Despite a flurry of actions by Gov. Martin O'Malley's administration to combat the rising number of opioid overdose deaths in Maryland, recently released statistics from the Carroll County Overdose Prevention Council, and the Maryland Department of Health and Mental Hygiene show that deaths continue to pile up at an alarming pace. And while state and Carroll County officials have launched new efforts to staunch the rising stream of deaths, more time and more — and better— data collection will be needed to see if they are having an affect.

DHMH statistics released Nov. 7 show 582 deaths from opioid drug overdoses between January and the end of June, almost two-thirds of the 838 deaths associated with opioid drugs through all of 2013.


"The data through June is very troubling because it shows a 33 percent increase compared with the same time last year," said DHMH Secretary Dr. Joshua Sharfstein. "That increase can be almost entirely explained by heroin and fentanyl."

Fentanyl, a synthetic prescription opioid medication that is roughly 100 times more powerful than morphine, was associated with 114 of the overdose deaths through June this year, while 296 deaths were related to heroin and 172 related to prescription opioid medications other than fentanyl, according to the DHMH data.

In 2013, according to the same data set, there were 496 heroin-related deaths, 316 associated with prescription opioid medications and only 58 deaths associated with fentanyl, numbers that reflect what Sharfstein said are two deadly trends: users who became addicted to prescription opioid drugs moving to cheaper and more easily obtainable heroin, and drug cartels using fentanyl to cut that heroin, leading to wild variations in potency and subsequent overdoses.

"What's going on is we are seeing the cheapest heroin in decades. It's very pure, and it is cut with a more powerful opiate," Sharfstein said. "We used to have two fentanyl-related deaths per month, we are now seeing 20 to 30 deaths from fentanyl per month. ... It's a huge, huge problem."

While the majority of opioid overdoses in the state have occurred in Baltimore City and Baltimore County, Carroll County has not gone untouched by the epidemic. Thus far, in 2014, DHMH reports 22 overdose deaths through the end of June, with nine related to heroin, seven related to prescription opioid medications and three deaths related to fentanyl. Additional statistics from the Carroll County Sheriff's Office take the total number of opioid-related deaths in Carroll up to 25 through the end of October.

In 2013, DHMH reports there we 24 overdose deaths from all drugs and alcohol. With two months left in 2014, opioid drugs alone have already outpaced last year's tally.

Thwarted goals

The trend lines in the overdose data belie O'Malley's goal to reduce overdose deaths by 20 percent by the end of 2015. Taking the 799 overdose deaths in 2012 from intoxication of any kind as a baseline, and looking at the 858 deaths in 2013, the Maryland StateStat website shows negative 7.4 percent progress toward that goal. The dashboard-style progress dial on the website rests heavily on the zero.

The lack of progress toward the goal of reducing overdoses was not lost on Gov.-elect Larry Hogan, who criticized the O'Malley administration's strategy from the campaign trail. Hogan will not discuss policy specifics before being sworn into office, according to Hogan Press Secretary Erin Montgomery, but she said he will be taking swift action on the issue.

"One of the very first things that he is going to do as governor is to declare a state of emergency regarding the heroin epidemic in [Maryland]," Montgomery said.

O'Malley did take a number of actions however, including signing a June 27 executive order that created a state level Overdose Prevention Council. The statistics available through June give a picture of the crisis point where the governor intervened to take those emergency actions, according to Sharfstein.

"There are multiple things that have happened since that executive order including a major PR effort for people to call for drug treatment and learn the signs of, and how to respond to an overdose," Sharfstein said. "We have been accelerating our efforts, so the data just doesn't show the impact of anything since [late June]."

A possible antidote

One program that has shown some tentative results both in Carroll and statewide is the Overdose Response Program, where in health departments have trained law enforcement officers, drug users, their friends and family members in the use of naloxone, an opioid antidote.


Carroll County began training civilians in the administration of naloxone in April, and Carroll County Sheriff's deputies in July, according Dawn Brown and Sue Doyle, director of quality assurance and prevention and director of the bureau of prevention, wellness and recovery at the Carroll County Health Department, respectively, and more than 70 civilians have been trained. Brown said there has been one administration of naloxone — by law enforcement and medical personnel — that is believed to have saved a life, and there may have been other uses of naloxone that have not been reported to the Health Department.

"At this time the Carroll County Health Department, Bureau of Prevention, Wellness and Recovery is pleased with the progress [of the program]," Brown and Doyle wrote in a statement. "In the short time frame that the program has been around we have seen positive changes, increased enrollment in classes and individuals who were trained as a part of their job who initially did not request a prescription contacting the agency to get a [naloxone prescription]."

Statewide, more than 3,000 individuals had been trained in the use of naloxone and the antidote had been used 43 times, according to DHMH statistics current through Sept. 30.

Unfortunately, it is not known how many of those 43 administrations were successful, according to Bruce Anderson, director of operation at the Maryland Poison Center, which helped collect the data.

"We would love to be able to provide that kind of information, but it is a very difficult problem to try and document accurately," he said. "I think it's important to remember this program started out as a trial, as a proof of concept ... and it has quickly expanded due to the nature of the problem. It is not terribly surprising that there is a little bit of a gap in the data recording process."

Finding better ways to capture the results of naloxone use in the field is an ongoing effort at Maryland Poison Control, according to Anderson, and finding better ways to measure the results of all anti-overdose efforts is a large part of the DHMH response to the problem, according DHMH Director of Communications Chris Garrett.

"We are continuing to try and access data that will help us understand the scope of the problem and they will inform our policy," he said. As data collection becomes better, and final overdose data for 2014 becomes available in the new year, the hope is that the new efforts at the state and local level will have bent the arc of deaths downward.


Even in such a "hurry up and wait" scenario, it's not all bad news. Even as the results of Maryland's anti-overdose campaigns remain out of statistical focus, the state has received recognition for quick work since June. On Oct. 27, Acting Director of the U.S. Office of National Drug Control Policy Michael Botticelli wrote to Sharfstein to praise the work of DHMH.

"There is much many other states can learn from your efforts," Botticelli wrote.

Reach staff writer Jon Kelvey at 410-857-3317 or