Setting Up the Defense: The Opioid Addiction Fight

July 2015, The Business Monthly, By Mark R. Smith, Editor-in-Chief

By the time Steve Schuh took office late last year as the new Anne Arundel County Executive, he was well aware of the horrors of the local opioid market.

He’d heard the stories about the continual overdoses. He was aware of the news reports. He’d conferred with the county’s police force and its health department about its magnitude.

So Schuh and the county’s health industry powers-that-be organized a task force in an effort to thwart a heroin epidemic in the area and the region that some observers feel has hit Anne Arundel County particularly hard, as proven by Anne Arundel County Police data that indicated more than 300 overdoses and close to one death per week in 2014.

While Schuh’s task force devises a plan, area authorities and various organizations are collaborating to stop the scourge before 2015’s numbers start to approach last year’s.

Two Years On

Just two years ago the use of opioids in Anne Arundel County, or anywhere else, wasn’t particularly noted in the news or discussed much, for heroin had always been an expensive addiction, most often found among heavy drug users who took their chances on dancing around smack’s often deadly grip.

But recently, some ugly circumstances meshed: The cost of prescription opioids rose, even for generics; around that time, a more potent version of heroin hit the street. Oddly enough, it was less expensive, too.

Suddenly, prescription users who became addicted to prescription opioids could skip the pharmacist’s counter and get their fix on for $10–$15 — with predictable and often tragic results.

“For many people, addiction does start with prescriptions for pain, then develops into an addiction and [access] to heroin,” said Joshua Sharfstein, former secretary of the Maryland Department of Health and Mental Hygiene and now dean of the School of Public Health at The Johns Hopkins University, adding that there has “been an increase” in prescribing opiates.

On that note, Sharfstein noted that Maryland recently established, for the first time, a requirement that all doctors, nurses and nurse practictioners to take a class concerning the perils of opiate abuse before they get their state licenses.

He said the epidemic seems to be happening, moreso, up and down the East Coast, pointing to a study from the Trust for America’s Health that indicated that Maryland ranked 26th in 2011–13 for overdose deaths.

Sharfstein said not only is heroin particularly cheap, it is also being laced with fentanyl, “which also is even more dangerous than heroin and is rarely prescribed by a doctor,” he said, “so on the street, we’re seeing about 25 deaths a month in the state, whereas two years ago — you can almost pinpoint this trend to November 2013 — you might have seen a couple.”

Seeking Treatments

Sharfstein said that there “are many efforts underway” to tackle the issue in Maryland “and we know that they are helping. The increased use of Narcan is helpful, as it immediately reverses an overdose and so the user can receive treatment. Methadone [available in clinics] is a drug that helps to stave off the cravings of the addicted and there are also treatment programs, like those offered by Gardenzia.”

The multi-tiered approach to fighting addiction that starts with early intervention is what is being promoted at the Howard County Health Department, said Roe Rodgers-Bonaccorsy, director of behavioral health for the Howard County Opioid Overdose Response Program (HCOORP).

And Howard County has news: Starting July 1, a grant from the Governor’s Office of Crime Control & Prevention was awarded to the Howard County Detention Center to administer the Vivitrol injection, which controls cravings for opiate and alcohol users, to inmates who are set to be released, and thus eligible for the outpatient program.

“I’m also hearing from other counties about plans to roll it out and how to be consistent with the injections, which must be administered for 30 days,” Rodgers-Bonaccorsy said. “Research shows that six months to a year is the general span of treatment.”

The drug, however, isn’t very well known, partly due to its expense. “Retail, it can cost from $1,000–$1,300 per injection. Medicaid reimburses about $900 of the month’s injections,” she said, and it is available via the federal government’s 340B Drug Pricing Program for “about $520 per shot. We’re hoping to treat 30 patients per year with the grant, and perhaps more with Medicaid and private insurance reimbursement.

“Washington County has been providing the service for a couple of years,” said Rodgers-Bonaccorsy. “Their people told me it was successful, and they’re offering presentations around the state, including Anne Arundel, Calvert and Harford counties.

Examine the Docs

While counseling is part of the treatment, various drugs are obviously just as crucial. Like Vivitrol, Methadone is used to control cravings, and one local businessman says that it’s been too hard for addicts to access it.

The solution of Ron Grossman, president of SPJ Consultants, of Odenton, is to bring the services to the patients who lack transportation in a mobile unit “that falls under ACA rules” that is “basically a Winnebago, since there are no brick and mortar facilities south of Glen Burnie [though the Schuh administration has budgeted $800,000 for a facility in central or south county].”

Grossman said that, via the mobile unit, SPJ would “address the entire gamut of what’s being offered in today’s market and have our clients back working and off medical assistance within 18 months.

“We think [municipalities] need to take a harder look at this,” he said. “The cause, in our opinion, is doctors who are not being held accountable for what they prescribe. We’ve got ex-patients from the Eastern Shore, for instance, who come back to Anne Arundel County to see doctors who write prescriptions to addicts. We want to make it harder for doctors to write prescriptions for 400 pills a month for patients who live out of the county.”

While saying that Howard County’s brick and mortar facilities “are more easily accessible,” Grossman feels that it’s a better idea to get the addicts “away from [such facilities], and the shame that comes with them, via our mobile service,” adding that SPJ is planning to expand to Howard and to the Eastern Shore “after Anne Arundel County gets up and running.”

In the big picture, what is needed is “a county-by-county approach with more oversight by each county, with prescriptions that include no more than a three days’ supply of opioids,” he said. “For anything more, they’d need federal blessing.”

Another Approach

Grossman met with Schuh and Anne Arundel Health Department Officer Jinlene Chan on June 26 to discuss the concept and the meeting was “very productive,” said Owen McEvoy, a spokesman for Schuh.

“[SPJ] wanted a certain amount of input from the county, and they have a proposal that needs to be worked on. The challenge we face is, since this concept is innovative, to make sure everything complies with myriad local, state, federal laws. We’re willing to think outside the box,” said McEvoy, “but we are of the opinion that there is a challenge concerning federal regulations about issuing methodone out of a van, for instance. So we want them to come back in the coming weeks with a more refined program.”

Chan supported that approach.

“I met with Mr. Grossman more than a year ago and offered some feedback about state and federal regulations, and how they might apply to his plan,” she said, also adding, “We are willing to work with him to provide training resources and to create a plan. However, we also will be working under appropriate state and federal laws.”

Joan Webb Scornaienchi, executive director of HC DrugFree, touched on the subject of prescription drugs and the law when she stated that the current circumstances present “More than a heroin epidemic. It’s prescription drug epidemic that we need to address.”

On that note, Webb Scornaienchi, who is also chair of the Howard County Alcohol & Drug Abuse Advisory Board and is coordinating the HCOORP, said any county resident can go to the health department for free training in treating overdose victims.

“The point of it is to learn to administer the Narcan and Naloxone, which buys the victim and administrator time to get to the hospital,” she said. “The training has been available for more than a year, but we’re not getting as many people to attend the training as we’d hoped for,” noting that 234 citizens have participated in the program since the start of this year. The target by June 30 was 400.

Webb Scornaienchi also echoed Grossman’s point about doctors who are overprescribing medications for individuals who are misuing, as opposed to abusing, opioids.

“This epidemic isn’t about deciding you’re going out to find a dealer, get some heroin and get high,” she said. “Doctors need to [more] closely monitor their patients, what drugs they are taking and how much. And we, as family members and friends, need to stop sharing our medications with other family members and friends.”

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