February 6th, 2017

Addressing Opioid Addiction In Maryland

Opioid addiction continues to be a serious problem in Maryland. The number of heroin-related overdose deaths rose 72 percent, to 918, during the first nine months of last year, compared to the same period in 2015. Fatal overdoses related to prescription opioids jumped 17 percent, to 270, during the same period.

When the magnitude of a drug problem is this great, government intervention can be helpful. It can also, however, make the problem worse. The key is to achieve a balance between addressing both treatment and law enforcement issues. A common tendency in the past has been to “get tough on drugs,” emphasizing punishment in a way that is ultimately counterproductive.

Governor Larry Hogan began to focus on opioid addiction during his first campaign for office in 2014. Since his election, he has followed through on his promise to make it a priority.  His most recent move is the “2017 Heroin and Opioid Prevention, Treatment, and Enforcement Initiative.” It outlines actions that range from increasing treatment opportunities for addicts to stepping up penalties for drug traffickers. It also creates an “Opioid Operational Command Centerto facilitate the coordination of these actions.

Fortunately, regarding treatment, Governor Hogan is the beneficiary of the infrastructure created 10 years ago by the Baltimore Buprenorphine Initiative. It expanded access to buprenorphine – a methadone-like medication that improves treatment outcomes – and reduced the heroin overdose rate. But no single intervention works permanently. So this improvement was temporary.

At Kolmac, the number of patients presenting with opioid addiction is substantial but the numbers have for the first time in 15 years stopped growing. Last year they represented 31 percent of our patients. As useful as buprenorphine has proven to be, it is still secondary to the psychosocial part of our treatment program especially providing talk therapy and a bridge into the recovery support community.

The Governor’s initiative also attempts to address the problem at its source by proposing to limit the supply of opioid painkillers. Physicians seeing a patient for the first time would be limited to prescribing a seven-day supply with longer supplies allowed mostly for the treatment of cancer. Despite the guidelines promulgated last year by the Centers for Disease Control, some physicians continue to write prescriptions for overly large amounts of opioids, allowing for the diversion of unused pills.

I believe that by increasing access to treatment for addicts while still targeting drug traffickers, Governor Hogan’s new initiative achieves the goal of what the Washington Post describes as “shifting from punishing drug addiction to treating it.” I’ll be waiting to see the response of the medical community to what it may regard as an intrusion into medical practices.

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