Maryland is in the grip of a growing, lethal wave of heroin use. Marylanders have struggled for a long time with heroin use, especially in the Baltimore area. Heroin use has always been dangerous, and now Maryland’s addiction and overdose rates are some of the highest in the country.
In recent years, heroin use in Baltimore has intensified. It has also spread to rural parts of the state unfamiliar with large-scale addiction, places like the Eastern Shore and Appalachia.
In 2016, a total of 1,212 Marylanders died with heroin in their system, a 62 percent increase from the year before.
Since the start of the 2010s, drug traffickers across the United States have started to make inroads into areas outside major cities. Suburbs, townships, and rural areas are now sites for serious drug trafficking. Maryland is no exception to this trend.
Heroin use has boomed in Maryland’s small towns and rural areas. Eastern Shore and Appalachian counties have all seen fatalities related to opioids double or triple between 2015 and 2016.
As a result, according to a joint University of Maryland and Washington Post poll, three in ten Marylanders know someone who is struggling with opioid addiction. The percentage of Marylanders who know someone struggling with drugs is highest in and around Baltimore and in rural areas.
The surge in heroin and opioid use in rural areas is connected to the boom in opioid prescriptions and sales during the 1990s and 2000s. In those decades, drug companies aggressively marketed prescription opioid painkillers, and doctors began to prescribe the drugs in increasing amounts.
Maryland still has more prescription painkillers than it needs. Marylanders filled 7.3 million opioid prescriptions during the first ten months of 2016. Many of those prescriptions were written in rural areas. Maryland’s rural areas have economies based in industries that require strenuous manual labor, such as logging, farming, and fishing. Workers in those industries often require pain treatment, so small towns in rural areas have a surprisingly large supply of opioids.
A large prescription opioid supply leads almost directly to a large demand for heroin. According to the CDC, three in four heroin users previously had a prescription opioid habit. When dealers spread their networks to the small towns, they discovered a ready-made market for heroin. According to the state health department, the increasing number of prescription opioid-related deaths is largely a result of the use of these drugs in combination with heroin or fentanyl.
Baltimore also has a serious heroin crisis. In fact, heroin use in the city is so prevalent that some observers have called it the heroin capital of the United States. Large numbers of Baltimoreans — estimates range between 21,000 and 60,000 — use heroin. According to the DEA, that’s the highest heroin use rate of any city in the country. The city’s heroin problem is longstanding, according to the local DEA director, Tom Carr, who said in an interview with ABC News, “It’s an old heroin town. There is an appetite for heroin in Baltimore.”
However, heroin use in Baltimore has become far more common, and far more fatal, in recent years. The opioid prescription wave hit Baltimore in much the same way as it did rural areas of Maryland, with some prescription drug users eventually starting to use heroin. The difference is that Baltimore already had a large population of heroin users. That’s why Baltimore has seen frightening numbers of heroin-related deaths.
In 2016, Baltimore City and Baltimore County were the sites of a combined 662 deaths related to heroin, 180 of which were related to prescription opioids and 601 related to fentanyl. Some overdose victims overdosed on a combination of these drugs or others.
The last drug on that list, fentanyl, is a significant reason for the 44 percent increase in Baltimore heroin deaths between 2015 and 2016, according to public health officials. Fentanyl is a powerful synthetic opioid — one of the most powerful regularly administered to humans. It is used for extreme cases of pain, such as with late-stage cancer.
Fentanyl is extremely dangerous and is the main cause of the spike in Maryland drug deaths between 2015 and 2016. The number of Marylanders who died with fentanyl in their body in 2016 was 1,119 and 58 percent of Marylanders who died from heroin overdose that year also had fentanyl in their system.
Increasingly, heroin dealers ship fentanyl into the United States from China or Mexico then mix it with heroin, or they perform the same process in Mexico before shipping the drug cocktail across the border. Fentanyl is cheaper than heroin to manufacture because it’s entirely synthetic and because its precursors can be bought legitimately. Also, since it’s potent, a little bit goes a long way and can boost a weak heroin shipment.
A heroin-fentanyl mix is almost guaranteed to cause an overdose, even in people with a high tolerance for opioids. Fentanyl is so concentrated that a dose as small as three milligrams can be lethal.
Now, fentanyl is a mainstay of Maryland’s heroin supply, often with fatal results.
Health care workers and first responders help their fellow Marylanders struggling with opioid addiction. Frequently, that assistance involves administering naloxone, a drug that revives people experiencing an opioid overdose. All Maryland first responders now carry the drug with them.
Retired Baltimore police officer Timmy Hall reported reviving the same people multiple times. In an interview with PBS NewsHour, he called naloxone a “great tool,” but said it was limited to first response. Even though the drug can save the life of someone who has overdosed, it can’t cure the underlying addiction.
The only way to end Maryland’s heroin epidemic is to get everyone who is struggling with addiction the help and treatment they need when they are ready for it. Maryland has taken some encouraging steps in that direction. Gov. Larry Hogan declared a state of emergency in 2017 that will make more funding available for treatment and first responders.
For the deaths to slow and, eventually, stop, Marylanders must work hard to get their neighbors into treatment and help them maintain their recovery when they get out.