Opioids killed thousands of Maryland residents in 2021
In 2021 there were over 100,000 fatal drug overdoses in the United States, with over 76,975 of these deaths being attributed to opioids, according to the Center for Disease Control and Prevention.
Opioid and fentanyl-related deaths have been growing nationwide in recent years. According to the National Institute of Drug Abuse (NIDA), 70% of all overdose deaths in 2018 (some 46,802 deaths altogether) involved opioids.
Maryland saw an increase in opioid and fentanyl-related deaths in 2021. When looking at data spanning from January through September, opioid-related deaths increased by 2.09 percent from 1,865 in 2020 to 1,904 in 2021, and fentanyl-related deaths increased by 3 percent from 1,731 to 1,783.
In 2020, there were 964 deaths from opioids in Baltimore City, nearly triple the number of people who were victims of homicide.
In 2018, Maryland’s opioid-related death statistics were even higher than the national average, with 2,087 deaths, making up “nearly 90% of drug overdose deaths,” according to NIDA.
Synthetic opioid-related deaths other than methadone, including fentanyl, also increased in 2018 to 1,825 in Maryland and were involved in upwards of 90 percent of all opioid-related deaths.
These numbers increased in 2019, with the CDC reporting that nationwide, “overdoses involving opioids killed nearly 50,000 people in 2019, and nearly 73 percent of those deaths involved synthetic opioids.”
The CDC splits opioid deaths and overdoses into four different categories, natural opioids (which include morphine, codeine, and semi-synthetic opioids like oxycodone, hydrocodone, hydromorphone, and oxymorphone), methadone, synthetic opioids other than methadone (fentanyl and tramadol) and heroin.
According to the CDC, “reports indicate that increases in synthetic opioid-involved deaths are being driven by increases in fentanyl-involved overdose deaths, and the source of the fentanyl is more likely to be illicitly manufactured than pharmaceutical.”
The growth of fentanyl in the United States over the past decade has been substantial. According to the United States Drug Enforcement Administration, reports of fentanyl identified in forensic laboratories increased from 5,541 in 2014 to 100,378 in 2019 in the United States.
While opioid-related and fentanyl-related deaths have continued to grow, heroin-related deaths have trended downwards.
From 2018 to 2019, heroin-related deaths nationwide decreased by over 6 percent, while opioid-related deaths and synthetic opioid-related deaths increased by over 6 and 15 percent, respectively.
According to American Addiction Centers, fentanyl is cheaper, stronger, and easier to obtain, part of the reason for its popularity.
Fentanyl deaths are also on the rise among teens. According to a study conducted by The Journal of the American Medical Association, adolescent drug rates didn’t change much over the last decade, with the rate only growing by 0.2 percent between 2010 and 2020. Yet, the study found overdose deaths among teens grew exponentially, with the overdose mortality increasing by 94.03 percent from 2019 to 2020 and then again by 20.05 percent from 2020 to 2021.
The study found that fentanyl use among adolescents was “identified in 77.14% of adolescent overdose deaths.”
It was also found that American Indian and Alaska Native adolescents had the largest overdose rate at 11.79 per 100,000, something that remained consistent among the adult population in 2020 as well. Latinx adolescents were second with a rate of 6.98 per 100,000, followed by white, non-Hispanic, and black, non-Hispanic.
By Riley Brennan
Capital News Service
Maryland’s Cardin, other Democrats, push to include dental coverage under Medicare
Led by Maryland Sen. Ben Cardin, Senate Democrats are renewing a push to include dental care benefits under Medicare.
“Oral health is integral to overall health and well-being,” Cardin said Wednesday at the year’s first hearing of the Senate Finance Committee’s health care subcommittee, which he chairs. “It can make worse an underlying health condition, impacting overall healthcare costs. It can impact a person’s ability to get a job and be well enough to work. It impacts a person’s ability to go to school, impacting the local and national economy.”
“It seems to me the solution is clear,” said Sen. Elizabeth Warren, D-Massachusetts. “It’s time to expand Medicare to cover dental care.”
Medicare currently does not cover dental costs in most cases. As of 2019, nearly half of Medicare beneficiaries, or 24 million people, did not have dental coverage, according to a study by the Kaiser Family Foundation (KFF). The average out-of-pocket spending for those with Medicare coverage was $874 in 2018.
