handled 21 overdose calls.
In 2016 Fire Station 35 responded to 13 calls for an overdose. In the first six months of 2017, Station 35 has handled just five overdose calls.
It is important to remember that the statistics from DataMontgomery.com do not get into specifics of which type of drug was overdosed or if the overdose was fatal. The run data simply state the nature of the call. It also does not include patients who may have been driven to local emergency rooms for treatment of an overdose.
On July 7, the Hogan Administration announced plans to spend more than $22 million to fight the heroin and opioid epidemic. Eighty percent will go to Maryland’s 24 local jurisdictions and service providers to fund prevention, enforcement, and treatment efforts throughout the state.
“Finding real solutions to the heroin and opioid crisis that is ravaging our communities is a top priority of our administration and a cause that myself and Lt. Governor Rutherford have been personally committed to since before we took office,” said Governor Hogan. “This new funding will make real differences in people’s lives as we work together to turn the tide in this deadly fight.”
The funding for Fiscal Year 2018 includes the first $10 million of Governor Larry Hogan’s $50 million commitment to address the crisis announced in March 2017, the first $10 million from the federal 21st Century Cures Act and $2.1 million from the Governor’s Office of Crime Control & Prevention.
“Here in Maryland, we continue to face a crisis situation with the number of overdoses rising every day. I am confident that with these resources we are announcing, we have a balanced approach to fighting this epidemic – and we are giving the majority of our resources to the local level where we have the greatest opportunity to save lives,” said Clay Stamp, executive director of the Opioid Operational Command Center. “It is important to note our successes will continue to be driven by the significant support and cooperation of our federal and state agencies and local coordinated teams, including key advocacy groups, supporting our important work to combat the opioid crisis.”
On Monday, July 10, the members of the Montgomery County Council discussed the issue at the regular meeting of the Council’s Health and Human Services Committee.
The Committee received a report from the County’s Office of Legislative Oversight outlining what legislative options County officials might take to combat the opioid problem in Montgomery County.
In the memo accompanying the report, Timothy L. Firestine, the County’s Chief Administrative Officer wrote, “We are particularly concerned with both the dramatic increase in overdose deaths and by the drugs used in those deaths. In reviewing prescription opioids, the number of deaths has increased by 3 percent between 2014 and 2016 (from 23 to 26); however, within that number, deaths from oxycodone overdose doubled from 8 to 16 in the past year in Montgomery County alone. Still more alarming is the fact that overdose deaths due to fentanyl rose from 8 in 2014 to 43 in 2016, an increase of more than 500 percent, while in the same period heroin-related deaths rose by 45 percent.”
The memo went on to say, “Montgomery County Government, our providers, concerned citizens, and families who have lost loved ones to addiction have not been idle in attacking opiates as the deadliest drug of choice or as the underlying addiction that drives drug abuse. For example, as part of the County's prevention plan in past years, we provided education and information to prescribing physicians in the County. Though efforts did not have the level of impact we desired on prescribing practices, we have continued our efforts to include education and public awareness, interdiction and law enforcement, drug take-back programs, and treatment.”
However, in the meeting with the HHS Committee, which consists if Councilmembers Craig Rice, George Leventhal, and Council President Roger Berliner, Dr. Raymond Crowel, Chief of the Behavioral Health and Crisis Services, DHHS said that the stepped-up attention to opiate addiction has resulted in doctors being more aware of the problem and cutting back on prescribing opiates.
“Prescription opiate use by physicians, meaning prescribing opiates, has declined by between 12- to 18 percent from 2013 to 2015,” said Crowel. “Which tells us that both physicians and consumers are becoming more aware of the risks and the issues. So somewhere along the way we are having an impact in terms of the awareness.”
“In January, the governor declared a state of emergency and asked that regions form an opiate intervention team at the local level,” said Crowel. “Our Drug Addictions Workgroup has now become the opiate intervention team.”
Governor Hogan’s State of Emergency declaration activated the governor’s emergency management authority and enables increased and more rapid coordination between the state and local jurisdictions. The Opioid Operational Command Center, established by Hogan in January through an Executive Order, facilitates collaboration between state and local public health, human services, education, and public safety entities to combat the heroin and opioid crisis and its effects on Maryland communities.
Local Opioid Intervention Teams will receive direct funding as noted below for each jurisdiction to determine how best to use to fight the heroin and opioid epidemic. This amount does not include other grants and additional funding distribution. According to Governor’s July 7 press release, Montgomery County is slated to receive $191,964 from the State in FY 2018 to fight the opioid issue.
