Substance Abuse Trends in Maryland

In 2016, Maryland saw a frightening spike in drug-related deaths. That year, 2,089 Marylanders died from drug-related causes, a 66 percent increase from the 1,259 Marylanders who died in 2015.

Maryland’s state medical examiner’s office may lose its accreditation because the office has struggled to clear overdose death autopsies in the time required by professional standards. Governor Larry Hogan declared a statewide public health emergency because of the drug crisis in early 2017.

The crisis is mainly driven by a drastic increase in opioid use — particularly heroin and fentanyl — in Maryland. Baltimore has historically had a substantial population of heroin users and durable drug dealing networks. Since the turn of the century, dealers in those networks have continued to expand their operations to the suburbs and rural areas of the state.

As a result, the Eastern Shore and Appalachia have seen significant increases in overdose deaths. Those deaths have shocked and devastated communities that, until recently, hadn’t seen drug use on such a scale.

The expansion of drug networks has also brought increasing amounts of cocaine into the areas outside Maryland’s cities. More and more opioid users have begun to mix cocaine with heroin, fentanyl, or prescription opioids. This combination, known as a speedball, has been common for decades, but its recent rise in use is proving deadly.

Alcohol deaths have also begun to increase in Maryland, where dangerous drinking is on the rise.

All of these trends in combination have caused a great deal of stress to Maryland’s emergency workers. Firefighters and EMTs are the first responders for many overdoses. They’ve seen a staggering number of deaths in recent years. First responders suffer from PTSD more often than the civilian population, and many cope with mental health issue by self-medicating with substances.

Drug Trafficking in Maryland Expands Outside Baltimore

Maryland’s drug trafficking organizations are well-established, especially in Baltimore and the Washington, D.C., area. Drug trafficking networks put down roots in Maryland in the 1980s, a time when crack cocaine became a lucrative business. Drug dealers also sold heroin in Baltimore on a fairly large scale going back to the 1950s. However, those 20th century drug trends pale in comparison to the scale and scope of the current wave of drug use. During the 2000s, drug dealers began to expand their operations outside Baltimore and Washington. Illicit drugs such as heroin and cocaine are now available all over the state from networks of dealers, some of which started in the crack trade but expanded their operations to meet growing demand for heroin. According to the U.S. Drug Enforcement Administration, most of Maryland’s illicit drug supply originates in Mexico. It arrives overland from the southwest border or via ship or plane from ports in the New York area. The Sinaloa cartel controlled most of Maryland’s wholesale drug supply in 2016.

Opioids Overprescribed in Maryland

Starting in the 1990s, prescription drug use began to rise all over the United States. The pharmaceutical industry successfully lobbied legislators and medical associations to make pain pills more available than they previously had been. Maryland was no exception to this trend. As in the rest of the country, prescription pain medication began to flood parts of the state where most people work in industries heavy on manual labor. Those working-class suburbs and rural communities are where the opioid crisis has taken the strongest hold. The Eastern Shore now has large-scale drug use, as does Appalachian Maryland. Allegany County borders West Virginia, the state with the highest overdose death rate in the country. Powerful prescription drugs can now be found in the homes of many Marylanders. In October 2016 — well before the year was over — Marylanders had already received more than 7 million prescriptions for opioids, or more than one prescription for each resident. That massive supply of drugs has yielded two new groups of people who misuse opioids. The first group is pain patients who have become dependent on the drugs. The others are people who have tried opioids out of curiosity and become addicted.