Medicaid beneficiaries have optional and limited services for dental care.
Earlier this month, Cardin and Sen. Bob Casey, D-Pennsylvania, introduced legislation allowing Medicare to cover dental, vision, and hearing services and increasing the federal investment in Medicaid covering these services.
Cardin has been an outspoken proponent of accessible dental health coverage, often referring to the case of Deamonte Driver, a 12-year-old from Maryland whose difficulty receiving Medicaid eligibility prevented him from getting the proper dental care that would have saved his life.
“What would have initially cost $80 for a tooth extraction ended up costing hundreds of thousands of dollars, and, tragically, Deamonte Driver lost his life,” Cardin said. “So, that really struck home. A person in my community that I represented, that we could have that kind of outcome.”
In February, Cardin, Sen. Debbie Stabenow, D-Michigan, and Rep. Nanette Diaz Barragán, D-California, reintroduced legislation that would significantly expand dental insurance coverage available to children nationwide through the Children’s Health Insurance Program (CHIP).
As of Jan. 1, Maryland’s adult Medicaid beneficiaries became eligible for dental coverage, including regular checkups as well as emergency procedures under the Maryland Healthy Smiles Dental Program.
In 2019, two states had no dental coverage under Medicaid, 15 had “limited” coverage, and 13 had only emergency coverage, according to a study by the Center for Health Care Strategies.
The American Dental Association estimated $4 million in savings per year to Maryland’s Medicaid budget by expanding dental coverage to adults.
Emergency visits for dental problems that could have been avoided by regular check-ups cost taxpayers, hospitals, and the government, according to research by the American Dental Association.
“There are more than 2 million emergency hospital room visits in America for oral health conditions,” Marko Vujicic, chief economist and vice president of the Health Policy Institute at the American Dental Association, said at the Senate hearing. “If you do the math, that’s about one every 15 seconds. This is heartbreaking, but as an economist, I also want to highlight that this costs our healthcare system upwards of over $2 billion per year.”
Other witnesses named workforce diversity and size, geography, and education as barriers to dental care across the United States.
“It is well established that a person’s healthcare and trust in the medical community improve when they are seen by a provider of their own choice,” said Cherae Farmer-Dixon, dean of the Meharry Medical College School of Dentistry in Nashville.
Only 4% of dentists are Black, according to data from the American Dental Association.
Farmer-Dixon pleaded with Congress to find a solution to the limited diversity in dentistry, stating that the job of educating a diverse workforce should not lie solely in the hands of the Meharry School and Howard University in Washington, both HBCUs.
By MICAELA HANSON
Capital News Service
Wider access to overdose-reversing drug could ease deadly toll of opioid crisis, experts say
An FDA panel last month approved over-the-counter use of the nasal spray naloxone – commercially branded as Narcan, and it could be available at stores and online retailers by late summer.
“Having these types of treatments is important for people that are not able or ready to stop using drugs,” Eric Weintraub, who heads the addiction research and treatment division at the University of Maryland School of Medicine, told Capital News Service. “It’s basically keeping people alive.”
Over-the-counter access to Narcan will help Marylanders who face a drug supply that is increasingly dangerous and lethal, Weintraub said.
Fentanyl was involved in 81.4 percent of all fatal overdoses in Maryland from November 2021 to November 2022, according to the state’s Opioid Operational Command Center.
The national number of deaths involving synthetic opioids – primarily fentanyl – has also been rising, with opioid overdoses claiming more than 70,000 lives nationwide in 2021. That death toll has increased 97-fold since 1999, according to the U.S. Department of Health and Human Services.
Before the FDA approval, some state laws and standing orders allowed people to get naloxone without a prescription at a pharmacy. Various advocacy groups and government agencies have also distributed the spray for free in dozens of states.
Wednesday’s decision addresses the “dire public health need” of the opioid epidemic and improves access to life-saving treatment, FDA Commissioner Dr. Robert Califf said in a statement.
Naloxone’s approval is the latest initiative that Maryland health officials say could help curb the state’s opioid crisis.
Multiple bills in the Maryland General Assembly this legislative session look to improve fentanyl testing and increase penalties for distributing fentanyl-like substances. Manufacturing, selling, or distributing fentanyl in the state currently carries a $20,000 fine and 20 years of prison.
