Despite increasing efforts to stem the grim tide of overdose deaths, the use of heroin and fentanyl, largely in the Baltimore region, pushed up the number of fatalities 21 percent last year in Maryland to 1,259, the state reported Thursday.
That's nearly twice the number of overdose deaths in 2010, according to the new data from the state Department of Health and Mental Hygiene.
The deaths include all those who died of overdoses from drugs and alcohol, but the biggest increases were related to opioids. Heroin-related fatal overdoses rose 29 percent, to 748. Deaths from Fentanyl, which is many times stronger and often mixed with or substituted for heroin without a user's knowledge, rose 83 percent, to 340.
Public health officials have said that heroin has become cheaper as authorities have clamped down on prescription drugs such as oxycodone through law enforcement and prescription monitoring efforts. The data show deaths from prescription drugs had a much smaller rise of 6 percent last year, to 351.
Many overdose deaths in the state are counted in more than one category because the death may involve more than one drug.
Dr. Michael Fingerhood, an addiction specialist and an associate professor at the Johns Hopkins University, said users often can get heroin or fentanyl near where they live, and often without much effort. This week, he said, a patient showed him a text she got advertising heroin samples.
"All it said was, 'T on the street,'" Fingerhood said. "That means testers on the street, free heroin. She said she couldn't not go out and try it. ... It's amazing. You get a text and someone you don't know gives you something on a street corner and you inject it. That's how powerful addiction is."
The doctor said the woman was on the treatment drug buprenorphine, which blocked the effects of heroin. He said she later told him she "felt stupid for taking it."
But he and others say many more users are not in treatment. When they get a dose of heroin, it may be laced with fentanyl or entirely fentanyl, increasing their odds of overdosing. Public health officials have been trying to warn the public about the potent drug.
The trend has been so pervasive that the overdose deaths no longer surprise treatment specialists, including Dr. Yngvild Olsen, medical director for the Institutes for Behavior Resources/REACH Health Services in Baltimore.
"This is certainly awful, but not unexpected and unfortunately I don't think we have seen the peak of this crisis yet," she said. "Fentanyl, and particularly the illicitly produced analogues that are becoming more and more readily available, is so powerful and potent that even experienced users are at significant risk."
Efforts to stem overdose deaths are "laudable and necessary" but not sufficient, Olsen said. The state needs to expand access to treatments, including medications that block the effects of opioids, she said. Interventions such as training people to use the overdose drug naloxone will save lives but only in the short term.
Overdose deaths span ages, genders and races, increasing more rapidly among whites than blacks and among those aged 45-54 than other age groups, for example.
The problem has been particularly acute in Baltimore City, where there were 393 overdose deaths in 2015, with most related to heroin, fentanyl and prescription opioids. Baltimore County was second with 220 deaths, followed by Anne Arundel County with 112.
Public health officials from the city, as well as the state, explored methods of combating the scourge in the last year and recommended more treatment services among other measures.
Since becoming the city's health commissioner, Dr. Leana S. Wen has taken steps to vastly expand access to naloxone in the community.
She said officials also have set up a 24-7 hotline to help steer people to treatment and are working on opening a stabilization center where those intoxicated on drugs or alcohol can be taken, rather than emergency rooms or jail, for immediate services and connections to treatment.
Across the state, doctors have also been offered expanded education to better control powerful prescription painkillers that are often at the root of addiction as well as screening and intervention for patients identified as at risk for addiction and outreach to those who survive an overdose.
Wen noted there were 49 more deaths from overdoses than homicides last year, a record year for violence in the city, making drugs a bigger threat than guns and a true public health emergency requiring more resources. It's a problem, however, for more than just Baltimore and Maryland.
"Unfortunately, this mirrors a trend across the country," she said. "The 2015 numbers are disappointing but not surprising."
The state data showed only one area of improvement. While deaths from heroin, fentanyl, prescription drugs, cocaine and alcohol also ticked up, fatal overdoses dropped nearly 12 percent in the benzodiazepine category, which includes tranquilizers such as Valium and Xanax often used to treat anxiety.
The work continues, said Van T. Mitchell, state health secretary.
"Maryland, like many states across the nation, has been in the midst of an opioid epidemic," he said. "Health and Mental Hygiene continues our work to try to save lives by making residents aware of the peril associated with substance-use disorder and of the resources available to treat those who grapple with this problem."