Drug and alcohol overdoses could become the third leading cause of death in Harford County — behind heart disease and cancer — if the overdoses continue at the rate where they have been, Harford County’s acting health officer said last week.
In 2015, 50 people died from overdoses in Harford, according to Dr. Russell Moy, acting health officer for the Harford County Department of Health. Overdoses were the seventh leading cause of death in Harford that year.
In 2016, the number of overdose deaths rose to 84, a 68 percent increase from the prior year.
Preliminary data for 2017 indicates a possible 100 percent increase year over year, which would put deaths from drug and alcohol overdoses around 160, Moy said.
“At the rate that deaths are coming in 2017, there could be twice as many deaths in 2017 as 2016,” Moy told members of the Harford County Council Oct. 17 during the bi-annual Board of Health update. “If it goes up to 160 in 2017, it could become the third leading cause of death in Harford County. When you have a disease that increase from seventh to third, when it moves that quickly — this is why the overdose epidemic is a real crisis.”
Statewide, heroin is the leading cause of overdose deaths at a rate of 62 percent from 2015 to 2016 across Maryland, according to Moy. In 2016, fentanyl overdoses became the second leading cause of overdose deaths, jumping 229 percent from 2015.
“Fentanyl is the one that’s 50 times more potent than heroin,” Moy said. “So whenever you have something like this happening, this is why people are dying much more quickly.”
The Harford County Sheriff’s Office, which only measures heroin and other opioid-related overdoses not other drug- and alcohol-related deaths, reported 373 heroin/opioid overdoses in Harford County this year, 72 of which have been fatal. In 2016, there were 289 overdoses, 55 of which were fatal, and 28 fatal overdoses in 2015.
One of the outcomes of the opioid crisis is the increase in the number of substance-exposed newborns, which Moy said has “skyrocketed” over the last 16 years.
In 2000 in Harford, 4.5 of every 1,000 babies born was exposed born to a mother with drug and alcohol use. Since then, that number has increased rapidly, to 38.2 babies born to a mother who used drugs and/or alcohol, Moy said.
“That leads to more problems with neo-natal intensive care unit babies, learning disabilities, educational problems, juvenile justice problems, employment and housing problems,” Moy said. “It’s an entire generational cycle of drug problems in the future for our community.”
Overdose deaths are increasing at the highest rate in the 45- to 54-year-old age group, Moy said, followed by 25- to 34-year-olds.
Combating overdose death
The health department is part of the local Opioid Operational Command Center, which has created an Opioid Intervention Team co-chaired by the health department and Harford County Department of Emergency Services. It provides substance abuse disorder treatment for the county’s Medicaid and uninsured patients; works with the Harford County Detention Center to provide Vivitrol treatment and Naloxone training; works with the District Court’s Opiate Recover Court; and provides peer recovery specialist services with Upper Chesapeake Health, the Harford County Sheriff’s Office and other groups, Moy said.
The Maryland Opioid Operational Command Center was created by Gov. Larry Hogan in July to bring together state and local partners to support prevention, treatment and enforcement efforts to combat the heroin and opioid crisis in Maryland.
Harford was awarded $170,000, which Moy said will go to Addictions Connections Resource to allow its “good services” to continue throughout the county.
Addictions Connections Resource provides a central intake, navigation and recovery team to assist drug addicts and their families. It provides central intake with screenings and assessments, helps navigate the treatment system and provides housing and peer support for people in recovery.
Addictions Connections Resource can be reached at 443-417-7810.
The health department also provides behavioral health treatment. The clinic had nearly 10,000 visitors in fiscal year 2017, a 5 percent bump from 2015, Moy said.
“It’s truly a safety net service,” Moy said. “A private provider can pick and choose who they see and what insurance it accepts. The county clinic sees everyone regardless of their ability to pay. It’s a service that needs to continue because there is no other provider in this county to take our place.”
The health news for Harford County isn’t all bad, however. Many of the county’s rankings in non-opioid related categories are improving, Moy said, and throughout the county overall health has improved.
From 2014 to 2015, the life expectancy of Harford residents has gone up from 79.6 years old to 79.7 years old, Moy told the council.
Harford ranks as the ninth healthiest county in Maryland for health outcomes (birth outcomes, death rates and quality of life), behind Montgomery, Howard, Carroll, Frederick, Talbot, Calvert, Queen Anne’s and St. Mary’s counties and ranks eighth healthiest for health factors (health behaviors, access to care, socio-economics and environment) behind Howard, Mongtomery, Frederick, Carroll, Talbot, Queen Anne’s and Calvert counties.
Harford’s three leading causes of death are heart disease, cancer and chronic obstructive pulmonary disease. While mortality rates for heart disease and cancer are improving, mortality rates for COPD are not, Moy said.
The top three factors contributing to those deaths are smoking, being overweight and/or obese, and alcohol use, Moy told the council.
Smoking among adults in Harford is at 20.7 percent, more than 5 points above the state average, and among teens it is at 19.2 percent, nearly 3 points above the state average.
“That’s definitely an area we need to improve,” Moy said, adding Harford has implemented several smoking cessation programs.
The Harford Department provides smoking cessation classes and public health education classes for adults and youth, has a Quitline referral program, 800-QUIT-NOW, and has worked with the state to pass a house bill that will make sure minors can’t buy tobacco products in stores without a civil citation issued and a report sent to the state comptroller, which holds retail tobacco licenses.
Safety net for the community
The Harford County Health Department provides a number of programs for Harford residents, insured and under-insured, Moy said.
But changes to the insurance industry could create significant problems in coming years, Moy told the council.
Maryland is the only state where hospital rates are set by a commission and not based on market forces, he said. It’s an agreement that has been in place for 40 years, but it must be approved by the federal Medicaid program.
It has been allowed for the last four decades because Maryland has saved the system money because of hospital efficiencies, Moy said. But in the last five to 10 years, Maryland hospital costs have exceeded the national average and the federal government is threatening to withdraw its waiver. That would mean a loss of $1.5 billion in federal money from Maryland hospitals, which Moy said would have an “enormous impact” on all health care across the state.
To reduce costs, hospital systems are trying to reduce the number of emergency department visits and provide adequate care once they leave a hospital, Moy said.
“There is a push to provide more community-based care so people don’t need to rely onh emergency departments and hospitals,” he said. “They’re trying to beef up the front end of community based services and on the back end with after-care services.”
Another uncertainly is the proposal two weeks ago to withdraw $7.4 million from the Affordable Care Act Insurance Exchanges, which also would have a dramatic effect on health care in Harford.
Before that announcement, Moy said, people were already looking at 25 percent increases in their premiums.
“With that announcement, the premiums could be much higher and could price a lot of folks out of insurance,” Moy said.
“We are a safety net for many vulnerable and underserved populations,” he said. “However, if people start losing health insurance and suddenly we have more uninsured folks in the community, they will be showing up at our doorstep, so our services are needed probably more than ever in this health care climate.”
During the same meeting, the council agreed to recommend to the Maryland State Health Department that Moy be named health officer for Harford County, removing the interim title. Moy, the former deputy director of the health department, became interim director July 1 after the retirement of Susan Kelly.