Weintraub said that Maryland has “always been a leader” in helping people struggling with substance use disorders.
But he added that naloxone’s approval sends a loud message supporting harm reduction strategies, which look to meet people who use drugs “where they’re at” when mitigating overdoses, according to the National Harm Reduction Coalition.
Since 2017, Maryland residents have been able to get naloxone without an additional prescription from pharmacies.
But overdose response programs, which often distribute the life-saving drug for free, need a sign-off from a medical prescriber or must provide training before administering naloxone, according to Zach Kosinski, a harm reduction director with the Behavioral Health System Baltimore.
Offering over-the-counter treatment could “change the game” for how response programs provide access to naloxone in Maryland, Kosinski added.
The Maryland Department of Health will share additional information about the availability of over-the-counter naloxone in Maryland as more details are finalized, according to Michael Coury, a spokesperson for the Opioid Operational Command Center.
Improved naloxone access could also help reduce stigma around substance use disorders in the state, Kosinski said. A person may be more willing to get naloxone at a grocery store or gas station than through an overdose response program because it affords them more privacy, he added.
“On the flip side, there’s no requirement that places that now will legally be able to sell it over the counter actually will, so stigma could also contribute to retailers not carrying it,” Kosinski said. “People who use drugs are already shopping at all of these establishments in every way that anyone who’s not using drugs is, and all this would do is make those stores a safer place.”
In a statement Wednesday, Robert Kramer, the CEO of the Gaithersburg-based company that manufactures Narcan, Emergent BioSolutions, also emphasized the need for community collaboration in setting up widespread naloxone access.
“With leaders across government, retail, and advocacy groups, we must work together to continue increasing access and availability, as well as educate the public on the risks of opioid overdoses,” Kramer said.
FDA approves first over-the-counter Naloxone nasal spray
The U.S. Food and Drug Administration approved Narcan, a 4 milligram (mg) naloxone hydrochloride nasal spray for over-the-counter (OTC), nonprescription use – the first naloxone product approved for use without a prescription. Naloxone is a medication that rapidly reverses the effects of opioid overdose and is the standard treatment for opioid overdose. Today’s action paves the way for the life-saving medication to reverse an opioid overdose to be sold directly to consumers in places like drug stores, convenience stores, grocery stores, and gas stations, as well as online.
The timeline for the availability and price of this OTC product is determined by the manufacturer. The FDA will work with all stakeholders to help facilitate the continued availability of naloxone nasal spray products during the time needed to implement the Narcan switch from prescription to OTC status, which may take months. Other formulations and dosages of naloxone will remain available by prescription only.
Drug overdose persists as a major public health issue in the United States, with more than 101,750 reported fatal overdoses occurring in the 12-month period ending in October 2022, primarily driven by synthetic opioids like illicit fentanyl.
“The FDA remains committed to addressing the evolving complexities of the overdose crisis. As part of this work, the agency has used its regulatory authority to facilitate greater access to naloxone by encouraging the development of and approving an over-the-counter naloxone product to address the dire public health need,” said FDA Commissioner Robert M. Califf, M.D. “Today’s approval of OTC naloxone nasal spray will help improve access to naloxone, increase the number of locations where it’s available, and help reduce opioid overdose deaths throughout the country. We encourage the manufacturer to make accessibility to the product a priority by making it available as soon as possible and at an affordable price.”
The Narcan nasal spray was first approved by the FDA in 2015 as a prescription drug. In accordance with a process to change the status of a drug from prescription to nonprescription, the manufacturer provided data demonstrating that the drug is safe and effective for use as directed in its proposed labeling. The manufacturer also showed that consumers could understand how to use the drug safely and effectively without the supervision of a healthcare professional. The application to approve Narcan nasal spray for OTC use was granted priority review status. It was the subject of an advisory committee meeting in February 2023, where committee members voted unanimously to recommend it be approved for marketing without a prescription.
The approval of OTC Narcan nasal spray will require a change in the labeling for the currently approved 4 mg generic naloxone nasal spray products that rely on Narcan as their reference listed drug product. Manufacturers of these products will be required to submit a supplement to their applications to effectively switch their products to OTC status. The approval may also affect the status of other brand-name naloxone nasal spray products of 4 mg or less, but determinations will be made on a case-by-case basis, and the FDA may contact other firms as needed.
