BERLIN — In February of 2015, just months after being elected to office, Maryland Gov. Larry Hogan issued an executive order to create the Heroin and Opioid Emergency Task Force. That task force was chaired by Lt. Governor Boyd Rutherford, and after months of research and deliberation with health officials, law enforcement and experts across the state, Rutherford’s taskforce released the final report last December.
In the opening lines of that report, Rutherford said that he and Hogan heard countless tales on the campaign trail of the spread of heroin and opioid addiction and how it was wreaking havoc on the state’s communities.
The report recommends a multi-prong approach with 10 funding announcements with seven allocations to the Department of Health and Mental Hygiene aimed at improving access for treatment and rehabilitation and three significant grants to the Governor’s Office of Crime, Control and Prevention to support law enforcement efforts, including $124,635 to fund license plate reader technology at the north end of Ocean City (it’s already in place at the Routes 50 and 90 entrances to town).
Since the report’s release, Hogan and Rutherford have continued to keep the battle against opioid addiction as a high priority, and Rutherford spoke with The Dispatch this week in a phone interview about what he calls the state’s holistic approach to heroin addiction.
Q: First off, tell me about the report’s findings and how that translated into the additional funds ($2 million in FY 2016). Also, speak to how those funds have been used to combat this epidemic in our state?
A: It’s hard to really pinpoint anything in terms of utilization of funds or even our efforts to address the issue because the problem continues to grow. The main thing that we were able to accomplish is increasing the awareness in terms of this being a problem that affects all of Maryland’s communities: every county, every jurisdiction.
We focused a lot on prevention and awareness. We have to stop that pipeline of new users. We were able to provide funding in the 2016 budget, particularly for the Whitsitt Center, which is a rehabilitation center run by the state in the Upper Shore area. That was something that we could do immediately and that’s why we put it in the interim report, as well as providing some grant funding on the treatment side as well as some assistance for law enforcement. Those were things we could do immediately rather than waiting for the final report, in terms of getting things out there and to start the process of trying to address this problem.
Q: In the report, you say the aim is to take a holistic approach, focusing on treatment, education, criminal justice, overdose prevention, and offender re-entry. However, heroin isn’t a new problem in our state, it’s just a problem that is getting much worse than it ever was before. So, tell me where the system was lacking and where you believe this holistic approach will make the most impact?
A: The difference between the traditional heroin usage in the state that has long been the case, particularly in Baltimore, is that it was somewhat a ‘back alley’ or ‘other side of town’ problem. The difference now is the new users, as high as 70 or 80 percent of the new users, did not come into heroin through the traditional means. The traditional heroin user didn’t start with just heroin, they started with some other drug or alcohol.
But, 70 to 80 percent of the new users are coming off of prescription medication. That’s where we are seeing the big surge that’s going on. So, the gap or flaw in the system with regard to the new users was not understanding early enough how addictive these pills were: these pain relievers that are based on opium. So, when states and the medical community started figuring that out and the states started coming down on these illegal dispensaries or ‘pill mills’, people started turning to heroin. Somewhere along the line, they were introduced to heroin as something that was cheaper than buying the oxycontin on the street and it was also more powerful. And in some cases, many of those people were taking those medications at the direction of a doctor, so they didn’t think there was a problem. We still had some of the heroin users, particularly the younger heroin users, some of them have come to the drug through traditional means, but many have come off of getting prescriptions legally and then found themselves addicted and then gone to harsher drugs like heroin.
Q: We’ve seen this trend and how that has turned into these staggering statistics. Since 2010, the number of Marylanders who have died of heroin overdoses has more than doubled. In 2014, then number of people who died of heroin overdoses in the state was actually higher than the number of people who died in car crashes. In the first half 2015, 340 people died of heroin overdoses, compared to 293 during the same time period in 2014.
Yet, there is a debate about where the focus should be on the issue in order to bring those numbers down. Some say it’s a police issue, while others say it’s more of a public health issue. The debate surrounds where the focus should be in order to make the most difference. Obviously focusing on the police side of it could stop the supply, but some say the public health side of the debate could curb the demand. Where do you stand and where do you think the focus should be?
A: We did look at the treatment side and the prevention side: working with those who are already addicted and trying to cut down on the marketplace. But, we also looked at law enforcement and took it very seriously.
The distinction that we like to make is the distinction between the user and the person who is selling, particularly the people who are trafficking. We want to go after the people who are trafficking but treat those who are addicted. Now, one of the things we did in regards to the traffickers, we called for a state version of the RICO (Racketeering Influenced and Corrupt Organization) statute in our report. That is intended to go after the criminal organizations so that not only can we go after their money in terms of civil penalties, but also we eliminate those jurisdictional lines; whereas, the prosecutor in Frederick County can go after drug dealers in Baltimore City because they are part of an illegal organization or a criminal gang.
That was one of the things that we were able to get through the legislature to assist the State’s Attorneys with regard to this type of prosecution. I think there’s a balance, and we are making a distinction between the users and those who are selling and trafficking this poison.
Q: As you well know, Maryland is a very diverse state. Much of the population lives in the state’s more urban or suburban areas, while the majority of the landmass of the state is extremely rural. Tell me about the differences between heroin’s proliferation and the enforcement and treatment of that proliferation in the urban communities versus our rural ones, such as here on the Eastern shore?
