Over the past three years, Carroll County, like Maryland and the country at large, has seen a steady increase in deaths due to opioid drugs — prescription painkillers such as OxyContin, black market heroin and the powerful synthetic fentanyl. In Carroll, however, there have been some fluctuations that hint at a possible plateau to the growth in fatalities.
But while the number of fatal overdoses may be starting to plateau, local officials are saying there is still a problem, one that could be hidden by the change in fatal overdoses — nonfatal overdoses are going up.
"Luckily the naloxone is keeping people from dying from the overdose, but it's getting worse," Sheriff Jim DeWees said.
Through the end of November 2016, Carroll County had seen at least 16 fatalities related to opioids, including heroin, fentanyl and prescription pain drug deaths, according to statistics from the Carroll County Sheriff's Office. This is compared with the 19 opioid related deaths the office recorded in 2015.
In 2014, those numbers were 15 opioid related deaths.
Statistics recorded by the Sheriff's Office are somewhat provisional concerning deaths, however, as many cases counted have not yet been reviewed by the Office of the Chief Medical Examiner. The Maryland Department of Health and Mental Hygiene releases reports based on this data, but less frequently: At present, the most current DHMH statistics cover only the first six months of 2016, where 15 deaths related to all kinds of drugs or alcohol were confirmed, 12 of which involved heroin. DHMH overdose numbers reflect deaths involving more than one drug, so that that a single person's death could be counted as three times — as a heroin, fentanyl and cocaine overdose — and the number of deaths associated with each individual substance do not sum to the total number of fatalities from all substances combined.
DHMH identified 22 deaths related to heroin in Carroll County during the entirety of 2015, and 16 such deaths in 2014, a 37.5 percent increase. Maryland as a whole had 749 heroin-related deaths in 2015, up 29 percent from 578 such deaths in 2014. There were 566 heroin-related deaths in the first six months of 2016.
But while Carroll County fatalities due to drugs are growing at a slower pace than the state at large, nonfatal drug overdoses are increasing.
Taking heroin overdoses as an example, there were 12 heroin-related deaths in Carroll in 2014 but 69 nonfatal heroin overdoses reported, meaning about 15 percent of heroin overdoses were fatal, based on Sheriff's Office data. In 2015, again according to Sheriff's Office data, there were 15 fatal heroin overdoses and 97 nonfatal heroin overdoses reported, making approximately 13 percent of heroin overdoses fatal. In 2016, through November, there have been 10 heroin fatalities recorded by the Sheriff's Office and 161 nonfatal overdoses reported, which means approximately 6 percent of the heroin overdoses were fatal.
Although some reported overdoses may involve spontaneous recovery, many of these nonfatal overdoses are instances where a person would likely have died if not for the availability of the opioid antidote naloxone, sometimes know by the brand name Narcan. Since mid-2014, drug users, their families and other civilians have been able to obtain and keep this lifesaving medication in addition to it being deployed by emergency medical and law enforcement personnel in the county.
In 2014, paramedics used naloxone 196 times with around 34 duplications, which is when multiple doses are used on one person, said Libby Luebberman, a paramedic with the Sykesville Freedom District Volunteer fire company and a member of the Carroll County EMS Quality Assurance Review Board. In 2015, the amount of naloxone uses increased by almost 80, with 275 uses and about 35 duplications. As of Dec. 22, in 2016 paramedics used naloxone 402 times with approximately 80 duplications, almost double the amount of times in 2015, according to Luebberman's statistics.
Without the naloxone, DeWees predicts the number of fatalities would be triple, possibly quadruple, the amount seen.
"It's not if you die, it's when you die if you're a heroin user," he said.
DeWees said using heroin is like playing Russian Roulette. Eventually, one time will result in an overdose and possibly death. The addiction is so strong that even though users know it will likely kill them, they can't stop.
"Heroin addicts are craving the heroin so much that they know it's going to kill them," DeWees said.
In Carroll, the addiction problem is being tackled in three ways. There are prevention tactics, like education programs in the county public schools, law enforcement tactics to stem the flow of illicit substances and treatment methods to get people with substance abuse disorder into help.
It's a collaborative effort that seems to be working, said Commissioner Stephen Wantz, who is also a volunteer with the Pleasant Valley Volunteer Fire Company.
Carroll's numbers are better than other jurisdictions when it comes to overdoses and fatalities, State's Attorney Brian DeLeonardo, adding that Carroll offers programs and resources that are unique to the county.
DeLeonardo compares the drug problem in Carroll to a flooding bathroom. The sink needs to be turned off before the rest of the water can be addressed. In Carroll, prevention like education and law enforcement efforts to stem the amount of dealers help to turn off the metaphorical sink. The water in the bathroom is the people already hooked on heroin, prescription pills or another substance.
"There's no question that we need more treatment," DeLeonardo said.
In Carroll, there are private funds helping to get people into treatment, and Tim Weber, the drug prevention and treatment liaison with the State's Attorney's Office, is able to connect people with substance abuse disorders with resources. Through Weber and other efforts in the county, DeLeonardo said there are people who have been taken off the streets and put into treatment programs.
But Carroll's not an island, he said, which makes it harder to control the amount of drugs and users in the county. Arrests made by another county could lower the supply in Carroll because a dealer could have Carroll ties. At the same time, if the supply isn't being cut off, more drugs can come into the county.
Carroll County received a High Intensity Drug Trafficking Area designation early in 2016, which means Carroll shares and receives information about drug trafficking across the country. DeLeonardo said dealers have been caught through the HIDTA network. But even with the HIDTA designation, DeWees said that the county is sometimes at the mercy of what other counties and the federal government do to address the supply of drugs.
DeLeonardo's office has tried to decrease the amount of users through education programs in the high schools and middle schools. The high school program focused more on heroin and prescription pill usage, while the current middle school program teaches kids ways to say no when there is peer pressure.
"I think the education provided by the State's Attorney's Office is our first line of defense," he said.
While there is more that can be done in terms of treatment, Wantz said that Carroll is addressing the problem correctly, and if anything, those working to address substance abuse disorders need to continue to do what they are already doing.
"I don't think there's anything we need to change," he said.