“We want to take our role very seriously,” Bayless said. “We know that the medical community, health care systems, hospitals, have been part of the problem, and we also need to be very deliberate about being part of the solution.”
Bayless said work over the years have included the development and implementation of Safe Stations, the creation of designated drug drop-off locations as well as naloxone training and overdose survivors outreach ser vice programs.
In Baltimore City, Health Department Senior Advisor Dr. Shelly Choo said more than 35,000 residents had been naloxone trained, saving 1,500 lives. Choo said the city is using a three-pillar approach to combating the epidemic.
Addressing the overdose deaths, the department educates the community about using naloxone, something Choo said everyone should have in their medicine cabinet, like Tylenol or Advil.
The second pillar, realizing naloxone alone isn’t the solution, is working to increase on-demand access to treatment. Programs using medication assisted treatment combined with psychosocial counseling coupled with wrap-around services have been shown to help patients recover and decrease mortality rates, she said.
The third pillar is fighting the stigma of addiction using science and evidence to show that addiction is a disease “rather than a moral failing or a crime.”
Cardin said he didn’t believe the opioid epidemic had reached rock bottom as overdose deaths continue to increase, mainly from the introduction two years ago of the dangerous chemicals fentanyl and carfentanil.
Cardin said many times people become addicted to opioids through legal prescriptions that they do not handle correctly. Once the prescription medication becomes unavailable or too expensive, users move on to heroin, which is less expensive. Cardin said the drug dealers have found fentanyl less expensive than heroin and have started cutting their product with the deadly chemical.
“That cycle is still continuing and needs to be stopped,” he said.
Part of the strategy to address those issues, Cardin said, is to have proper medical protocols on how to handle pain. By reducing the number of pills prescribed or by finding alternative pain-reduction methods, the number of people getting addicted will lessen.
Cardin said despite cooperative programs with the Mexican government, drug cartels are still finding ways to get the illicit drugs into the United States for distribution. He said the cartels are operating with impunity in Mexico and that more needs to be done to address the inflow of drug activity.
On a positive side, Cardin said the Medicaid program covers behavioral health and addiction, as does the Affordable Care Act, so reimbursement is available for some programs individuals enter. Cardin also said as much as $10 billion has been allocated in the federal budget to address crisis. He said the entire federal delegation supports these efforts.
One of the major challenges in reaching addicted patients is reaching them when they are attentive. If someone goes to the emergency room at 3 a.m. with an issue and no follow up is conducted, the discharged patient is “likely to be returning to the hospital or worse, probably killed by an overdose.”
Finding programs that meet the needs of the specific community is essential, Cardin said, stating different programs work in different areas.
In Anne Arundel County, the creation of Safe Stations within the past year has aided more than 500 people get treatment and has a 58 percent success rate of keeping people sober, said Jen Corbin, leader of the public crisis effort in the county. The Safe Stations program is run through the mental health agency in Anne Arundel County.
One challenge patients find in getting treatment is the amount of time it takes to get into a program, so Corbin and her team have come up with creative ways to find a patient a safe space to be located until whatever treatment is needed can be obtained.
All day every day, people using can present themselves to a fire or police station in the county which will then reach out to the crisis team that will follow the person through “the whole spectrum.” Corbin said it is essential to not just find the person the help they want but to stay with them throughout the process. Those individuals follow the patient as they enter a recovery house, find employment and aid in tasks like writing a resume, she said.
Funding can be an issue, Corbin said, as patients exit treatment having not worked while getting sober and need to pay for food and rent. As the program is grant funded, more money allocated for grants was recommended.
Corbin said inpatient services are important but they are only a small piece to sustaining longterm sobriety for an individual, stating the need for more support services after inpatient care.
Having the fire and police stations open up their doors as a hub when patients are ready to seek treatment is important, Corbin said, because it reduces the number of people going to the emergency room. Once a person enters the station, personnel contacts the crisis system’s “warm line,” which operates all-day, every-day, and someone is dispatched immediately to assess and move the individual to a safe place.
The crisis team then makes phone calls to place the individuals need to screen for treatment, and transports the individual to the treatment facility. Because the county has a larger crisis system, Corbin said, care coordinators visit the patient during treatment and aid in finding further placement opportunities.
Other counties in Maryland have begun creating Safe Stations with the help of Anne Arundel County personnel.
Queen Anne’s County Sheriff Gary Hofmann said continuing to fund grants that can be used to create Safe Stations would be beneficial for his department and community. Hofmann said the sheriff’s office is open for individuals to come in to receive help, “but treatment on the Shore is very, very difficult for us to get.”
With only “a small emergency room,” Hofmann explained how first responders many times rely on area hospitals and services, despite rural health improvements being made.
One issue Hofmann told the roundtable his department has encountered is residents administering Narcan to an individual overdosing but not informing the 911 system or emergency services.
Hofmann also shared how the department has tracked drug dealers down and sent a message to anyone selling illicit substances that the office will “hunt you down.”