When Anne Arundel County announced a program to open police and fire stations to people seeking treatment for drug addiction, expectations were low that many people would come.
Yet within an hour of the debut of Safe Stations in April, a woman who spotted a notice on Facebook about the program walked into the Brooklyn Park fire station asking for treatment. A man who accompanied her that day returned the next acknowledging that he, too, needed help.
To date, more than 200 people have come to fire and police stations in the county seeking treatment for heroin addiction.
Officials say the goal of Safe Stations is to remove barriers for people seeking help for heroin and other opiate addictions. In addition to immediate access — police and fire stations are open all day, every day — the program offers counseling, expedited treatment and coordination with other agencies, including the court system, to get people into treatment.
"It's a big step to say, 'Hey, I need help," said Anne Arundel Fire Chief Allan C. Graves. "We want to keep them on that path."
About 60 percent of those seeking help entered 28-day inpatient treatment programs in the county. Five percent went to outpatient treatment and 9 percent went to mental health treatment. Even those who came from outside Anne Arundel found help: Crisis counselors placed about half of the out-of-county cases into treatment facilities as well.
Safe Stations has drawn the attention of the Maryland Opioid Operational Command Center, which is battling a statewide opioid crisis that has surged in recent years despite public awareness campaigns and efforts to broaden services.
"We are encouraging jurisdictions to take a close look at it," said Clay Stamp, director of the command center.
The state also awarded a grant to Anne Arundel to help hire more crisis counselors to assist the program.
Analysts say 24-hour access to help is crucial to fighting the opioid epidemic. The nature of addiction is that there's a narrow window of time to get someone into treatment.
"If you wait, they're almost guaranteed to use again because they'll go into a horrible, uncomfortable withdrawal," said Dr. Joshua Sharfstein, the former Baltimore health commissioner and state health secretary who is now a professor and associate dean at the Johns Hopkins University's Bloomberg School of Public Health. "If you can get someone to treatment quickly, they can avoid that motivation."
Sharfstein said it's also important to have options where people can seek treatment. He called the use of fire stations "very creative." Officials must "help people access effective treatment from multiple locations," he said, "so that you can take advantage of every opportunity."
That was the thinking in Anne Arundel, where overdoses nearly doubled in 2016.
"People are more successful when they come on their own," said Jen Corbin, director of the Anne Arundel County Crisis Response System.
She said county officials asked: "What if we had a place where people would come when they're ready?"
Anne Arundel and the City of Annapolis decided fire and police departments would be ideal. Located in every community, stations are staffed around-the-clock and everyone knows where they are.
Fire stations have seen the vast majority of walk-in cases. Officials believe that's because people are used to turning to firefighters for help.
"We're capitalizing on the comfort level people have with a fire station," Graves said.
Yet even in desperation or resolve, people can be wary. Officials say some come to a station, ask a few questions, get a little information, then leave.
Paramedics try to accommodate immediate needs — at Brooklyn Park, the busiest Safe Stations location, firefighters often run to the McDonald's across the street to get food for a hungry client.
Sometimes it takes two or three visits for individuals to be comfortable enough to ask for treatment. When they do, the Anne Arundel County Crisis Response System is called, and within about 15 to 20 minutes — day or night — a licensed social worker or counselor arrives to evaluate them. Crisis team members have a menu of options available based on the severity of an individual's addiction and whether they have insurance.
"We know where to guide them pretty fast," Corbin said.
Prior to Safe Stations, crisis team members made visits to people who survived overdoses, trying to nudge them into treatment. Only about 10 percent would go, she said.
"People don't want treatment right out of overdosing," Corbin said. "They're angry, they're mad."
Safe Stations's early success has offered a nugget of hope against a rising tide of overdoses and drug-related deaths in Anne Arundel. On one weekend in July, there were more cases of people seeking help through Safe Stations than there were overdoses.
That's considered a win. Still, more than 100 people have died from overdoses in the county so far this year.
"We're not seeing the big numbers making the turn," Graves said. "But it's nice to see these glimmers."
No other Baltimore area jurisdiction has replicated Safe Stations, but most are working to expand access to addiction treatments.
Baltimore County, for instance, accepts walk-ins seeking treatment on weekdays at the Eastern Family Resource Center in Essex, and is planning to expand the service to the Liberty Family Resource Center in Randallstown, said Dr. Gregory Branch, the county's health officer.
A state grant will pay salaries for four additional peer recovery counselors who will be on-call to help Baltimore County police officers and firefighters who encounter people seeking help. The county hopes to expand hours of its hotline, 410-88-REACH, which currently operates 8:30 a.m. to 4:30 p.m.
"It's all during the day," Branch said. "We want something in non-traditional hours. If I come to you at 10 o'clock at night, I can't wait until 8 in the morning."
Baltimore County Councilman Todd Crandell said he wants the county to try Safe Stations.
"I think our county is a little bit behind," the Dundalk Republican said. "I just see the writing on the wall that this problem is only going to get worse."
A spokesman for Baltimore Mayor Catherine Pugh couldn't say whether the city has considered Safe Stations.
Howard County is reviewing whether Safe Stations might work, health department spokeswoman Lisa de Hernandez said.
Carroll County health officer Edwin Singer said Safe Stations might not make logistical sense there. Carroll has both county government and multiple small municipal governments, and the fire companies are independent organizations run by volunteers.
But Carroll is taking other steps, including preparing to launch a crisis response team for the first time. The team will offer counselors to help police and firefighters who deal with people in crisis, whether it's substance abuse or mental health issues.
"When we're dealing with the substance abuse crisis, you have to look at the right fit for the jurisdictions," Singer said.
Harford County has similar challenges, with an independently elected sheriff, multiple fire and emergency medical companies plus county and town governments. The county recently received a state grant to expand its hotline, 443-417-7810, to 24-hour coverage, county spokeswoman Cindy Mumby said.
In Anne Arundel, the unified approach between agencies has been a key component of Safe Stations.
Officials say they had to consider that people seeking treatment might be wary of being arrested — so the police department agreed to dispose of any drug paraphernalia that individuals bring in, but not arrest them.
And if an individual has an outstanding warrant — a hurdle that often thwarts entry into drug treatment programs — the state's attorney's office has agreed to handle minor warrants in a way that won't involve sending the person to jail.
So far, about 15 percent of Safe Stations cases have involved an individual with a warrant, typically for nonviolent offenses such as theft, drug possession or not showing up to court. In those cases, Arundel State's Attorney Wes Adams' team has gotten District Court commissioners to release the individual into treatment rather than jail.
"We want people in a position to be amenable to good resolutions in the courtroom, getting into treatment, getting their life back together," Adams said.
Adams, like many Marylanders, has dealt with heroin addiction on a personal basis. He lost a brother-in-law to an overdose in January.
He sees the fight against addiction as a matter of saving lives, and improving public safety.
"If we can help someone step out of the life of addiction, then there are the thefts, break-ins and other crimes that will decrease," he said.