The number of people who died in Maryland from drug and alcohol related overdoses surged 66 percent in 2016, compared with 2015, exposing the magnitude of the growing opioid epidemic and the ineffectiveness of the increased resources aimed a stemming deaths.
The 2,089 deaths last year represent an all-time high, triple the tally from 2010, according to the data released Thursday by the state Department of Health and Mental Hygiene. Last year's jump is the state's largest recorded annual increase.
"The numbers are terrible and they are extremely disappointing," said Dr. Leana Wen, health commissioner for Baltimore City, which accounted for about a third of all overdose deaths in the state.
The city saw 694 overdose deaths last year, more than twice the 318 homicides recorded by police.
The greatest number of deaths, both in the city and statewide, were attributed to the illegal opioids heroin and fentanyl, a cheap and powerful drug pouring in from overseas that is typically mixed into heroin without the user's knowledge.
Gov. Larry Hogan called opioid addiction a "national scourge that is tearing families and communities apart at the seams, and it cannot be solved by a single state or administration. Although today's news is discouraging, we will never stop searching for innovative solutions to this problem, or fighting as hard as we can to save Marylanders' lives."
After the city, Baltimore and Anne Arundel counties in the Baltimore metro area had the second and third highest numbers of deaths, followed by the Washington, D.C., area counties of Prince George's and Montgomery. Only rural Cecil and St. Mary's counties saw declines in fatal overdoses.
"People are dying in our cities and across our state," Wen said. "This underscores more than ever how dire this emergency is and how we have to do a lot more to combat this epidemic."
The city and state officials have responded in various ways to the epidemic. They have provided guidance to doctors about prescribing addictive painkillers that are often linked to addiction and have been ramping up a prescription drug monitoring program so doctors and pharmacists can see who already has gotten pills before providing more.
Officials also have launched hotlines that connect residents to available treatment, though they say far more treatment spots are needed. And they have made naloxone, the overdose reversal drug, available without a prescription and now also without training.
The city reports naloxone has been used to save 800 lives since 2015, though Wen said Baltimore is running out of supplies. She said the city is awaiting a share of the $10 million the state is due from the federal 21st Century Cure Act to buy replacements as well as to fund other related priorities such as crisis beds and an educational campaign called "Don't Die."
Christopher Garrett, a spokesman for the state health department, said the agency received the funding in May and has "begun working to implement the related activities."
Clay Stamp, executive director of the state's Opioid Operational Command Center, said the state gained federal permission to soon begin offering Medicaid beneficiaries residential treatment for addiction and not just out-patient services. Medicaid recipients make up a disproportionate share of those who overdose, state data shows.
Stamp said officials also will continue working in hospital emergency rooms to link patients to community peer recovery specialists to help enroll them in treatment and support services.
Many of those who overdosed died with a combination of drugs in their system. After heroin and fentanyl, alcohol contributed to 582 deaths, while cocaine contributed to 464 deaths. Prescription opioids contributed to 418 deaths.
Some in the treatment community say the rise of fentanlyl in particular, which contributed to 1,119 of last year's deaths, up from 349 in 2015, may require a new response.
"This is horribly tragic," said Dr. Yngvild Olsen, past president of the Maryland Society of Addiction Medicine. "Fentanyl has changed the landscape of the opioid epidemic in Maryland. We need out-of-the-box thinking on how to get a handle on this, building on what we know works."
One new approach undertaken by Baltimore police involves sending officers to the scene of the fatal overdoses to gather evidence that could help identify drug dealers so they could be charged in the deaths.
Police officials say they believe potent batches of drugs could be contributing to groups of overdoses and the new policy could have a real effect on the numbers.
"Overdoses continue to escalate," said T.J. Smith, a police spokesman. "We're trying to look at it in a different way."
But a coalition of advocacy groups said they fear making the sites of overdoses into crime scenes will scare people from seeking needed help and put off others from rendering aid.
"A knee jerk criminal justice enforcement approach will do nothing to reduce the prevalence of fentanyl," said Kaitlyn Boecker, a policy coordinator for the Drug Policy Alliance
Smith said the police don't arrest people who've overdosed and the new policy is not intended to interfere with officials or bystanders providing aid to someone who has. He cited a state Good Samaritan law that protects anyone who administers aid, including naloxone.
Boecker said several organizations in Maryland are working to ensure drug users' rights and safety and oppose the police policy. They say addiction is a disease that should be treated as a public health issue.
They are calling for more education and naloxone, broader protections for Good Samaritans and safe consumption sites, where users can take drugs using clean needles, under supervision and without fear of legal repurcussions, among other things.
"With fentanyl deaths more than tripling in the course of a year with no signs of decreasing it is time for new and innovative approaches...," she said. "Unless we really embrace a public health approach in Maryland it's hard for me to imagine overdose deaths decreasing in the near future."
Maryland overdose deaths in 2016
Total drug and alcohol intoxication deaths for 2016
Baltimore City: 694
Baltimore County: 336
Anne Arundel County: 195
Prince George's County: 129
Montgomery County: 102
Frederick County: 88
Harford County: 84
Washington County: 66
Allegany County: 59
Wicomico County: 48
Carroll County: 47
Howard County: 46
Charles County: 45
Cecil County: 30
Worcester County: 28
Source: Maryland Department of Health and Mental Hygiene