The Washington PostDemocracy Dies in Darkness

Md. legislature rushing to pass opioid bills before session ends

With two weeks left before the end of Maryland's 2017 legislative session, lawmakers are rushing to pass a package of bills aimed at combating the heroin and opioid epidemic that a new Washington Post-University of Maryland poll shows is touching about one-third of state residents.

Gov. Larry Hogan (R) and members of the Democratic-majority legislature have introduced at least 30 bills combined to address the crisis, the most since the rate of overdose deaths began skyrocketing about six years ago. The proposals, many of which have merged in recent weeks, focus on prevention, treatment, law enforcement, insurance coverage and public awareness.

Two of the most sweeping measures, sponsored by Democrats but which also have Republican support, drew the endorsement Friday of House Speaker Michael E. Busch (D-Anne Arundel) and Senate President Thomas V. Mike Miller Jr. (D-Calvert).

Both are expected to come up for floor votes this week.

A House work group scaled back a separate bill from the Hogan administration designed to hold doctors accountable for how many pain pills they prescribe to an individual, following criticism that the proposal left physicians with almost no flexibility to do what they think is best for patients. The revised legislation also is on track to reach the House floor this week.

“We’ve checked our parties at the door, and we’re getting the job done,” said Del. Eric M. Bromwell (D-Baltimore County), the head of the work group, which was tasked with reviewing and revising the opioid-related bills in an effort to advance a comprehensive legislative package.

The Post-U. Md. poll finds 34 percent of Marylanders have a family member or close friend addicted to prescription pain pills or heroin, up slightly from 29 percent in 2015.

Read full poll results | How it was conducted

Health experts say rising addiction to prescription opioids is driving a more than five-year surge in overdose deaths, with people becoming hooked on pain medication and later turning to cheaper heroin for a similar high. Increasingly, users unwittingly take heroin mixed with fentanyl, a synthetic opioid that is more powerful.

One of the Democratic measures, known as the HOPE Act, would establish at least 10 new crisis-treatment centers throughout Maryland; require the state to increase its reimbursement rates for substance-abuse clinics every year; request at least $2 million in the governor's next budget to expand drug-court programs; and allow individuals to administer an overdose-reversal drug without training.

The other Democratic bill would require public schools to keep overdose-reversal drugs on hand; authorize school nurses and other health personnel to administer the drugs; mandate that colleges educate incoming students about substance abuse; and require that degrees for many health occupations include instruction about addiction treatment and safe pain management.

Leaders in Montgomery County consider launching new ‘recovery’ school

At a news conference Friday, Hogan said his administration has “taken every step possible” to address the opioid epidemic, and was glad to see the legislature taking action as well.

Hogan's prescriber-limits legislation originally would have barred doctors from prescribing more than a seven-day supply of an opioid, with exceptions for certain patients, such as those dealing with cancer or receiving hospice care. But the state's medical society resisted the rule, saying it wasn't practical and left physicians too few options.

The state health department and the medical society, known as MedChi, worked out a compromise that would require doctors to follow best practices, such as standards from the Centers for Disease Control and Prevention, while making them accountable to the Maryland Board of Physicians for following those guidelines.

“In a way, the seven-day will become the rule in many cases, because that’s what the standards actually say,” said Gene Ransom, MedChi’s chief executive. “There is a clear message now from the General Assembly that physicians have to pay attention to what is going on with prescribing.”

Hannah Marr, a spokeswoman for the governor’s office, said the administration believes Hogan’s original proposal was stronger but that the revised version is “a step in the right direction nonetheless.”

The Hogan administration also proposed creating a new felony category that would allow prison sentences of up to 30 years for sales of fentanyl-laced heroin resulting in a fatal overdose. The legislation has been changed to add 10 years to a sentence for individuals who knowingly distribute fentanyl, regardless of whether a death occurs.

Lawmakers on the House Judiciary Committee, which is reviewing the measure, say the bill may not advance in time to pass both chambers before the end of the legislative session on April 10. “There’s a higher mountain to cross for that one, mostly because it adds a new penalty,” said Del. Brett R. Wilson (R-Washington), a member of the panel.

The latest data from the state health department shows that 317 Marylanders died of overdoses related to prescription opioids from January through September of last year, up 41 percent compared to the same period in 2010. Another 918 heroin-related deaths occurred in Maryland during the first three-quarters of last year, more than four times the number for the same stretch in 2010.

Hogan declared a state of emergency this month over the heroin and opioid crisis, pledging to provide $50 million over the next five years to address the problem with treatment and prevention efforts. Last week, he asked the legislature to approve $10 million of the funding, and his fiscal 2018 budget would provide another $11.5 million to deal with the issue, including more than $6 million for treatment programs.

The Post-U. Md. poll showed the governor’s approval rating on the issue has increased 12 points since last year, rising to 47 percent.

Many addiction-services advocates are pushing the state to expand access to long-term residential treatment, saying it is one of the most effective ways to reduce the number of overdose deaths.

“We need a lot more resources for treatment, and it has to be long-term and quality treatment,” said Linda Williams, executive director of Addiction Connections Resource. “I would like for there not to be a waiting list.”

The poll shows 72 percent of Marylanders support increasing state funding for long-term residential treatment, with about 41 percent in favor of adding $10 million or more, while the rest either prefer a smaller rise or have no opinion on an amount. Support for increased funding is strong regardless of party affiliation, with 80 percent of Democrats, 70 percent of independents and 59 percent of Republicans backing the idea.

“I can never find enough beds,” Williams said. “Sometimes it takes me two to three weeks to get someone in.”

The poll, conducted March 16-19 among a random sample of 914 Maryland residents reached on landline and mobile phones, has a margin of sampling error of plus or minus four percentage points.

Scott Clement and Emily Guskin contributed to this report.