A: The challenge in the rural areas is really two-fold.
There are less facilities and because of the landmass and less density issue, where we have facilities in rural communities, be it the Eastern Shore, the Western Shore, or even Southern Maryland, people have to travel longer distances to get treatment or get the kind of services that they need. In urban or suburban areas, the distance is not as far and there may be public transit that can assist you in getting to these locations. Another issue that we have to confront with regard to the rural areas is making sure we have a sufficient number of treatment professionals in those areas as well.
That’s an overall challenge with regard to healthcare both on the fiscal side, particularly on mental health, because mental health and drug addiction often go hand in hand. Many of the users that we find either have a pre-existing mental health issue or they develop one from using these drugs. They call it co-occurring symptoms, so that’s one of the challenges we have in rural communities.
Q: Let’ s talk resources. Funding for long-term treatment of heroin addiction is the answer I hear the most when I ask people what is missing in this battle against heroin addiction. They say the ’28-day model’ of rehab is not nearly enough to combat this disease, and critics of the state’s stance on the use of methadone as a treatment option say methadone is just as addictive and worse to withdraw from than heroin itself. Outline the state’s stance on methadone and the strategy to address long term treatment in the coming years.
A: We talked a lot about quality of care, and when we mention quality of care, we are talking about the whole idea of treatment. When people hear treatment, they automatically assume that it’s in-patient for some amount of days. You mentioned 28 days, and that’s pretty much a standard that a lot of the insurance companies will pay for. In some cases, 28 days will work, and in other cases, it won’t work at all. Treatment doesn’t necessarily mean that a person needs to go to an ‘in-bed’ or ‘in-patient’ setting. They could be out-patient and have sufficient treatment for their particular addiction or issues. So, we have to make a distinction between those two, but it is all based on a thorough assessment of what that person needs. One of the challenges that we have is that the individual needs to have mental health and emotional societal counseling as well. One of the issues is how do they deal with going back into their own community, back to an area where they used to use drugs and running into the same people they used to use drugs with. Is there an alternative for them not to go back?
Or if they did go through the 28-day in-patient program, is there, like in the criminal justice system, a halfway house or group home they can go to, to re-socialize themselves with the greater society before they go back into the community full-on? There was some funding that was put into the budget and proposed for that. Some of it came through okay, and some of it didn’t. We will continue to look at these step-down type of programs that help socialize people back into regular society.
Q: Let’s talk about the money and the funding for a moment. I went to a halfway house in Salisbury earlier this week. They say they don’t have the supply (number of beds) to meet the demand, and on top of that, they are struggling financially. That’s something I’ve been hearing from facilities like this all over the shore. The places that are available from a resource or treatment standpoint, are seemingly all struggling to meet the demand, which as we’ve been talking about, is rising. Talk about the administration’s plans as far as funding this fight. Have you and the governor talked about putting more money than you have already put toward this issue in future fiscal years?
A: Yes and we’ve had those conversations. As we start to really craft the budget, and that will start in late August or early September, we are going to be looking at ways to get more money into treatment and addressing that idea of quality of care. So, yes, it will be one of the key things that we are going to be looking at moving forward from a budgetary standpoint.
Going back to your earlier question about methadone, that was something that we had a lot of debate about whether it works or whether it doesn’t. There are some facilities that really run methadone clinics like mills. They are able to get paid through Medicaid and other sources to basically keep people just coming back. There are other facilities that use methadone as truly medically assisted treatment and they step the person down, giving them less and less, so they are no longer dependent.
The good part of methadone is that it allows someone to become functional and not be using heroin. The bad part is there are a lot of facilities out there that all they do is dispense it and they don’t try to provide the counseling or step the person down from the amount of methadone they are providing the person. There’s a challenge we have there, and we are looking into what we can do about that.
Q: You and the governor have certainly drawn a line in the sand and taken a very significant stand against the uptick in heroin abuse and addiction in our state. I’ve read articles where you have said that you believe there is much work to be done and I think everyone is in comprehensive agreeance of that. Yet, like we said earlier in this conversation, heroin has been a problem in our state and many other states for much longer than just the past few years when it started creeping into suburban communities and grabbed headlines for killing our neighbors children. Obviously, the question comes up: is this a battle that we can win because we haven’t won it yet? In your mind, how do we now when we have made progress, and furthermore, how do we know when we can actually say ‘mission accomplished?’
A: I don’t know if we can ever get to the point where we can say ‘mission accomplished.’ But, we will see progress if the amount of deaths and the amount of people in treatment go down. I think that is when we will know that we are making headway with this problem.
You are right, heroin has been a problem in this state for a long time, particularly in Baltimore. I grew up in Washington DC and there was a surge of heroin in the late 60’s and early 70’s, but then it died down. But, Baltimore has been known as a traditionally heroin town, and you can talk to any of the old timers and they will tell you that. We have to change the culture in terms of people looking for that type of escapism. There needs to be much more information that gets out to people at a younger age that it’s a dead end. So, I don’t know when we will be able to say mission accomplished, but we are just going to keep working at it.
(To listen to the entire conversation, click over to www.mdcoastdispatch.com/podcasts.)