From Prescription Opioids to Heroin

The prescription opioid wave is a primary reason for heroin deaths tripling in Maryland commuter towns between 2007 and 2016. Within that time period, 4,927 Marylanders died with heroin in their system. Baltimore, which is notorious for heroin, is no longer the only place in the state where people use heroin in large numbers. People who misuse prescription opioids sometimes start using heroin and other illicit opioids. Someone who has developed a prescription opioid dependency will eventually struggle to maintain their habit when doctors and pharmacists stop writing and filling prescriptions for them. Prescription opioids are also far more expensive than street drugs. People with substance use disorders have a harder time getting their fix, so crime rates such as theft and robbery inevitably rise. The scope of the heroin wave is hard to comprehend. In 2016, there were 662 heroin overdose deaths in Baltimore City and Baltimore County. That is a drastic increase from 2015, when 394 city and county residents died from heroin. Baltimore has the highest rate of heroin use out of any large city in the country, according to the DEA. Baltimore officials estimate that 21,000 city residents use heroin regularly. Director of the Washington/Baltimore High Intensity Drug Trafficking Area Program Tom Carr says that Baltimore “[is] an old heroin town. There is an appetite for heroin in Baltimore.” That is not the case outside the Baltimore area. Maryland’s rural and suburban regions had not seen large-scale heroin use prior to the 2010s. However, with the prescription opioid wave, demand for cheap opioids in the rest of the state has boomed. Nationally, approximately three in four heroin users misuse prescription opioids before they start to use heroin regularly. Maryland’s opioid crisis is likely to become even more lethal. In 2015, Maryland drug dealers began to sell heroin cut with fentanyl. Fentanyl is a powerful synthetic drug that is used medically for patients in the most extreme cases of pain, like severe burns and late-stage cancer. Fentanyl is administered even to those patients in very small doses: just three milligrams of fentanyl can be fatal. State officials and autopsy statistics suggest that fentanyl is behind the spike in drug deaths: 1,119 Marylanders died with fentanyl in their system in 2016, compared with 340 in 2015.

Cocaine, Crack and Speedballs

Maryland was one of the states that was hardest-hit by the crack epidemic. During the 1980s and 1990s, crack use was epidemic in Baltimore on a scale similar to that of heroin and other opioids now. Indeed, the two drug trends are related. For one, the crack wave allowed drug organizations to gain a foothold in the state. Some of the same operations that fueled the crack boom are now supplying heroin to a new generation of Marylanders. Cocaine is also increasingly used by people who also use opioids. The combination of heroin and cocaine is called a speedball, and is much more dangerous than either drug on its own. Speedball use is the primary driver behind Maryland’s resurgent wave of cocaine-related deaths. After 221 people died from cocaine overdoses in 2015, the following year saw 464 Marylanders suffer fatal cocaine overdoses. In 2016, 66 percent of Marylanders who died with cocaine in their systems had used a speedball.

Risky Alcohol Use in Maryland

Dangerous drinking behaviors are on the rise in Maryland. In 2016, heavy drinking in Maryland went up by 25.7 percent. So did alcohol-related deaths: 582 Marylanders died with alcohol in their systems in 2016, up from 309 in 2015.

Binge drinking has also gone up in Maryland in recent years. That trend is driven by a large spike in the amount of women who binge drink: 34.7 percent more Maryland women binge drank in 2016 than in 2005.

Maryland is home to dozens of colleges and universities , which are the sites of no small amount of dangerous drinking. According to a report compiled by representatives from all of Maryland’s institutions of higher education, Maryland’s college students are more likely than their peers in the rest of the United States to drink.

In all, 41 percent of Maryland college students aged 24 and under meet the diagnostic criteria for either abuse or dependence.

Maryland Firefighters, EMTs and Substance Abuse

Rising drug use and the frequency of drug-related deaths have placed tremendous strain on Maryland’s first responders. Maryland firefighters and EMTs are often the first on the scene when someone overdoses.

Maryland firefighters and EMTs are the ones who most often administer naloxone to people experiencing an opioid overdose. Some Maryland first responders report administering naloxone to the same people over and over again. This can cause psychological stress for the person administering care.

Firefighters have a job that is physically challenging. Yet their psychological challenges can be much worse. Firefighters are disproportionately more likely to suffer from PTSD. That’s why firefighters are more likely than civilians to need specialized substance use treatment.

Addiction can be harder to treat in firefighters than in the general population. Effective treatment must address the trauma firefighters experience. Listening to stories about that kind of trauma — house fires, car wrecks, and shooting victims — can overwhelm even seasoned caregivers.

The International Association of Fire Fighters is a union that represents many Maryland firefighters. In light of the unique challenges firefighters face, the IAFF has set up a first-responder-only treatment facility in Prince George County. The facility, the IAFF Center of Excellence for Behavioral Health Treatment and Recovery, helps firefighters get back on their feet with the help of their comrades.

Maryland faces many drug challenges. Each has its own origin, but all have one solution: compassion and care. Treatment is the only way to save the lives of thousands of Marylanders struggling with addiction.

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