The Heroin Epidemic in rural Maryland

Rural Health Learning CollaborationSept. 28, 2015

James A. Cockey, MD, FACP

Deputy Health Officer

The Cost of Alcohol and Illicit Drug Use on the Eastern Shore of Maryland October 2014

Eastern Shore of Maryland – 9 counties, pop. 449,000 - 2013

Wicomico County

New demographics

• Increase in pregnant clients• Larger numbers of white, male, middle aged patients• Change in past drug history• Formerly clients had dabbled more with pot, alcohol, cocaine• Now a more common route is acute or chronic pain, prescription opioids,

addiction, heroin

Collateral damage

• A lost generation• Children of addicts

• Neonatal abstinence• Multiple NAS babies• Parents absent, high, struggling

• Older parents of adult addicts• Time, money, energy for their children’s addiction• Raising grandchildren for dead or incapacitated parents

• Adolescents experimenting with drugs earlier in life, get into legal system early, affecting job, education opportunities• Human trafficking

Physician response

• Highly publicized scandal around local pain management physician - 2012• Physicians are reluctant to prescribe opioids compared to pre-2012. • More referrals to pain management and rheumatology practices• Some pain management will do procedures only• Insufficient pain specialist resources

Physicians and opioid prescribing

• Increased heroin related hospital admissions• A few large practices have agreed on universal policies • They have experienced “a vast exodus of narcotic seekers”• Standardizing opioid prescribing practice seems more important than the

specific standards

• Naloxone not commonly prescribed in primary care

PoliticsCampaigns focused on addictions

• Maryland governor, Larry Hogan (R) campaigned on heroin epidemic• Lt. Governor’s regional summits - 6 locations around the state• Lt. Governor’s Task Force• To release recommendations on all aspects of drug abuse.

• New state laws facilitating naloxone distribution• Good Samaritan law• Hard to get the word out

• Wicomico County Executive, Bob Culver (R) also focused on heroin epidemic

Overdose Response program

• Maryland state law, grant funds for naloxone – aimed at getting more naloxone into the community• SB516 goes into effect Oct. 1 – allows for authorized lay person to

dispense naloxone on the street• Reduced barriers in law regarding dispensing of naloxone• standing orders for pharmacies• SB516 goes into effect Oct. 1 – allows for authorized lay person to dispense

naloxone on the street

Maryland PrescriptionDrug Monitoring Program

Local efforts• Prescription Drug Task Force

• Monthly collaborative meetings – public health, hospital, media, law enforcement, pharmacists, MCO’s, addictions treatment offices

• Community Pain Management Task Force• Overdose Fatality Review Team• Collaboration with pharmacies• Wicomico Drug Talks• Funding for outreach, health promotion

Billboards, internet, TV• 211 line – training for telephone operators for Life Crisis• Drug Drop off boxes• Overdose Response Program – naloxone training – all law enforcement has been trained

• Regular trainings for public

4 WiCo rug drop off boxes for 2 years

2 more recently – 1 in a pharmacy

211 promotion

Treatment Same day walk-in

evaluations, Monday – Thursday

•Intake assessment•Connect client to IOP or private services rapidly•For possible MAT (Suboxone, methadone) more steps involved•Mandatory counseling•Medication Assisted Treatment clinics – methadone & suboxone

Perceived barriers in accessing

addictions services

•Client and family difficulties in accessing treatment•Referring provider difficulties in understanding treatment access•Ongoing outreach efforts