A proposal to battle Maryland's heroin crisis advanced in the House of Delegates Friday, but in a significantly scaled back form. The sponsors' goal of opening new drug treatment centers across the state fell victim to cost concerns.
The bill still includes provisions aimed at making it easier for addicts to get into treatment. But originally, it called for 10 centers to be created around the state. It now directs the Department of Health and Mental Hygiene to open just one by the summer of 2018.
The original bill had an estimated price tag of $18.8 million in the first year to get the centers started and an overall cost of more than $270 million over five years. The cost of the amended version has not yet been calculated by state budget analysts, but will likely be much lower.
Del. Eric Bromwell, a Baltimore County Democrat who has been steering the effort in the House, said the changes helped bring down costs and ensure that the bill received unanimous support.
"I wanted a product we could all vote for, without compromising the bill," he said. "I think we succeeded in that."
With final figures expected to show that some 2,000 people died from heroin overdoses last year, legislators and Hogan administration officials have been scrambling for ways to get the crisis under control.
Gov. Larry Hogan has declared the overdose crisis a state of emergency, and he provided $10 million in extra funding for the health department to to tackle it.
But advocates had been looking for additional help through the Hope Act, as the legislation that advanced Friday is called. Insufficient resources to treat addicts have long dogged efforts, advocates say, and the director of the state's medical society said reducing the planned number of crisis centers was a major blow.
"There's no way one is enough," said Gene Ransom, the executive director of MedChi. "We need to do whatever will get additional treatment availability immediately. That was what was so great about the 10 centers."
The Senate version of the bill passed unanimously on Tuesday. While it still calls for the creation of 10 centers, its sponsor, Sen. Kathy Klausmeier, said she has reluctantly agreed to go along with the plan developed in the House.
"I said OK as long as I get my one by next year," the Baltimore County Democrat said. "I would have rather had it the other way, but they said this is how they wanted to do it, and with such a big bill you have to make some compromises."
The bill would leave the door open for the establishment of additional crisis centers based on the findings of a report by an advisory group that is scheduled to lay out its recommendations by the end of this year.
The centers would be open 24 hours a day, seven days week and be operated by clinical staff who could assess a person's condition on the spot and get them into care immediately.
The bill, one in a package of anti-heroin measures that moved forward in the House Friday, also would provide for drug treatment centers to be reimbursed at rates that increase in line with inflation. That measure is also costly, but its advocates say it's necessary for addiction treatment facilities to keep operating and attract high quality staff.
The bill also would set new rules for how hospitals handle patients who come in after suffering an overdose, direct the health department and Department of Public Safety and Correctional Services to develop a plan for treating addicts who are locked up, and make it easier for people to get the overdose-reversing drug naloxone.
The crisis centers idea was the most concrete in the wide-ranging bill and was touted when three-dozen Democratic lawmakers gathered to announce their plan on March 24.
But Del. Nic Kipke, the Republican leader in the House, said he sent a midnight text message to Bromwell — a personal friend and groomsman in Kipke's wedding — pushing for the change.
"I lost sleep Monday over this," Kipke said.
The Anne Arundel County Republican said the centers were not necessarily the best use of money because when people are suffering a crisis they first think to go to a hospital emergency room, and some counties have mobile teams that can respond to a crisis where it arises.
"It was the belief of many of us that we already have access to that crisis step and any new resources that get put into treatment should go towards inpatient, detox and long term treatment," he said.
Bromwell also agreed to change a proposal he was especially attached to — the creation of a hotline to get people immediate help over the phone. Rather than requiring it, the bill now says the health department would have to create the hotline only if money is available.
"The hotline can still happen, but I agreed that the other parts of the package are more important," Bromwell said.