Political leaders in Annapolis and Richmond are searching for ways to combat a wave of heroin overdoses that is killing dozens of their constituents each month — in inner-city neighborhoods, suburbs and rural enclaves.
Maryland Gov. Larry Hogan (R) has declared reducing heroin use a priority and put his lieutenant governor in charge of finding solutions. Virginia Gov. Terry McAuliffe (D) introduced a package of heroin-related bills in the past week that would, among other provisions, increase criminal penalties for drug dealers who supply lethal doses and reduce penalties for drug users who seek help for friends who have overdosed.
The governors’ actions reflect mounting concern among public officials up and down the East Coast about the escalation in overdoses, which some say has become a public health epidemic. Despite a sense of urgency to pass legislation, however, experts say there is no simple or inexpensive cure for heroin addiction — and there are differing views on which approach to try first.
“This is one of those things no one likes to talk about, but it’s gone too far,” said Cecil County Executive Tari Moore (R), who pushed to make heroin one of the top four legislative priorities of the Maryland Association of Counties. “We can’t hide from it anymore. . . . We have to own it. We have to do something.”
As the number of deaths related to heroin has spiked in the past three years, governors have scrambled to increase awareness and equip first-responders with medication that can reverse an opioid overdose. A few have declared an “emergency” to illustrate the gravity of the situation. Vermont Gov. Peter Shumlin (D) focused his 2014 State of the State address on the topic.
Opioid abuse often begins with an addiction to prescription pills such as oxycodone and Percocet. Federal officials have cracked down on the illicit use of prescription drugs in recent years, driving up their price on the black market — and making heroin a cheaper alternative in hardscrabble communities where it has long been a problem and in higher-income areas where heroin addiction used to be rare. Heroin often sells for less than $5 for a bag containing enough for one dose, making it cheaper than a pack of cigarettes, according to addiction specialists. Sometimes it is laced with fentanyl, a painkiller that can make the drug even more lethal.
“People are kind of migrating from prescription opiates — they’re expensive and we have a very well-functioning prescription-monitoring program, and physicians are tending to be more cautious about their prescription of opiates — to heroin,” said Mellie Randall, who oversees substance abuse services at the Virginia Department of Behavioral Health and Developmental Services.
Former Maryland governor Martin O’Malley (D), whose tenure ended Wednesday, worked hard to reduce the number of overdose deaths during his eight years in office. For a while, the state made progress, but then came an influx of cheap heroin. Overdose deaths from heroin spiked from 247 in 2011 to 392 in 2012, a nearly 60 percent increase. The number climbed to 464 in 2013, and there were 296 overdose deaths in the first six months of 2014.
The largest number of deaths has consistently been in Baltimore, but some of the highest per-capita rates have been in rural counties, such as Cecil and Wicomico.
In 2013, Maryland lawmakers passed legislation that allowed medics and other first responders to administer naloxone, a medication that can reverse an opioid overdose. More than 30 states and the District have done the same, according to the National Conference of State Legislatures; Virginia lawmakers will consider a similar law this session.
Last year, Maryland joined about 20 other states and the District by passing a good Samaritan bill that gives drug users some criminal immunity if they summon help for someone who has overdosed. A good Samaritan bill is also part of Virginia’s legislative package, but the Virginia version is far more limited, mostly because of pushback from law enforcement. In Virginia, a drug user who calls 911 to get help for an overdosing friend could cite the good Samaritan provision only as a defense if prosecuted; the measure would not grant immunity.
Hogan, who succeeded O’Malley on Wednesday, said he learned about the pervasiveness of heroin as he campaigned across Maryland, especially while visiting volunteer fire departments that have been encountering the problem in rural counties.
“It’s impacting every aspect of our society,” Hogan said last month. “It’s going to continue to get worse unless we get a handle on it.”
Hogan has pledged to find more funding for treatment and to convene a summit of experts and activists to advise him. His spokeswoman said Friday that he and Lt. Gov. Boyd K. Rutherford (R), who will lead the effort, plan an announcement with state leaders “very soon.”
Far fewer heroin overdose deaths have occurred in Virginia than in Maryland, although Virginia’s population is much larger. But the number of heroin overdose deaths in Virginia more than doubled between 2011 and 2013. The state recorded 213 fatal heroin overdoses in 2013 and an estimated 210 in 2014. (The 2014 total was extrapolated from figures for the first six months of the year.) The rates are higher in rural Southwest Virginia, while Fairfax and Prince William counties have seen the highest overall numbers.
The commonwealth also has a serious problem with overdoses from prescription opioids; 468 people died of prescription opioid overdoses in 2013, compared with the 213 fatal heroin overdoses. (In Maryland, prescription overdose deaths have typically trailed the number of heroin-related deaths.)
McAuliffe convened a task force late last year with the goal of reducing deaths in the next five years. The governor has endorsed six bills this legislative session that arose from the task force’s work. Four more bills came out of the work of Virginia Attorney General Mark R. Herring (D), who has made heroin and prescription drug prosecutions a priority. In addition to the good Samaritan measure and one to expand the use of naloxone, there is a bill that would make delivering a fatal dose of any illegal drug second-degree murder, a charge that right now can only be brought at the federal level. Three more would tighten and encourage use of the state’s prescription-monitoring program.
But expanding treatment and support options remains a difficult sell. Some Maryland addiction programs have had difficulty sustaining their state funding, let alone getting more. In Virginia, lawmakers and activists say there wasn’t time to prepare legislation this year that would create more help for addicts. Even relatively minor proposals, such as creating a state Web site to address addiction, have triggered concerns about cost.
At the same time, the increasing death toll has produced a new generation of parent activists, many of them well-connected professionals with the means to lobby those in positions of power. They are telling lawmakers that addiction is an illness needing humane intervention and sustained treatment, not just heavy-handed legal action. Advocates say the argument has become easier to make as heroin has become more prevalent in wealthier suburban communities.
“If you went to the local shopping center and asked 10 people ‘What’s the difference between an opioid and a trapezoid?’ few of them could answer that question,” said Don Flattery of Fairfax, whose 26-year-old son died of an overdose after becoming addicted to painkillers. The elder Flattery serves on the Virginia task force.
“Heroin is the great big boogeyman,” he said. “It scares the willies out of people that live in the suburbs.”
Herring recalled being approached at a dinner by a woman whose daughter had overdosed on heroin. “She looked at me right in the eye and said, ‘Please don’t let this happen to another child in Virginia.’ ” He is trying to build law enforcement support for McAuliffe’s opiate-related bills and is encouraging prosecutors to make heroin and prescription drug crimes a priority.
In Maryland, Sen. Katherine A. Klausmeier (D-Baltimore County) said she had difficulty sympathizing a few years ago with a couple she met whose son had died from a heroin overdose. Then a friend’s daughter overdosed.
Klausmeier ended up introducing the naloxone legislation in the state Senate.
“At that point, I thought, ‘You know what? It’s hitting everybody. It’s time to start acting on it,’ ” Klausmeier said.