The use of Narcan nasal spray in individuals who are opioid dependent may result in severe opioid withdrawal characterized by body aches, diarrhea, increased heart rate (tachycardia), fever, runny nose, sneezing, goose bumps, sweating, yawning, nausea or vomiting, nervousness, restlessness or irritability, shivering or trembling, abdominal cramps, weakness, and increased blood pressure.
“Naloxone is a critical tool in addressing opioid overdoses, and today’s approval underscores the extensive efforts the agency has undertaken to combat the overdose crisis,” said Patrizia Cavazzoni, M.D., director of the FDA’s Center for Drug Evaluation and Research. “The FDA is working with our federal partners to help ensure continued access to all forms of naloxone during the transition of this product from prescription status to nonprescription/OTC status. Further, we will work with any sponsor seeking to market a nonprescription naloxone product, including through an Rx to OTC switch, and encourage manufacturers to contact the agency as early as possible to initiate discussions.”
The FDA has taken a series of measures to help facilitate access to naloxone products. In November 2022, the agency announced its preliminary assessment that certain naloxone products, such as the one ultimately approved today, have the potential to be safe and effective for over-the-counter use and encouraged sponsors to submit applications for approval of OTC naloxone products. The agency previously announced in 2019 that it had designed, tested, and validated a model naloxone Drug Facts Label (DFL) with easy-to-understand pictograms on how to use the drug to encourage manufacturers to pursue approval of OTC naloxone products. The model DFL was used to support the approved application along with the results of a simulated use Human Factors validation study designed to assess whether all the components of the product with which a user would interact could be used safely and effectively as intended.
Through the FDA Overdose Prevention Framework, the agency remains focused on responding to all facets of substance use, misuse, substance use disorders, overdose, and death in the U.S. The framework’s priorities include: supporting primary prevention by eliminating unnecessary initial prescription drug exposure and inappropriate prolonged prescribing; encouraging harm reduction through innovation and education; advancing the development of evidence-based treatments for substance use disorders; and protecting the public from unapproved, diverted, or counterfeit drugs presenting overdose risks.
The FDA granted the OTC approval of Narcan to Emergent BioSolutions.
U.S. Sen. Mark R. Warner (D-VA), released the statement below after Federal Drug Administration (FDA) authorized the over-the-counter sale of Narcan, a nasal spray drug that rapidly reverses the effects of opioid overdose and is the standard treatment for opioid overdose. Prior to today’s action by the FDA, this lifesaving medication was available by prescription only.
“This announcement is welcome news for the communities in Virginia and across the country that have been torn apart by the opioid epidemic, including deaths from fentanyl. As we continue pursuing a comprehensive range of solutions to tackle the opioid epidemic, I applaud the FDA for acting to put this lifesaving medication in the hands of more Americans – a move that is sure to fight overdose deaths and save lives.”
Fauquier Health welcomes new general surgeon Dr. Nathaniel Saint-Preux
Fauquier Health announced the welcoming of their newest general surgeon, Nathaniel Saint-Preux, MD. Dr. Saint-Preux has joined Fauquier Health’s Northern Virginia Surgical Specialists group, which was recently acquired in the fall of 2022. Dr. Saint-Preux joins board-certified physicians Joseph Brown, MD, FACS, Cynthia Dougherty, MD, and Benjamin Wampler, MD, FACS.
Dr. Saint-Preux graduated from the University of Mary Washington in Fredericksburg, Virginia in 2013. He completed his Doctor of Medicine at Howard University College of Medicine in Washington, D.C. in 2017. Dr. Saint-Preux then completed his general surgery residency at the Detroit Medical Center/Wayne State University in Detroit, Michigan in 2022.
“As a physician I strive every day to develop a deeper understanding of the interaction between health, social, cultural, and environmental issues in our communities,” commented Dr. Saint-Preux. “I enjoy working with my patients to ensure they feel educated about the issues they may be facing, what options they have, and what their future path of wellness could look like.”
