Greg and Carin Miller, shown in their kitchen in Mt. Airy, Md., have four grown children, including one who has battled an addiction to heroin and is 17 months clean. Greg has also be battling an addiction to pain killers. (Ricky Carioti/The Washington Post)

Maryland Gov. Larry Hogan (R) and the Democratic-controlled legislature are weighing options for tackling the fast-growing heroin epidemic that has taken root across the state and throughout the country.

Many of the solutions focus on loosening criminal penalties for drug offenses and shifting more money — including the potential prison savings — to treatment and rehabilitation programs.

The efforts have drawn praise from experts, including Joshua Sharfstein, the physician who served as state health director under Hogan’s predecessor, Martin O’Malley (D). But they are viewed with skepticism by some advocates, who want the state to immediately and significantly expand long-term residential treatment.

The debate comes as the White House and Congress are taking steps to address opioid addiction, which has also been a nagging theme on the presidential campaign trail. In March, the U.S. Senate overwhelmingly approved legislation to create grants to expand drug-abuse treatment and awareness programs; encourage medical providers to reduce unnecessary prescriptions; and expand access to overdose-reversal drugs. President Obama said last week that he would propose $1.1 billion in his 2017 budget to boost treatment at community health centers.

“There are steps that can be taken that will help people battle through addiction and get on to the other side,” he said at an Atlanta summit on prescription drug and heroin abuse. “And right now that’s under-resourced.”

Greg Miller shows the anti-withdraw medication he takes to manage his painkiller addiction. (Ricky Carioti/The Washington Post)

Heroin-related deaths in Maryland climbed to 527 through September of last year, more than triple the total from the same period in 2010, according to the latest data available from the state health department. By comparison, there were a combined 378 cocaine- and alcohol-related deaths during the first three quarters of 2015.

Unlike in the past, when heroin was largely isolated to the inner city, the drug has steadily crept into the suburbs as a cheaper and sometimes more accessible alternative to prescription painkillers that offer a similar high. Heroin-related deaths increased to 33 in Montgomery County and 27 in Prince George’s County through September 2015, roughly doubling in both cases compared with 2010.

The spikes aren’t limited to heroin. Fatal overdoses of the synthetic opiate fentanyl, which heroin dealers often add to increase the potency of their products, also have exploded. There were 184 fentanyl-related deaths in Maryland in the first nine months of 2015 — eight times the number from the same period in 2013.

A Washington Post-University of Maryland poll in October showed that nearly 3 in 10 Marylanders have a close friend or family member who was or is addicted to opioids.

The bills pending in Maryland include broad criminal-justice legislation that, among other things, would direct many nonviolent drug offenders to treatment rather than prison. Sen. Bobby A. Zirkin (D-Baltimore County), chairman of the Senate Judicial Proceedings Committee, said the resulting savings in prison costs could help pay for an expansion of rehabilitation services — an idea that has bipartisan support.

Some advocates, however, are skeptical that the state would actually do that. Michael Gimbel, a former Baltimore County drug czar, said he thinks the government is more likely to use prison savings for other corrections programs or spread it throughout the state budget.

“To think they’re going to take justice money and put it into community drug treatment is a joke,” said Gimbel, a former addict himself.

Zirkin acknowledged that there are no guarantees of where the savings would be directed. “They’re correct in their concern,” he said of Gimbel and other advocates. “The legislature doesn’t control the budget, but we can mandate spending through policy, and that’s what we’re trying to do.”

Hogan, who lost a cousin to a heroin overdose, has proposed $3 million in new spending next year to support addiction treatment in prisons and $2.3 million to slightly increase the reimbursement rate for providers of substance abuse treatment, with the goal of attracting and retaining more workers in the field.

Last year, the governor released more than $2 million to increase access to treatment in Western Maryland and on the Eastern Shore, boosted police efforts to disrupt drug trafficking and launched a public awareness campaign about the dangers of addiction. The state also authorized pharmacists to dispense an overdose-reversal drug to people trained and certified through the state’s Overdose Response Program.

“The administration is funding a lot of treatment and is going to be spending more, but it can’t be the only tool in our toolbox,” Hogan spokesman Doug Mayer said.

Measures pending in the legislature would create a database to track potential abuse of painkiller medications, with a requirement to alert doctors and pharmacists and notify licensing boards and police, and strengthen the state’s ability to prosecute drug gangs under organized crime statutes.

Sharfstein, the former health secretary, said many of Maryland’s proposals align with those Rhode Island rolled out last year in a plan that he said could serve as a model for the nation. Rhode Island is focused on stronger prescription tracking, expanded use of withdrawal and overdose-reversal drugs, and increased efforts to ensure that hospitals connect overdose patients with treatment services.

“It’s a very clear and comprehensive plan,” said Sharfstein, who is now associate dean of public health at Johns Hopkins University.

Gimbel and other advocates say the state should focus more on long-term, residential treatment, which can be more expensive than short-term treatment and drugs to ease withdrawal.

Carin Miller, co-founder of Maryland Heroin Awareness Advocates, said addicts regularly reach out to her group seeking help but can’t find openings at clinics.

“There aren’t enough beds,” she said. “They have to wait six weeks, but when you’re ready for treatment, you need it immediately. There needs to be a bill introduced, almost as an emergency measure, to allow more access.”

Gimbel said he met with state lawmakers last year to propose converting vacant public buildings into regional rehabilitation centers, something he did with a former mental hospital in Owings Mills while serving as director of Baltimore County’s Office of Substance Abuse.

“They loved the idea, but so far nothing has happened,” Gimbel said. “We have four or five mental hospitals sitting empty. We could do this all around the state.”

Gimbel and Miller said the state should stop treating heroin abuse with opiate-based drugs such as methadone and suboxone, which ease withdrawal symptoms.

“The treatment they’re trying to push most is another opiate,” said Miller, whose husband and son are battling addiction. “You can’t treat an opiate addict with something opiate-based. It’s going to be an epidemic of people on suboxone.”

Gimbel also criticized Maryland’s efforts to increase access to overdose-prevention drugs and reduce incarceration for drug crimes, saying that fear of death, disease and prison can push addicts to seek help.

“It’s fear that makes people want to get off drugs,” he said. “What’s the reason to stop using heroin if there are no consequences? What message is that sending to addicts?”

But many doctors — including Sharfstein — say medication and more short-term treatment are proven ways to get results.

Sharfstein compared recovering opioid addicts to Type 2 diabetics, saying that many require medication for the rest of their lives to function.

“A major federal investment in medication-assisted treatment will save lives in Maryland as it will across the country,” he said.

Some of the most drastic proposals have come from Del. Dan K. Morhaim (D-Baltimore County), an emergency room physician who sees patients who have overdosed.

He proposed bills to establish “safe-use” facilities for supervised drug consumption, decriminalize low-level possession of many common narcotics and require hospitals to develop detailed plans for guiding addicts to treatment.

The House is expected to vote on the hospital requirement this week, but the other bills died at the committee level.

Morhaim acknowledged that his proposals wouldn’t pump new funding directly into rehabilitation programs but said they could free up money for the state to redirect toward addiction services.

“I’m just trying to develop the policies, and the policies imply money in this case,” he said.