An internasal atomizer of Naloxone.
An internasal atomizer of Naloxone. (Barbara Haddock Taylor, Baltimore Sun)

As Gov.-elect Larry Hogan pledged to declare a "state of emergency" to combat the spike in heroin-related deaths, state officials said Tuesday that about 140 pharmacies in 22 counties have agreed to stock a powerful overdose antidote.

The agreement with CVS Health, Safeway and Walgreens, as well as some smaller businesses, is part of a broader push in Maryland and elsewhere to make the overdose-reversing drug, known as naloxone or narcan, easier to access.


The state changed rules in October for the Medicaid drug benefit to allow doctors to write prescriptions for naloxone without preauthorization. Officials also sent letters to doctors urging them to prescribe naloxone to those receiving pain medication and others at risk of overdose.

The drug, which requires a prescription and can be administered by syringe or nasal spray, combats the effects of an overdose and is credited with saving thousands of lives.

"We want to make this, frankly, commonplace for prescribers," said Dr. Joshua M. Sharfstein, the state's outgoing health secretary. "In order to make it a realistic option, it has to be available."

More than 460 people in Maryland fatally overdosed on heroin last year — up 88 percent statewide since 2011 — and the problem has shown few signs of slowing. Of the 528 drug or alcohol intoxication deaths in the first six months of this year, 296 involved heroin, according to state statistics.

A city task force recently found that Baltimore is home to about 19,000 heroin users. Last year, 150 people fatally overdosed on heroin in the city.

During his campaign, Hogan faulted the O'Malley administration for not doing enough to combat the crime linked to heroin, calling the epidemic the "No. 1 problem we have in Maryland, with respect to crime."

On Tuesday, he reiterated a plan to declare a "state of emergency" to focus attention and efforts on combating drug problems. Last week, he said he would put his lieutenant governor, Boyd Rutherford, in charge of overseeing his administration's plan, to include an executive order, a task force and a summit.

"Everybody thought of this as an urban problem," but it has spread to Maryland's suburban and rural counties, Hogan said.

Nationwide, heroin use has increased as people hooked on prescription opiates such as Oxycodone turn to the illegal drug in response to efforts to crack down on overprescription of painkillers, according to health officials.

In March, Massachusetts Gov. Deval Patrick declared opiate abuse a public health emergency, a move accompanied by $20 million in added funding for drug treatment programs, as well as measures that mandated prescription monitoring, permitted all first-responders to carry naloxone and placed a temporary ban on some painkillers.

Hogan said declaring a state of emergency "sends a message" that the state is serious and hopefully will make more federal funds available. A spokeswoman did not respond to a request for comment about what Hogan would seek to do with emergency powers.

"The governor-elect is going to bring a whole new strategy, a whole new philosophy to fighting this war on heroin addiction," said Rev. Milton E. Williams, a Hogan supporter, pastor at East Baltimore's New Life Evangelical Baptist Church and a founder of the Turning Point Clinic.

"The current administration has become entrenched in talking about it as opposed to bringing action and resources to the table that's going to make a change in stopping this thing here and now."

Sharfstein said Maryland has already done a lot to address what he called "one of the top crises facing the state."


Gov. Martin O'Malley established an Overdose Prevention Council in June. Ambulance crews and state troopers have been equipped with naloxone and officers in some local police departments are receiving training to administer the drug, Sharfstein said.

Baltimore police officers do not carry the drug. The department said this fall that it is reviewing the idea.

The state's Board of Physicians recently moved to require training for doctors in prescribing pain medication, Sharfstein said. Other initiatives include organizing teams to review overdose deaths to figure out how they might be prevented.

"We've been working very hard this year to bring everything we can to bear on the overdose epidemic in Maryland, but we certainly think that there's a lot of progress that still needs to be made," Sharfstein said.

He said he was not aware of any federal programs tied to declarations of emergency.

Naloxone training in Maryland started in 2004 in Baltimore. The medication has gained traction as concerns have waned that naloxone would encourage drug use by making it seem safe. The antidote also became easier to use as it became more common to package it as nasal spray.

Maryland will be the second state in which CVS stocks the medication, keeping it on hand at about half the retailer's roughly 170 locations after the request from state officials, spokesman Michael DeAngelis said.

The company started stocking the drug at locations in its home state of Rhode Island this fall and preliminary discussions are underway elsewhere, he said.

Mishka Terplan, medical director for Behavioral Health System Baltimore, which works with addicts and trains people to use naloxone, said making the drug readily available will help avoid delays in filling prescriptions.

"It's excellent," Terplan said. "By having pharmacies stock medication, it reduces a significant barrier to people receiving the medicine."

Williams, who lost a daughter to drug-related violence in 2002, said naloxone is a useful tool, but without proper training and education, expanded access could have "unintended consequences."

"You can have the right medication in the wrong hands and you will end up doing harm," he said.

Baltimore Sun reporters Michael Dresser and Erin Cox contributed to this article.