The number of opioid-related overdoses in Maryland increased 14.8 percent in the first half of the year as public health officials and others continue to struggle to get a handle on the epidemic.
Most of the deaths were related to the powerful opioid fentanyl, which is often added to heroin and even cocaine to boost their effects without the user knowing.
Opioid overdoses accounted for most of the state’s intoxication deaths, killing 1,185 people from January to June, compared to 1,032 during the same period last year, according to data released Friday by the Maryland Department of Health. The total number of people who died from intoxication deaths was 1,325, a 12 percent increase over the last year.
Fentanyl played a role in more than three-quarters of all overdose deaths in the state. The powerful opioid is 50 times more potent than heroin and a tiny amount can kill.
State officials said stemming the epidemic has proved challenging in part because it has evolved so quickly. Early on, prescription drugs posed the biggest issue. Better monitoring of who is prescribed opioids and other efforts have led to decline in those deaths, and now illicit street drugs are the problem, said Clay Stamp, executive director of the state’s Opioid Operational Command Center.
From January to June this year, 199 people died from prescription opioid overdoses, compared with 213 in the same months last year. Deaths involving heroin slipped to 469 from 587 over the same periods.
“Lots of good people are working really hard on this issue across the state,” Stamp said. “We didn’t get into this overnight and we are not going to get out of it overnight.”
Meanwhile, deaths related to cocaine surged 54 percent from last year. The increase was mostly attributed to cocaine combined with opioids, which were found in 90 percent of cocaine overdose cases, according to the health department.
Cocaine-related deaths now outpace heroin-related deaths, making the addictive stimulant the second most prevalent drug among overdose deaths.
Many cocaine users are surprised to find their drugs were laced with fentanyl, said Fran Phillips, deputy secretary for public services with the Maryland Department of Health.
“This is a very different population and a very different market,” Phillips said. “In the past cocaine users had some sense of safety. They weren’t the users who might have been impacted by fentanyl. Now, we have to get that message out to them about the risk.”
The state has deployed a comprehensive approach to addressing the epidemic, including expanding access to naloxone, a drug that reverses overdoses and working with hospitals to urge people into treatment. Medicaid expanded the number of residential treatment beds it would cover and the state helped to fund a stabilization center in Baltimore that serves as a safe place for drug users to go when they are intoxicated to get medical treatment and links to other social services. The state also has worked to increase the number of medical providers who can prescribe buprenorphine, a medication that relieves withdrawal symptoms.
There are also efforts by local jurisdictions. Baltimore recently became one of several cities to participate in a program with the federal Drug Enforcement Administration to address the epidemic on many fronts. For example, the agency is working with Baltimore Police Department and the Baltimore State’s Attorney’s Office to evaluate cases that could be tried in federal courts, which offers lengthier sentences.
In Baltimore, long considered the epicenter of the opioid epidemic in the state, 483 people have died from overdoses through June of this year, the highest number of deaths in the state. That is an increase of 22 percent from 395 last year.
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Baltimore County had the second highest number of deaths at 215, up 14.3 percent from 188. Anne Arundel County reported 139 deaths, up 25 percent from 111.
Stamp said he hopes that new legislation recently passed by Congress will help stop illicit fentanyl from entering the country — the easiest route being the postal system. The new law puts in more tracking guidelines on packages coming from other countries, he said. The postal service is the only transportation carrier that does not gather electronic information on overseas cargo. Customs and Border Protection agents have a harder time screening packages for drugs because of this.
But Clay and others in public health said the epidemic is as much about demand as supply. There are customers who want the drugs. Getting more of these people into treatment is still key to ending the epidemic, Stamp said.
Adrienne Breidenstine of Behavioral Health System Baltimore said many of the programs that have been deployed to combat the epidemic haven’t been around long enough to see their full effect. The city’s stabilization center, for example, has only been open since the spring.
“We have initiated many things that I think will better address the crisis that we still haven’t seen the full effects,” Breidenstine said.
Nobody can guess when the epidemic will take a turn for the better, so the state will continue to deploy resources to address the problem, Clay said.
“The programs we have in place are good and they are evidence-based and expanding,” Stamp said. “As they continue to expand, we will see progress. It is not static.”