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Opioid-related deaths make a disappointing uptick in early 2020, possibly related to coronavirus

As the novel coronavirus began claiming lives in Maryland and beyond earlier this year, a more familiar killer made a fresh advance after easing last year — overdoses.

State data shows that opioid-related deaths, as well as fatalities from all other substances, ticked up in the first three months of 2020.

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The numbers mark a disappointing reversal after dropping in 2019 for the first time in a decade. And while officials say the overall role of the viral pandemic isn’t yet known, the state officials say there surely was an impact that will grow.

They noted a drop in substance users seeking care in emergency rooms, interruptions to treatment, and the emotional and physical toll of the pandemic.

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“While it is simply too early to understand the precise effect that the coronavirus pandemic has had on state’s war against substance use, I can assure you that we recognize the threat that it poses to our progress in the fight and to some of our most vulnerable populations,” said Gov. Larry Hogan in a statement that also announced a Maryland COVID-19 Inter-Agency Overdose Action Plan to address the link.

Public release of state overdose data is routinely delayed by months, so the virus outbreak was only a declared pandemic for the very end of the reporting period. Coronavirus cases first emerged in Maryland in mid-March and Hogan’s stay-at-home order came March 30, at the close of the period.

There were 561 opioid-related deaths in the three months ending March 31, according to data from the state’s Opioid Operations Command Center and the Department of Health. That’s a 2.6 percent increase from the first quarter last year.

Opioids make up about 90 percent of all fatal overdoses in the state. Fentanyl, a powerful synthetic opioid that has replaced much of the street heroin, accounts for most of the opioid deaths.

Health officials had gone on the offensive and spent millions of federal and state dollars to bring down opioid-related overdoses, which have claimed more than 2,000 Marylanders in each of the past three years. They widely distributed the overdose antidote naloxone and trained people to use it. They set up hotlines and sought funding for more treatment. Baltimore City opened a sobering center to divert people from emergency department and jails.

Fatalities related to cocaine, alcohol, benzodiazepine and methamphetamines also increased, in addition to those related to opioids. Many of the other substances were used in combination with opioids, the state report says.

The report showed that deaths related to heroin and prescription painkillers, also opioids, dropped more than fentanyl-related deaths grew. Officials said many people use drug combinations, leading to the overall increase in opioid fatalities, but didn’t fully explain how the deaths were recorded.

Those who treat substance use disorders say they expect deaths to continue rising. After the pandemic-related distancing orders, programs stopped taking new patients and distribution of the overdose remedy naloxone stopped, said Dr. Michael Fingerhood, who treats substance use disorders at Johns Hopkins Bayview Medical Center and is an associate professor of medicine and public health at Johns Hopkins University.

Some people got doses of naloxone to take home after an emergency visit, but many have been afraid to go to hospitals for fear of becoming infected with the coronavirus, he said.

Those in treatment for their disorder with the drug buprenorphine still could get prescriptions via a telehealth appointment with a doctor, but programs offering the widely used treatment methadone are in-person only.

“We expect numbers to go up in winter months because people stay inside and use alone so there is no one there to administer naloxone, if they have naloxone,” he said. “But everything stopped halfway through March, so that likely is where there was the biggest uptick.”

Fingerhood said many programs are again accepting patients, but he expects the numbers from April, May and June in the heart of the pandemic-related shutdowns to be worse than the previous months.

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Opioid-related overdose deaths dropped in nine jurisdictions, including Baltimore City, which has long had the most fatalities in the state. The total in the city dropped by about 14% to 205 in the first quarter.

In the region, Carroll County also reported a drop of 42% to eight deaths.

Anne Arundel reported a 6% increase to 42 deaths. Baltimore County reported an increase of 5% to 80 deaths. Howard County reported a 50% increase to 12 deaths. Harford County remained flat at 19 deaths.

Dr. Nilesh Kalyanaraman, Anne Arundel health officer, said the county worked with behavioral health providers to keep all programs going, but adding pandemic-related safety precautions took time and slowed access to services.

He said services are again available in some way, but overdose death numbers still may worsen because of pandemic-related anxiety and fear.

“It’s a stressful time and the way people cope is with substance use, so we are holding our breath,” he said. “We really encourage people to call mental help lines. Behavioral health providers are there to help. We have a lot of ways to keep people safe while getting care.”

The state separately reported overall intoxication deaths by jurisdiction, which includes opioids, which also showed drops in deaths in Baltimore City and Carroll and Harford County but increases elsewhere in the region.

“Now is the time to redouble our focus on solutions, both established and new,” said Steve Schuh, executive director of the state’s Opioid Operational Command Center, in a statement. “Everybody involved in addressing the opioid crisis — every clinician, every advocacy group, every concerned parent, and every citizen — needs to renew their dedication to addressing this problem.”

The state’s action plan is a combination of preventive, educational and health care access initiatives. But the pandemic remains a big question going forward, officials say, including how the governor’s March 30 stay-at-home order will affect the number of deaths.

The report already shows emergency department visits for nonfatal opioid overdoses decreased by more than 23 percent to 1,261 visits during the first three months of the year as the virus was taking hold in the state.

The report also says naloxone administrations by emergency personnel dropped in the first 15 weeks of the year by more than 19 percent to 2,489.

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