Heroin use is now one of the most deadly public health issues facing Maryland. Heroin-related deaths increased by 88 percent from 2011 to 2013, rising from 247 to 464, and by another 46 percent during the first six months of 2014. Heroin-related deaths in 2014 may more than double the 2011 count. Increases have been reported throughout the state, including Western and Central Maryland and the Eastern Shore. The upward trend is unmistakable. We must all work together to counteract the resurgence of this lethal drug.
Heroin is highly addictive and extremely dangerous. It can alter the user's brain permanently, sometimes after just one use. Experts estimate that about 25 percent of users become dependent on heroin, which can be injected, inhaled or smoked. In National Geographic, Susan Brink noted that the euphoria experienced by the first-time user "becomes a lasting memory and one to be obsessively chased." There is no safe dose, and heroin frequently is used by teenagers.
Users have no idea where their heroin comes from, nor its purity. Heroin can be mixed with anything. Heroin may be cut with harmless substances such as sugar, starch or powdered milk. It can also be cut with poison or fentanyl, an even more powerful opioid.
Heroin is relatively inexpensive, often about $10 per dose. Prescription opiates such as oxycodone pills, a frequent gateway to heroin, cost many times more on the street. Maryland's creation of a statewide prescription drug monitoring program has significantly reduced the availability of pharmaceutical drugs. One unfortunate consequence of the decreased supply of pharmaceutical opiates is that the resulting spike in cost led many addicts to turn to a less expensive, more readily available — and even more dangerous alternative — heroin.
Heroin kills because it depresses breathing and heart rate. The death rate would be much higher without naloxone, better known by the trade name Narcan. Narcan is a rescue medication now carried by most fire and rescue services and many police departments. When administered quickly to a victim, Narcan can reverse the effects of the overdose within minutes. In Montgomery County alone, Fire Rescue Services estimates that they administered Narcan to overdose victims 120 times last year.
But drug abusers who are saved by Narcan may not be saved for long because most addicts continue to use heroin. In response, the Maryland Department of Health and Mental Hygiene has spearheaded an initiative designed to reduce the number of heroin-related fatalities. This pilot-program will identify and target services to persons who have survived previous overdoses.
Narcan is an important part of the equation; however, in order to save lives, the 911 call must be made to notify authorities of the drug related emergency in the first place. Last year, the Maryland General Assembly passed a "Good Samaritan" law, which provides an incentive for otherwise reluctant persons to make that call for help. Essentially, the new statute grants immunity from criminal prosecution to individuals who in good faith seek emergency assistance for overdose victims.
Maryland has moved to address the life saving issues related to emergency response and the targeting of heroin addicts for treatment. A federal statute criminalizes and enhances penalties for the distribution of illegal drugs that result in death; however, Maryland lacks such a law. A new law would help state prosecutors deter drug dealers from selling heroin in Maryland by holding them responsible for deaths caused by the heroin they distribute.
Currently, we are investigating every heroin overdose as a homicide. The United States Attorney's Office and the Drug Enforcement Administration have joined the Montgomery County State's Attorney's Office in developing a best practices model for how to gather the evidence required for criminal prosecution.
The solutions to this crisis are complex and must be addressed in a comprehensive fashion. We support the following:
•The increased availability of Narcan for first responders;
•The promotion of public education and awareness regarding Maryland's new law providing immunity from criminal prosecution for those who report a drug overdose of another;
•The Maryland Department of Health and Mental Hygiene's commitment to treat overdose victims.
The most significant contribution that law enforcement can make is prosecuting distributors of deadly drugs. A state law providing authority that parallels existing federal law would strengthen the ability of state prosecutors to fight the resurgence of this dangerous drug and hold accountable purveyors of death.
Rod J. Rosenstein is the U.S. Attorney for Maryland; his email is usamd.comments@usdoj.gov. John McCarthy is the State's Attorney for Montgomery County; his email is states.attorney@montgomerycountymd.gov.