Overdose Prevention in Maryland
Did you know? According to the U.S. Centers for Disease Control and Prevention, every day in the United States 105 people die as a result of drug overdose, and another 6,748 are treated in emergency departments (ED) for the misuse or abuse of drugs.
Drug overdoses have become a serious public health challenge in Maryland and across the country. In Maryland, the total number of overdose deaths has risen steadily since 2010, mainly due to the increase in heroin-related deaths. According to the Department of Health and Mental Hygiene, as it has become more difficult and expensive to obtain prescription opioids, people have switched to cheaper and more accessible heroin. To address these concerns and save the lives of Marylanders, a goal was set to reduce overdose deaths by 20% by the end of 2015.
Maryland’s state agencies have engaged in comprehensive, cross-agency efforts to reduce opioid overdose deaths. These efforts include educating the public and implementing new medical practices.
Governor Hogan, Lt. Governor Rutherford Establish Maryland Heroin And Opioid Task Force And Coordinating Council
On February 24, 2015, Governor Larry Hogan and Lt. Governor Boyd Rutherford announced the establishment of both the Heroin and Opioid Emergency Task Force and a separate Inter-Agency Coordinating Council. Both groups will work and support efforts to address Maryland’s growing heroin and opioid crisis. “For far too long, state and local agencies have worked in silos with little communication and less coordination,” said Governor Hogan. “The purpose of the inter-agency council and task force is to connect the dots of prevention, treatment, and recovery and maximize our resources and expertise to come up with real solutions to save and restore lives.”
In order to better understand the epidemic, Maryland has enhanced surveillance in the state through reports on drug and alcohol intoxication deaths using data from the Office of the Chief Medical Examiner. The more detailed and timely review of data allows the Department and local jurisdictions to identify patterns of overdose activity, which enhances public health responses and planned interventions at the state and local levels.
Opioid Overdose Prevention Plans
Maryland's overdose prevention efforts are rooted in the Maryland Opioid Overdose Prevention Plan, a statewide strategy for reducing overdose deaths related to pharmaceutical opioids and heroin. The plan's state goal is to reduce unintentional overdoses involving opioids, such as prescription painkillers and heroin. Released in January 2013, the plan includes components such as:
Enhancing overdose-related data sharing and analysis,
Improving access to substance use disorder treatment and recovery services,
Providing clinical education and training for healthcare providers,
Implementing the Prescription Drug Monitoring Program,
Broadening access to naloxone, and
In 2013, all Maryland counties and Baltimore City submitted local overdose prevention plans to the Department of Health and Mental Hygiene. Key themes in the plans include:
Promoting clinician education on opioid prescribing practices and use of the Prescription Drug Monitoring Program,
Outreach to populations at high risk of overdose,
Expanding access to medication-assisted treatment for individuals with opioid dependence,
Encouraging naloxone distribution, and
Increasing public awareness.
New Law Expands Access to Naloxone in Maryland
The Maryland General Assembly passed a law that went into effect on October 1, 2015 that will expand public access to naloxone. This law is composed of a few key components that directly impact providers:
- Physicians, advanced practice nurses, dentists, and other providers with prescribing authority can prescribe naloxone to any patient who is believed to be at risk of experiencing an opioid overdose or in a position to assist an individual at potential risk of an opioid overdose. This means that Marylanders can go directly to their provider to get naloxone and get educated on how to use it to save someone’s life.
- Prescribers are immune from civil liability for prescribing naloxone. The law protects providers from civil lawsuits when they prescribe or dispense naloxone to patients in good faith and according to statutory requirements. If your patient administers naloxone to someone believed to be experiencing an opioid overdose, they may be protected from civil liability under an existing state “Good Samaritan” law.
- Enhancements to the Overdose Response Program (ORP). The new law also enhances the Maryland Overdose Response Program (ORP), a public health initiative providing overdose education and naloxone distribution to community members across the state. The ORP has trained over 10,000 Marylanders since its launch in early 2014. The program provides free educational resources for training patients and other laypersons on responding to an opioid overdose with naloxone. Licensed physicians or advanced practice nurses with prescribing authority may issue a standing order to delegate the authority for dispensing naloxone to an ORP certificate holder that completes the DHMH authorized training.
Prescription Drug Monitoring Program (PDMP)
Fully launched in December 2013, the Maryland PDMP aims to reduce prescription drug misuse and diversion by creating a secure database of all Schedule II-V controlled dangerous substances (CDS) prescribed and dispensed in Maryland. The PDMP can make data on prescription opioids and other CDS available to healthcare providers, pharmacists, patients, researchers, health occupations licensing boards, and public health and safety agencies.
Overdose Response Program
Maryland’s Overdose Response Program provides for the training and certification of individuals to administer naloxone (Narcan®) based on their ability to assist someone at risk of dying from an opioid-related overdose when emergency medical services are not immediately available. The law enables opioid users’ family members, friends and associates to legally obtain a prescription for naloxone in their own name. The Department of Health and Mental Hygiene oversees the program and authorizes local health departments, community-based organizations, substance use disorder treatment programs and other health care providers to offer educational training programs and issue certificates to trained individuals.
Good Samaritan Law (Limited Criminal Immunity)
The Maryland Good Samaritan Law effective October 1, 2015, provides protection from arrest as well as prosecution for certain specific crimes and expands the charges from which people assisting in an emergency overdose situation are immune.
If someone calls 911 in an effort to help during an overdose crisis, or they are experiencing an overdose, their parole and probation status will not affected, and they will now not be arrested, charged, or prosecuted for:
- Possession of a controlled dangerous substance
- Possession or use of drug paraphernalia
- Providing alcohol to minors
Local Overdose Fatality Review Teams (LOFRTs)
Modeled on other mortality review teams and established as medical review committees, LOFRTs comprise multi-agency/multi-disciplinary members that conduct confidential case reviews of overdose deaths with the goal of preventing future deaths. Teams identify missed opportunities for prevention, gaps in the system and areas for increased collaboration among agencies and stakeholders at the local level, and make recommendations for policies, programs or laws to prevent overdose deaths and to inform local overdose prevention plans. The Department of Health and Mental Hygiene currently provides overdose death records and technical assistance to teams..
Passage of HB 1282 in 2014 establishes LOFRTs under Maryland law and allows any jurisdiction to establish a team. The bill creates team structure and processes; includes provisions governing data collection, maintenance and reporting, including confidentiality and agency disclosure requirements; and provides immunity from civil liability to team members participating in good faith and to persons providing information to LOFRTs. Teams established under the bill may advise the State about changes to law, policy, or practice on preventing overdose death.
CDS Emergency Preparedness Plan
The Department of Health and Mental Hygiene has partnered with pain management specialists at the University of Maryland School of Pharmacy to develop and implement a plan to respond to the abrupt cessation of CDS prescribing and/or dispensing (e.g. due to prescriber loss of license) in a local community. The emergency preparedness plan focuses on working with the local health department and healthcare providers to mitigate risks to affected CDS patients and the surrounding community by assisting with patient triage and facilitating their transition to appropriate care.