Dr. Saint-Preux is trained in minimally invasive robotic surgery and has interests in hernia repair, colonoscopy, upper endoscopy, colorectal, appendectomy, skin lesions/lipomas, thyroid disease, breast procedures, and more. Dr. Saint-Preux has conducted multiple service trips, including outreach in Haiti to provide health care to under-served populations. Giving back to the community and providing cross-cultural care has led to a greater understanding of the health issues facing our world today.
Dr. Saint-Preux is accepting new patients at all four locations in Warrenton, Gainesville, Culpeper, and Manassas. The Warrenton office, located at 550 Hospital Drive, can be reached at 540.347.2805. The Gainesville office, located at 7915 Lake Manassas Drive, can be reached at 571.261.2782. The Culpeper office, located at 1100 Sunset Lane, can be reached at 540.812.2937. Lastly, the Manassas office, located at 9001 Digges Road, can also be reached at 571.261.2782. Additional details about Dr. Saint-Preux can be found at FHDoctors.org or FauquierHealth.org.
About Fauquier Health
Fauquier Health is a community health system dedicated to high-quality, patient-centered care in a unique environment that considers the multiple facets of healing and respects the individuality of each and every patient. Located at 500 Hospital Drive in Warrenton, Virginia, Fauquier Health serves the residents of Fauquier and several surrounding counties. It comprises: Fauquier Hospital, a fully-accredited, 97-bed hospital; Fauquier Health Rehabilitation and Nursing Center, a 113-bed long-term care and rehabilitation facility; the Villa at Suffield Meadows, an assisted living facility; the Wound Health Center and a medically supervised Wellness Center offering health and wellness programs. Fauquier Health also operates several physician’s offices, including primary care, generay surgery, OB/GYN, Neurology and more. More information on Fauquier Health is available online at FauquierHealth.org or by calling 540-316-5000.
New daily rail service into Tennessee begins in April, expanding port’s reach west and south
Beginning April 1, The Port of Virginia® will expand its westward reach with a new daily rail service between the port’s primary container terminals and Norfolk Southern’s regional intermodal terminal near Memphis.
“It’s an important step west and south for The Port of Virginia,” said Stephen A. Edwards, CEO and executive director of the Virginia Port Authority. “Both exporters and importers have asked us [Norfolk Southern and the port] to develop a high-quality Memphis rail service.
“When we first discussed this possibility, we agreed consistency was critical to developing a first-class product that provides daily service to and from this market. We have spent the past six months working together to ensure we are both ready and capable to meet customer expectations.”
The railroad’s regional terminal is in Rossville, which is in Southwest Tennessee, and located on Norfolk Southern’s Crescent Corridor route. The terminal is about 40 miles from Memphis, which is an important Midwest intermodal center. Memphis is one of only four cities in the US to be served by five Class I railroads, and according to the Greater Memphis Chamber, cargo moving through Memphis can reach 45 states and Canada and Mexico by rail within two days.
“We’re investing nearly a billion-and-a-half dollars to expand our on-dock rail capabilities, modernize one of our terminals and make our shipping channels the deepest on the US East Coast to create the East Coast’s leading global gateway,” Edwards said. “We are always looking for opportunities to expand into new markets and create demand. It’s important that we continue to collaborate with our long-time rail partner, Norfolk Southern, to create consistent, complimentary rail products to meet the needs of those companies that want to diversify their logistics and supply chains and reach new markets.”
The port is engaged in a $1.4 billion expansion effort called the Gateway Investment Program. This includes expanding the port’s overall annual rail capacity to 1.8 million TEUs (twenty-foot equivalent units); completely renovating the North Berth at Norfolk International Terminals to create the capacity for 800,000 lifts, annually; and deepening the commercial shipping channels to at least 55 feet deep and making them wide enough for two-way traffic of ultra-large container ships.
(The Virginia Port Authority (VPA) is a political subdivision of the Commonwealth of Virginia. The VPA owns and through its private operating subsidiary, Virginia International Terminals, LLC (VIT), operates four general cargo facilities Norfolk International Terminals, Portsmouth Marine Terminal, Newport News Marine Terminal and the Virginia Inland Port in Warren County. The VPA leases Virginia International Gateway and Richmond Marine Terminal. A recent economic impact study from The College of William and Mary shows that The Port of Virginia helps to create more than 437,000 jobs and generated $1 billion in total economic impact throughout the Commonwealth on an annual basis.)
