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Opioid and Heroin Legislation

On April 10, the Maryland General Assembly passed several bills addressing the ongoing statewide crisis of opioid addiction. Amongst the bills discussed both the Start Talking Maryland Act, HB1082, and the Heroin and Opioid Prevention Effort (HOPE) Act, HB1329, were passed. The Start Talking Maryland Act would require schools to have defined education programs on opioid addiction. According to the House Bill’s preamble of February 2017, Maryland is the fifth best state for public education. Maryland is also the fifth worst state in the country for heroin and opioid related deaths. This bill will create the proper discourse for the state’s communities to acknowledge the existence of this problem in our very own backyard. Due to many addictions beginning in the teenage years this bill will promote advocacy of terminating that problem through education. The HOPE Act would increase access to naloxone, an overdose-reversal drug and would require hospitals to establish a new protocol when discharging and assisting patients treated for substance abuse disorders and mental health. It also introduced Keep the Door Open, a provision that provides three years of funding to reimburse community health providers. The act also requires the Behavioral Health Administration to establish a crisis treatment center before June 2018. Another opioid related bill passed by the General Assembly was HB1432, which places a restriction on the dosage and quantity of an opioid painkiller which is dependent upon a certain disorder or certain pain. This bill will prevent overdose deaths in both opioid and heroin abusers. While SB539 was a bill passed to set new penalties for distributing fentanyl leading to the death of another person with the exception of death due to medicinal distribution. The opioid-related legislation had been sent to Maryland Gov. Larry Hogan’s desk for his signature. The governor had until May 30 to either sign or veto the 900 bills passed by the General Assembly; otherwise they automatically became law. On March 1, Hogan signed an executive order, declaring a state of emergency in response to the heroin, opioids and fentanyl crisis “ravaging communities in Maryland and across the country.” Hogan urged Marylanders to treat this crisis like they would any other state emergency. The final numbers for 2016 were expected to show that approximately 2,000 people died from heroin and other opioid overdoses in the state over the last year, about double the number of deaths in 2015. In reality 1,119 deaths were the result of fentanyl intoxication, 418 deaths were from prescription opioids directly, heroin intoxication resulted in 1,212 deaths. Additionally, drug overdose deaths rose by 19.2 percent from 2013 to 2014 in Maryland, according to a press release from Sen. Ben Cardin, D-Md. In an interview with Capital News Service, Cardin didn't question the obvious spike in opioid usage. He said Maryland numbers are a reflection of what’s seen around the nation. Both Cardin and Sen. Chris Van Hollen backed passage of the 21st Century Cures Act and the Comprehensive Addiction and Recovery Act of 2015 (CARA). Van Hollen was a cosponsor for the 21st Century Cures Act. The 21st Century Cures Act was signed by President Barack Obama in December 2016. It will provide $1 billion over two years for state grants to support opioid abuse prevention and treatment activities. CARA, a bipartisan bill, was signed into law by Obama in July 2016. CARA assists drug-dependent newborns and their parents.The federal Department of Health and Human Services awarded Maryland a $10 million grant under the 21st Century Cures Act. Despite the grants being small, Rep. John Sarbanes, D-Towson, said they were an encouraging step toward addressing the opioid crisis. He was among those who pressed for the funds in the law. “But to make real progress in our effort to combat the epidemic, it’s the responsibility of Congress to provide additional resources to programs, families and communities in Maryland and across America that are working day in and day out to end the crisis.” Van Hollen said there is more to be done with the crisis, including “protecting the significant investments made by the Affordable Care Act, and ensuring institutions like the National Institute for Drug Abuse at NIH in Maryland and others across the country have the resources necessary to carry out their critical missions.” On March 29, President Donald Trump signed an executive order creating a presidential commission designed to combat opioid addiction and the opioid crisis nationwide. New Jersey Gov. Chris Christie is leading the commission. A main reason for the doubling of overdoses for Maryland has been a new street drug, fentanyl, a powerful Chinese imported synthetic opioid that dealers are increasingly blending into regular heroin and selling cheaply. The senator added that there also is work to be done with Mexico to stop heroin from flowing from that country. “We’ve seen an abuse of using these drugs for pain and an abuse of people selling these drugs on the street and getting people addicted,” Cardin said. “There are things we can do to dry up the supply and help people who have addiction and health issues.” In response to the rise in drug-related deaths, Hogan announced on March 1 that he has budgeted an additional $10 million per year to combat overdoses over the next five years. Carin Miller, whose son began abusing heroin at 19 years old, said Hogan’s action would help, but more money is needed from the federal government. Miller is no stranger to opioid abuse as well. She said her husband, Greg Miller, had been abusing opioids since the late 1990s after he was hit by a drunk driver and had an additional, separate accident at work. It reached a point where her husband’s withdrawals were so terrible that he almost died after being denied narcotics prescriptions at Frederick Memorial Hospital six years ago, Miller said. “I was trying to get my husband off the pills, never thinking that my own kids would go on them after they saw the hell that I was put through,” Miller said. Three years ago, Miller co-founded Maryland Heroin Awareness Advocates (MHAA), a grassroots organization in Frederick. It was founded “out of necessity,” by a group of women from Frederick in order to save their children from the opioid and heroin epidemic, Miller said. “We have all been affected in some way, a lot of my colleagues have lost their children to overdoses,” said Miller, who is the president of MHAA. Miller noted that there is not enough education about these drugs in schools. While one of her colleagues is invited into middle and high schools in Carroll County to give presentations, MHAA is “just nipping the bud” at giving presentations in Frederick County, Miller said. Frederick County is a 40,000-student district with 10 high schools. Mike Maroke, Frederick County Public Schools deputy superintendent, said Principals have autonomy over the issues discussed in schools. Now that the Start Talking Maryland Act has signed by Hogan, it would require schools to have opioid education programs, possibly through presentations such as MHAA’s. After one presentation at a school, Miller handed out index cards to the students, ranging from seventh to twelfth grades, and asked for their feedback. She recalled what happened next: “One little girl came up to me and handed me her card and it said ‘Thank you for coming out and telling us about drugs because I wouldn’t want to lose any friends because my dad died a couple of months ago from a heroin overdose.'”

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