Growing Heroin Issue in Montgomery County
By S. Alexandra Tuttle
“Heroin overdoses are on the rise! Opiate abuse is rampant,” scream the headlines.
Indeed, the US Department of Health and Human Services, Centers for Disease Control and Prevention, note that “drug poisoning deaths involving opioid analgesics has leveled in recent years, but the rate for deaths involving heroin has almost tripled since 2010.” (NCHS Data Brief, No. 190, March 2015). Heroin is easier to obtain, thanks in part to “our open border policy.”
In a press release on September 22, 2016, the Maryland Department of Health and Mental Hygiene (MD HHS) posted from January to June, 2016, 920 deaths related to overdose, 319 more than this point last year” (https://goo.gl/oNlvlz). Currently, Maryland ranks 5th in the nation, as it sees “heroin deaths triple,” according to The Washington Times. A November, 2015 memorandum noted that Montgomery County had experienced more than 18 heroin related deaths (which may be cut with fentanyl and other chemicals) (Heroin Trends in Montgomery County, Maryland, 11/20/15).
This does not include the number of nonfatal overdoses, which was higher. Montgomery County police and other first responders are trained to use Naloxone/Narcan, an opioid antagonist to counter the effects of an overdose.
Simply put, opiates/heroin affects the “opioid receptors in the brain and disrupts endorphin production sent out to the rest of the body. This action creates intense euphoria while suppressing physical pain and is the reason why heroin also acts as a pain killer for the body. But heroin’s effect on the brain leads to physical and psychological dependency on the drug.” That is, over time, the body feels it needs heroin in order to function, and the mind cannot live without it (addiction).
As an Emergency Room psychiatric social worker, I have seen my share of heroin addicts (patients) seeking to ‘get off heroin,’ or detox in recent years. The agitation, shaking, sweating, nervousness, nausea and discomfort are apparent, along with the irritability as they await their assessment. Once it is determined that they are not suicidal, they will not be admitted for detox – instead they will be turned away. Their frustration is palpable. Sometimes, when I return, the patient seems fine – more often because they have just injected heroin – in the hospital.
An addict may come to the hospital, having made the decision to withdraw from heroin, only to find few options available. When they are at this point, most of them do not have commercial insurance (for whom more options are available), but rather Maryland Medicaid, or no insurance at all.
When this is the case, I refer them to the Avery Treatment Center, which offers inpatient detox, requiring Montgomery County proof of residence (or Maryland Medicaid) for a 21-28 day stay, after an assessment over the phone. A person seeking to withdraw from heroin most likely will have to wait up to two weeks – in which case they will likely continue to use. Hopefully, “they will be available,” when a spot opens up.
It is difficult to refer those people to outpatient providers who can prescribe what can be best described as more safe substitutes for heroin – suboxone or subutex to help them through the withdrawal process which can last days, sometimes longer. Those appointments, too, are hard to get. And, most prescribers, who must be certified to prescribe, don’t take Maryland Medicaid.
Fortunately, Governor Hogan has made this issue a priority early on. Indeed, the MD HHS is expanding access to Screening, Brief Intervention and Referral to Treatment (SBIRT) to identify individuals who have the potential for substance abuse and provide medical intervention, which should ideally include non medication alternatives such as auricular (ear) acupuncture and includes Montgomery County in its treatment area.
In 2015, MD HHS cosponsored a ‘Scope of Pain,” seminar to help providers manage their patients’ chronic pain issues while decreasing potential addiction to opioids. To that end, all providers and pharmacists will have access to their patient’s history of prescribed medications by July, 2017.
However, there are many competing needs in the state of Maryland. Is appropriating limited taxpayer dollars towards this issue going to make a difference? What are the tangible and intangible costs of acting or not acting? For example, AA and NA don’t receive taxpayer dollars and have helped a lot of people.
Fast forward: Why should we care? At one time, they might have cavalierly been referred to as the ‘throwaways’ in our society. Today, those ‘throwaways’ are in our back yards – they are the child of a family friend, or your next door neighbor, or even worse, your family member. What could have started out as prescribed pain pills (opiates) for a pain management issue can evolve into a heroin addiction. In sum, “there but for the grace of God, go I.”
Hopefully, 2017 will be a better year.