D.C. Guardian Angels return to the city to patrol Metro following increase in crime
The D.C. Guardian Angels, unarmed volunteer safety patrols dedicated to helping prevent crime in public spaces, are making their return to the Washington area’s Metro system after an increase in reported crimes.
The group is led by John Ayala, who started the Washington chapter in 1989 after previously being a New York City group member.
The Guardian Angels are a New York City-based nonprofit started in 1979 by Curtis Sliwa. Since then, thousands of volunteers have joined the organization in cities nationwide and worldwide.
Ayala moved to Washington from New York City when he was 19 to bring the Guardian Angels to the nation’s capital. During the 1990s, the New York and Washington groups focused on the “crack cocaine era,” Ayala said.
“We were involved with the open-air drug market, trying to get a hold on it. So people in D.C. saw it and said, ‘you know what, we have that same issue here in D.C.,’” Ayala said in an interview with Capital News Service.
Ayala grew the group to about 100 members in the early 1990s, with an average age of around 18. Today, the group is working on trying to keep the Metro safe while recruiting new members with the goal of returning to a core of about 100 people. There are currently 40 members signed up, averaging around 40 years old.
“Now it’s going to get to the point…where history is starting to repeat itself. It’s not the gang violence, it’s not the drugs, but it’s the young people going out there hurting so many people in the community, and people are saying ‘enough is enough,’” Ayala said.
While people in their 40s and 50s may remember the Guardian Angels from the 1990s and early 2000s, Ayala said younger people are less familiar with the group. So part of the Guardian Angels’ efforts is telling the younger generation about the group’s activities and mission, he said.
The Guardian Angels are currently concentrating their efforts on patrolling the Green Line, focusing specifically on the Anacostia and Congress Heights stations. Their goal is to be a deterrent, to observe and to report to Metro Transit Police Department, Ayala said.
Although the MTPD does not directly endorse the Guardian Angels, it “appreciates eyes and ears on the system,” Sherri Ly, Metro media relations manager, said in a statement to CNS.
Despite the MTDP’s efforts, Ayala said, “there are not enough police officers out there.”
Washington Mayor Muriel Bowser announced a partnership between MTDP and the Metropolitan Police Department early last month, aiming to increase police presence at Metro stations.
While police patrol the stations, Ayala said there are not enough officers to patrol trains. After hearing about the increased police presence, the Guardian Angels are focusing on what is happening on the trains while also monitoring the station platforms.
“We're tired of hearing everybody blaming the mayor, blaming the police chief, blaming the councilman,” Ayala said. “Those people are not the ones out...robbing people, they’re not telling people to rob people. They’re doing the best that they can, but they can't do it alone. It takes a village.”
The safety patrols are recognizable by their red berets and white shirts.
“Prevention is the best cure… so if wearing a recognizable pseudo-uniform can help deter people from getting froggy on public transport, that's the right way for a civilian to help, I think,” said
Christopher Dailey, a Washington resident interested in potentially volunteering with the Guardian Angels.
Dailey rides the Metro about once a week. He recently heard of the Guardian Angels through social media and saw they were looking for volunteers.
“I've seen increasing reports of violence and harassment on the Metro, particularly against women, and I'm a pretty strong and tall guy, so I'd like to think I'd step in and stop some acts like that, but it's easy to vigilante yourself thinking about it in confrontational terms like that,” Dailey said.
In February, there were a total of 195 arrests at various Metro facilities, including buses, Metro rail, and parking lots, compared to 121 arrests in February a year ago, according to data released by the Metro Transit Police Department.
The MTPD reported 569 total crimes in February, an increase of 125 percent over the previous February. Sixty-five percent of the reported crimes in February happened on the Metro rail system.
Overall, crime in Washington’s transit system decreased during 2020 and 2021, reflecting the height of the COVID pandemic. Over the past year, crime rates have started rising again.
A Guardian Angels patrol usually lasts two-and-a-half hours; volunteers are asked to put in eight hours a month.
The D.C. Guardian Angels' goal is to have 100 volunteers by spring. Those interested in volunteering can contact the Guardian Angels at 202-359-0601.
By YESENIA MONTENEGRO
Capital News Service
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