Pubdate: Mon, 04 Apr 2016
Source: Washington Post (DC)
Copyright: 2016 The Washington Post Company
Author: Josh Hicks


Advocates Say Addicts Need Long-Term Care

Maryland Gov. Larry Hogan (R) and the Democratic-controlled 
legislature are weighing options for tackling the fast-growing heroin 
epidemic that has taken root across the state and throughout the country.

Many of the solutions focus on loosening criminal penalties for drug 
offenses and shifting more money - including the potential prison 
savings - to treatment and rehabilitation programs.

The efforts have drawn praise from experts, including Joshua 
Sharfstein, the physician who served as state health director under 
Hogan's predecessor, Martin O'Malley (D). But they are viewed with 
skepticism by some advocates, who want the state to immediately and 
significantly expand long-term residential treatment.

The debate comes as the White House and Congress are taking steps to 
address opioid addiction, which has also been a nagging theme on the 
presidential campaign trail. In March, the U.S. Senate overwhelmingly 
approved legislation to create grants to expand drug-abuse treatment 
and awareness programs; encourage medical providers to reduce 
unnecessary prescriptions; and expand access to overdose-reversal 
drugs. President Obama said last week that he would propose $1.1 
billion in his 2017 budget to boost treatment at community health centers.

"There are steps that can be taken that will help people battle 
through addiction and get on to the other side," he said at an 
Atlanta summit on prescription drug and heroin abuse. "And right now 
that's under-resourced."

Heroin-related deaths in Maryland climbed to 527 through September of 
last year, more than triple the total from the same period in 2010, 
according to the latest data available from the state health 
department. By comparison, there were a combined 378 cocaine- and 
alcohol-related deaths during the first three quarters of 2015.

Unlike in the past, when heroin was largely isolated to the inner 
city, the drug has steadily crept into the suburbs as a cheaper and 
sometimes more accessible alternative to prescription painkillers 
that offer a similar high. Heroin-related deaths increased to 33 in 
Montgomery County and 27 in Prince George's County through September 
2015, roughly doubling in both cases compared with 2010.

The spikes aren't limited to heroin. Fatal overdoses of the synthetic 
opiate fentanyl, which heroin dealers often add to increase the 
potency of their products, also have exploded. There were 184 
fentanyl-related deaths in Maryland in the first nine months of 2015- 
eight times the number from the same period in 2013.

A Washington Post-University of Maryland poll in October showed that 
nearly 3 in 10 Marylanders have a close friend or family member who 
was or is addicted to opioids.

The bills pending in Maryland include broad criminal-justice 
legislation that, among other things, would direct many nonviolent 
drug offenders to treatment rather than prison. Sen. Bobby A. Zirkin 
(D-Baltimore County), chairman of the Senate Judicial Proceedings 
Committee, said the resulting savings in prison costs could help pay 
for an expansion of rehabilitation services - an idea that has 
bipartisan support.

Some advocates, however, are skeptical that the state would actually 
do that. Michael Gimbel, a former Baltimore County drug czar, said he 
thinks the government is more likely to use prison savings for other 
corrections programs or spread it throughout the state budget.

"To think they're going to take justice money and put it into 
community drug treatment is a joke," said Gimbel, a former addict himself.

Zirkin acknowledged that there are no guarantees of where the savings 
would be directed. "They're correct in their concern," he said of 
Gimbel and other advocates. "The legislature doesn't control the 
budget, but we can mandate spending through policy, and that's what 
we're trying to do."

Hogan, who lost a cousin to a heroin overdose, has proposed $3 
million in new spending next year to support addiction treatment in 
prisons and $2.3 million slightly increase the reimbursement rate for 
providers of substance abuse treatment, with the goal of attracting 
and retaining more workers in the field.

Last year, the governor released more than $2 million to increase 
access to treatment in Western Maryland and on the Eastern Shore, 
boosted police efforts to disrupt drug trafficking and launched a 
public awareness campaign about the dangers of addiction. The state 
also authorized pharmacists to dispense an overdose-reversal drug to 
people trained and certified through the state's Overdose Response Program.

"The administration is funding a lot of treatment and is going to be 
spending more, but it can't be the only tool in our toolbox," Hogan 
spokesman Doug Mayer said.

Measures pending in the legislature would create a database to track 
potential abuse of painkiller medications, with a requirement to 
alert doctors and pharmacists and notify licensing boards and police, 
and strengthen the state's ability to prosecute drug gangs under 
organized crime statutes.

Sharfstein, the former health secretary, said many of Maryland's 
proposals align with those Rhode Island rolled out last year in a 
plan that he said could serve as a model for the nation. Rhode Island 
is focused on stronger prescription tracking, expanded use of 
withdrawal and overdose-reversal drugs, and increased efforts to 
ensure that hospitals connect overdose patients with treatment services.

"It's a very clear and comprehensive plan," said Sharfstein, who is 
now associate dean of public health at Johns Hopkins University.

Gimbel and other advocates say the state should focus more on 
long-term, residential treatment, which can be more expensive than 
short-term treatment and drugs to ease withdrawal.

Carin Miller, co-founder of Maryland Heroin Awareness Advocates, said 
addicts regularly reach out to her group seeking help but can't find 
openings at clinics.

"There aren't enough beds," she said. "They have to wait six weeks, 
but when you're ready for treatment, you need it immediately. There 
needs to be a bill introduced, almost as an emergency measure, to 
allow more access."

Gimbel said he met with state lawmakers last year to propose 
converting vacant public buildings into regional rehabilitation 
centers, something he did with a former mental hospital in Owings 
Mills while serving as director of Baltimore County's Office of 
Substance Abuse.

"They loved the idea, but so far nothing has happened," Gimbel said. 
"We have four or five mento tal hospitals sitting empty. We could do 
this all around the state."

Gimbel and Miller said the state should stop treating heroin abuse 
with opiate-based drugs such as methadone and suboxone, which ease 
withdrawal symptoms.

"The treatment they're trying to push most is another opiate," said 
Miller, whose husband and son are battling addiction. "You can't 
treat an opiate addict with something opiate-based. It's going to be 
an epidemic of people on suboxone."

Gimbel also criticized Maryland's efforts to increase access to 
overdose-prevention drugs and reduce incarceration for drug crimes, 
saying that fear of death, disease and prison can push addicts to seek help.

"It's fear that makes people want to get off drugs," he said. "What's 
the reason to stop using heroin if there are no consequences? What 
message is that sending to addicts?"

But many doctors - including Sharfstein - say medication and more 
short-term treatment are proven ways to get results.

Sharfstein compared recovering opioid addicts to Type 2 diabetics, 
saying that many require medication for the rest of their lives to function.

"A major federal investment in medication-assisted treatment will 
save lives in Maryland as it will across the country," he said.

Some of the most drastic proposals have come from Del. Dan K. Morhaim 
(D-Baltimore County), an emergency room physician who sees patients 
who have overdosed.

He proposed bills to establish "safe-use" facilities for supervised 
drug consumption, decriminalize low-level possession of many common 
narcotics and require hospitals to develop detailed plans for guiding 
addicts to treatment.

The House is expected to vote on the hospital requirement this week, 
but the other bills died at the committee level.

Morhaim acknowledged that his proposals wouldn't pump new funding 
directly into rehabilitation programs but said they could free up 
money for the state to redirect toward addiction services.

"I'm just trying to develop the policies, and the policies imply 
money in this case," he said.
- ---
MAP posted-by: Jay Bergstrom