A 2016 Maryland Department of Health and Mental Hygiene report included the following findings regarding unintentional opioid-related deaths in Maryland;
• 89 percent of all 2016 intoxication deaths in Maryland were opioid-related;
• The total number of opioid-related deaths in the State increased by 70 percent from 2015 to 2016, from 1,089 to 1,856 deaths, and has nearly quadrupled since 2010;
• Sharp increases in heroin and fentanyl-related deaths are responsible for most of the rise in opioid-related deaths, but prescription opioid-related deaths have also increased, in large part as a result of the use of prescription opioids in combination with heroin or fentanyl; and
• Statewide data for 2016 show 20 heroin-related deaths per 100,000 population, seven prescription opioid-related deaths per 100,000 population, and 19 fentanyl-related deaths per 100,000 population.
However, overall, Montgomery County has experienced lower rates of fatal overdoses involving opioids relative to its population compared with most other Maryland counties.
According to Firestine memo, “In 2016, [Montgomery County] lost 102 residents to overdoses from multiple drugs. The State's annual report notes deaths from alcohol, cocaine, and benzodiazepines have all been on the rise in recent years. For example, the number of alcohol-related deaths doubled between 2015 and 2016. While collectively these deaths account for only 11 percent of all State-wide overdose deaths, these drugs, including alcohol, are often found in combination with each other and with opiates. It appears that, while opiates are currently the deadliest of abused drugs, we are also seeing a rise in the numbers of individuals who are suffering from addiction and are using multiple drugs to feed their addictions.”
Indeed, Crowel told the HHS Committee, “Typically, sometimes it is just heroin, but oftentimes it is a polypharmacy of drug abuse at the time of death for a person. Opiates seem to be the thing that is killing people, whether it is heroin or fentanyl, but it is the case that we are dealing with an addiction epidemic, not just an opiate overdose epidemic. Now, it may be driven some by opiates in the prescription realm, but I think it is important to realize that opiates is the latest killer. It is not the latest problem. It is not the core problem.”
While the death count from overdoses on prescription opioids is a lower number compared to deaths from heroin or fentanyl, one of the areas of concern for the Montgomery County is the rate at which a prescription opioid addictions transition to a heroin addiction.
“We remain concerned about the role that prescribed opioid medications may play as a starting point on the road to addiction,” wrote Firestine in the memo. “Through the work of the County's Overdose Fatality Review Team. We are studying, among other things, the prescription opiate histories of individuals who died from overdoses on opiates. Our goal is to examine the role of prescription opiates in greater detail in the coming months. As we learn more, this information will be used to help educate physicians and inform the public about the safe usage and risks of prescription opiates.”
According to the recommendations included in the County’s Office of Legislative Oversight report, “Currently, the County's opioid misuse prevention efforts do not include a prescriber outreach or education component. The Council may wish to discuss with Executive Branch representatives whether opportunities exist to work with State agencies or local chapters of professional associations to link prescribers with educational resources on opioids and the State's Prescription Drug Monitoring Program.”
Coincidently, in 2016, the same year that opioid-related deaths in the state increased by 70 percent the Maryland State Legislature voted to abolish the Maryland Board of Physicians’ requirement for doctors to take and complete continuing medical education classes on opioid prescribing.
As a result, any local legislation which Montgomery County might attempt to create which would require doctors to attend continuing education classes on prescription opiate abuse is hampered by Maryland State law prohibiting the establishment of such a requirement.
“When we had a briefing some time ago about the increasing number of overdoses,” said Leventhal. “Councilmembers asked if there was a bill that we can introduce champion this cause, and the results of the research shows that absolutely there is not. We have no role here. We are entirely preempted here. There is no legislation of any kind that the Montgomery County Council has standing to enact regarding physician training, physician licensing, physician requirements, and physician education. The County Council has no standing in this area; we are entirely preempted by State Law.”
According to the OLO report, “Currently, two out of the five Maryland State medical boards have established requirements for licensees to complete continuing medical education classes specific to proper prescribing as a condition of license renewal, and State law prohibits the Board of Physicians from establishing such a requirement.”
“What have we as lawmakers done to combat this epidemic?” asked Leventhal, “We, as lawmakers, have no authority in this area under State law. Anything we do is, sort of, cooperative, collegial, hortatory, encouraging, urging— we have no statutory authority.”
As a result, one of the recommendations of the OLO report was for the County to “discuss with relevant stakeholders in the County the benefits and drawbacks of requiring mandatory prescriber education, including which groups of practitioners should be included. If the Council determines that prescriber education should be mandatory, it could work with State legislators and other stakeholders to establish requirements within State law.”
Top Photo by Eric Molina from New York City, United States [CC BY 2.0 (http://creativecommons.org/licenses/by/2.0)], via Wikimedia Commons
Next Photo by Conneec7 (Own work) [CC BY-SA 3.0 (http://creativecommons.org/licenses/by-sa/3.0)], via Wikimedia Commons