In the battle to stem the epidemic of opioid addiction and overdoses in Maryland, state officials have opened a new front: teaching students from elementary school through college about the dangers of the powerful drugs.
Public schools are tweaking drug-education lessons and colleges are preparing sessions for incoming students to comply with the Start Talking Maryland Act, which becomes law July 1.
The act, passed by state lawmakers this year and signed by Gov. Larry Hogan, requires public schools to offer drug education that includes the dangers of heroin and other opioids starting as early as third grade.
It also requires public schools to stock the overdose-reversal drug naloxone, have staff who are trained to use it and to report naloxone uses to the state.
"The key is to start talking about it," said Del. Eric Bromwell, a Baltimore County Democrat and one of the lead sponsors of the measure. "You really need to get to people sooner, and you need to get to them over and over again."
The law requires schools to provide age-appropriate education at least once during each of three phases of a student's career — once between third and fifth grades, once between sixth and eighth grades and once between ninth and 12th grades.
The law requires all colleges and universities that accept state funding to have a heroin and opioid prevention plan that includes education for incoming full-time students and training in naloxone for campus police and public safety officers.
Senate President Thomas V. Mike Miller Jr. was lead sponsor of the bill in the Senate — an indication of the priority leaders placed on it. He said it was important to address education in the heroin-related legislation that passed the General Assembly this year.
"It's everywhere," the Calvert County Democrat said. "It affects all segments of society, rich to poor. It's a crisis that we need to identify and make educators as well as parents aware of it, and provide the resources to deal with it."
Maryland's opioid epidemic shows no signs of abating, even as politicians and health officials scramble to prevent overdose deaths and provide more treatment options for those who are addicted to opioid drugs.
The state suffered a record 2,089 deaths from drug and alcohol overdose in 2016, a 66 percent increase year over year that was driven largely by deaths associated with opioids, including heroin and fentanyl. Fentanyl is a potent drug that's mixed into heroin often without the user's knowledge.
In recent months, officials have seen a surge in overdoses of the synthetic opioid carfentanil. Developed as a sedative for large animals, carfentanil is said to be 100 times stronger than fentanyl, which itself is 50 times stronger than heroin.
Officials have attacked the problem in a variety of ways: expanding access to naloxone, providing guidance to doctors about limiting prescriptions to addictive painkillers, improving a prescription drug monitoring program and launching hotlines to connect people with treatment.
Maryland colleges and universities are beginning to work on how to incorporate heroin education into programs for incoming students to comply with the new law.
On Monday, officials from the University System of Maryland, private colleges and community colleges and the state secretary of higher education were briefed on the law's requirements, said Lee Towers, legislative director for the Maryland Higher Education Commission.
The University System of Maryland, which includes a dozen institutions and two regional higher education centers, supported the legislation that created the new law. At the University of Maryland, College Park, officials are evaluating how to comply with it.
"Education is essential to addressing the heroin and opioid problem in Maryland," Dr. David McBride, director of the University Health Center, said in a statement.
Harford Community College is planning to work a half-hour session on heroin into student orientation, spokeswoman Nancy Dysard said.
Dysard said it shouldn't be difficult for the college to comply with the law because it has a close working relationship with the Harford County sheriff's office. The college already has public safety officers trained and equipped with naloxone, she said, and some nursing students and psychology students are also trained.
Howard Community College plans to develop an online course on heroin for incoming students, spokeswoman Elizabeth Homan said. "That really works well for our population," she said.
As with Harford, Howard Community College has already equipped its public safety officers with naloxone.
At lower grade levels, school systems are using summer break to update or revamp their drug education programs. The state Department of Education provided a $4,000 grant to each of the 24 local school systems to help kick start those efforts.
Baltimore County is spending its grant on curriculum writers to revise lessons taught from elementary schools to high schools, said Joe Leake, health education supervisor for the school system.
Leake said it's important to update the lessons so students understand the pitfalls of opioids — not just illegal drugs such as heroin, but also prescription drugs such as morphine. "Some kids may think: 'It's prescribed by a doctor, how bad can it be?'" Leake said. "They have no idea of the addictive properties of opiates. They have no idea.
"Hopefully with the new resources we'll put in, we can combat that."
Leake said Baltimore County's instruction is geared toward different age groups. Lessons for the youngest elementary students focus on medicine safety and not taking someone else's medication. Later, students learn about peer pressure and making smart choices. Older students learn more details about the dangers of various drugs.
Baltimore County teamed with CVS this past year to bring pharmacists into some high schools to speak to students about opioid addiction — a program that could expand this year. The system is looking at bringing police officers into classrooms, too.
Anne Arundel County is using its state grant to buy more books on addiction for elementary students and materials on heroin for a parents' conference planned for the fall, said Gayle Cicero, director of student services.
Cicero said the system has been increasing its focus on heroin and opioids in the last couple of years, including producing a video featuring local parents of children who died from overdoses. She said those videos, shown to older students, help drive home the fact that heroin addiction is a problem in their community.
"This isn't just a story or a problem that happens somewhere else. They live in Anne Arundel County. The mom you hear speaking, they went to our schools," Cicero said. "That's a powerful addition to the education piece."
State Sen. Kathy Klausmeier sponsored heroin legislation this year and is co-chairing a panel with Bromwell to consider additional legislation for next year.
The Baltimore County Democrat said she knows parents who have lost children to heroin addiction. She said many teenagers don't appreciate just how risky heroin, fentanyl and other opioids can be.
"When I'm with a group of kids, I tell them, point blank: 'Stay away from heroin.' And they kind of look at you like you're crazy."
"I don't think they realize it's as severe as it is," she said. "We can't just say, 'Drugs are bad. Alcohol is bad.'
"This is the worst — and this could happen to you with one time."