The Opioid Operational Command Center (OOCC) and the Maryland Department of Health (MDH) have released their report on the opioid crisis in Maryland for the third quarter of 2020. The report includes preliminary data detailing further increases in opioid and other substance-related fatalities amid the coronavirus pandemic. In addition to targeted grant funding and ongoing efforts to maintain access to treatment and recovery services, the state’s response focuses on new initiatives designed to address the disproportionate impacts of the opioid crisis on minority communities.
According to MDH’s Vital Statistics Administration, there were 2,025 unintentional intoxication deaths involving all types of drugs and alcohol in Maryland between January and September of 2020. This figure represents a 12.1 percent increase from the same period in 2019, when there were 1,806 such fatalities. These increases are likely the result of the coronavirus pandemic, which has disrupted treatment and recovery support systems and has led to economic stress, despair, and uncertainty, especially among vulnerable populations. Officials believe that these circumstances have elevated substance misuse not only in Maryland but also across the country. The CDC cites an increase of 16.9 percent in reported fatalities from all types of drugs between May 2019 and May 2020. CDC officials have indicated that this figure may continue to increase as toxicology reports confirm more cases. Officials also noted that these increases have accelerated across the country as pandemic conditions worsened.
Opioids were involved in 1,829 deaths, or over 93 percent, of this year’s cases, representing an increase of 14.5 percent as compared to the same period in 2019. Fentanyl remains the opioid responsible for the most fatalities in the state. Fentanyl factored into 93.1 percent of all opioid-related deaths from January to September of 2020. Deaths related to prescription opioids and non-opioid substances, including cocaine and alcohol, also increased during the reporting period.
“The COVID-19 pandemic has created additional challenges for people suffering from substance use disorder,” said Governor Larry Hogan. “People are hurting, and we must continue to increase access to care, particularly for our underserved communities. I am confident that, by maintaining our focus on existing programs and reinforcing our efforts to assist vulnerable populations, we can once again turn the tide on substance misuse in the state.”
The Opioid Operation Command Center has placed increased emphasis on addressing the disparate impacts of substance misuse on different racial/ethnic, age, and gender groups. “The pandemic has shown us that addressing opioid issues in our minority communities must remain one of our highest priorities,” said Lt. Governor Boyd K. Rutherford. “We are using new and existing initiatives to help us make the most of our efforts in these communities by delivering assistance in more efficient, strategic ways.”
Efforts to Address Racial Disparities. Lt. Governor Rutherford is creating a racial disparities workgroup under the Inter-Agency Heroin and Opioid Coordinating Council. The group will be chaired by Dr. Aliya Jones, MDH’s Deputy Secretary for Behavioral Health, and Dr. Noel Brathwaite, Director of the Office of Minority Health and Health Disparities. Membership will include stakeholders from state and local governments and community organizations. The group will study racial disparities related to the impacts of the opioid crisis and the availability of substance use disorder (SUD) services with the goal of developing policy recommendations to address such disparities.
The Governor, Lt. Governor, and the OOCC are pleased to announce in the Governor’s forthcoming budget a $3.5 million grant to the Center for Urban Health Equity housed at Morgan State University (MSU). MSU will use this funding to develop innovative methods to address health disparities by training researchers and engaging underserved communities to identify and solve a variety of health issues, including substance misuse. Members of the state disparity workgroup will partner with members of the center to address disparities in substance-related fatalities.
“We are proud to partner with the State of Maryland on this important issue,” said Dr. David Wilson, president of Morgan State University. “Leveraging the expertise of our world-class faculty and researchers in collaboration with government partners to address minority health disparities is central to the mission of the Center for Urban Health Equity.”
Maryland has already made encouraging progress in its efforts to expand access to behavioral health resources for vulnerable populations throughout the pandemic. A recent report from the federal Substance Abuse and Mental Health Services Administration showed that Maryland ranked third among U.S. states for increasing access to Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) for vulnerable populations, including those with co-occurring substance use disorders, though the SSI/SSDI Outreach, Access, and Recovery (SOAR) initiative. Eligible adults and children who are experiencing or at risk of homelessness can access SUD and other services through SOAR. Maryland’s efforts under SOAR include a pilot program established by MDH’s Behavioral Health Administration (BHA) to coach case workers in Montgomery County on processing SSI/SSDI applications more efficiently.
Additionally, the OOCC is working with jurisdictional Opioid Intervention Teams to promote adoption of the Opioid Screening and Treatment in Correctional Settings program, which was developed through HB116 in 2019. The program was created to decrease the number of fatal overdoses experienced by individuals involved with the criminal justice system, a disproportionate number of whom are minorities. The program requires correctional facilities to assess each inmate for mental health and substance use disorders and to provide access to FDA-approved medication assisted treatments (MAT) for opioid use disorder. The Governor’s Office of Crime Prevention, Youth, and Victim Services and BHA have begun working with local jurisdictions to implement the provisions of the program. So far, over half of the jurisdictions in the state offer some form of MAT in correctional facilities, while a greater number of jurisdictions offer an equivalent form of outpatient treatment to former detainees.
Grant Programs. This summer, the OOCC provided $9.6 million in grant awards through its fiscal year 2021 Block Grant and Competitive Grant programs. The grants support a broad range of programming across the state that is aligned with Governor Hogan’s policy priorities of Prevention & Education, Enforcement & Public Safety, and Treatment & Recovery. The funding is part of a $50 million, five-year commitment that the Hogan-Rutherford administration announced in 2017.
OOCC grants support several organizations focused on addressing racial disparities, including Paul’s Place, Charm City Care Connection, and the Johns Hopkins Bloomberg School of Public Health SPARC Center. These organizations work with underserved communities to provide services such as mobile health clinics, nutritional assistance, case management, and naloxone distribution. Their work focuses on understanding the everyday realities faced by people who use drugs and building trust to encourage treatment and recovery.
Maryland was also recently awarded nearly $51 million through the State Opioid Response II program. These federal grants will be used to increase behavioral health services for youth and young adults, expand the behavioral health workforce through partnerships with historically black colleges and universities and the University of Maryland School of Social Work, and enhance Maryland’s crisis helpline, Call 211, Press 1.
Ongoing Efforts. The third quarter report provides an update on the state’s progress in implementing Maryland’s COVID-19 Inter-Agency Overdose Action Plan, which was developed this summer to address the initial effects of the coronavirus pandemic. The plan outlines several strategies, including increased access to telehealth services, which allow individuals to receive SUD treatment while avoiding the risks associated with in-person care, and targeted mail distribution of the life-saving opioid antidote naloxone through authorized overdose response programs. The state is also working to increase availability of test strips that alert users to the presence of the potent opioid fentanyl, and BHA has developed a surveillance system that can detect abnormal increases in overdose deaths at the county-level and can help officials direct resources accordingly.
“We must not forget that we have been successful in flattening the opioid curve in our state before,” said Steve Schuh, executive director of the OOCC. “That experience provided us with an entire inventory of programs that we are adapting to our new realities. We have a community of treatment professionals and advocates who stand for the interests of those who are suffering. And we have the knowledge and will to bring these elements together as we continue to respond to the situation at hand.”
Before It’s Too Late is the state’s effort to bring awareness to the opioid and substance use crisis and to mobilize resources for effective prevention, enforcement, and treatment. Marylanders struggling with a substance use disorder can find help at BeforeItsTooLate.Maryland.gov; through our state’s crisis hotline, Call 211, Press 1; or by texting their ZIP code to 898-211.