UPPER MARLBORO – One person in Prince George’s County dies every four days from opioid overdose.
The county council, in its capacity as the Board of Health, heard that statistic at a briefing it held on Monday on the nationwide opioid crisis as it relates to Prince George’s County. Representatives from the police department, the health department and the Department of Social Services spoke about how the issue impacts their work and what they are doing to combat the problem.
While the number of deaths seems striking, officials say the figure is not as alarming as those seen elsewhere in the state. Prince George’s County has the second-lowest rate of unintentional opioid overdose deaths in the state, behind only Montgomery County.
“As a county, we are doing very well. We still have a lot to go, but we are moving in the right direction,” said Jacqueline Duval-Harvey, deputy health officer with the health department.
The one death every four days figure is from 2016 data. That year, 87 people died in the county from opioid overdoses outside of hospitals.
Although numbers remain relatively low, there is evidence that some aspects of the statewide epidemic have begun to come to Prince George’s. Fentanyl, a drug related to heroin but 100 times more powerful, caused more deaths than heroin for the first time in 2017. From April 2016 through March 2017, 74 fentanyl-related deaths were recorded.
“In the first quarter of 2017, 90 percent of our opioid-related deaths involved fentanyl as a cause of death. So it’s really taking over, it’s nearly all of those opioid related deaths for us,” said Donna Perkins, health department epidemiologist. “About 28 percent of these deaths were non-residents. Over two-thirds were male and by race, about 58 percent of the overdoses were African-American.”
Many of the patients who survive an overdose say they were not aware there was fentanyl in the drugs that they took, health officials said.
Incidents of the use of naloxone, a drug that prevents the absorption of an opioid and reverses an overdose, have also risen. For the last quarter of 2016, the county fire/EMS department reported 62 (October), 78 (November) and 81 (December) such uses, while in the second quarter of 2017 there were 70 in April, 88 in May and 102 in June. In 2016, there were more than 700 incidents where naloxone was used, compared to nearly 500 in the first half of this year.
“That is about doubled compared to the first half of 2016. Some of these represent multiple uses at the same address,” Perkins said.
Although the problem of opioid overdose isn’t as serious here as in other parts of the state, the county is still taking steps to address it. Statewide, prescribers of pain medications can now access a patient’s prescription history to see if they have gotten opioid medications from other providers and could be abusing the drugs. County agencies have increased their outreach to train people in the use of naloxone and educate residents about addiction. The health department keeps track of every incident where naloxone is used in the county. Addresses with repeat incidents receive follow-up visits from health department staff to encourage residents at the address to seek help.
Chief Hank Stawinski of the Prince George’s County Police Department said he likes having the health officers go with his personnel to make these visits.
“I don’t like the idea of enthusiastic amateurs trying to do work that we have professionals to do. That’s why I wanted those health officers involved in this,” he said. “The idea that a 26-year-old patrol officer is going to turn somebody’s life around after a lifetime of addiction, that’s not going to work. But those health officers have that skill set.”
Councilwoman Mary Lehman said although the number of deaths may be lower than elsewhere, she was still troubled by the increases in the use of naloxone.
“You’re talking about two people per day are being saved from overdosing. So that’s significant,” she said.
Duval-Harvey said the uses of naloxone don’t directly correlate with overdose deaths because first responders can’t diagnose in the field. If they suspect an overdose, they administer the medication, but it could turn out to be a different medical emergency causing the symptoms.
“There are going to be certain symptomatic things that are happening where they’re going to be cautious and provide naloxone just to make sure they are covering all their bases and trying to save a life,” Perkins said. “So we can’t tell you that this is actually the number of overdoses that are occurring, but this is a good marker to be able to keep an eye on the situation.”
Lehman also wondered why outreach is focused on addresses with repeat overdose responses and not all cases. Health officials said patients often literally run away after naloxone is administered, and it often takes multiple near-misses before a patient begins to consider seeking help. But, there are staff members at emergency rooms to help any patient or family who requests it.
While the county is using data-driven models to inform their efforts, Duval-Harvey admitted the health department only has one epidemiologist on staff to handle all the number-crunching. Council Vice-Chair Dannielle Glaros said understaffing, especially in health and human services agencies, is an issue she has been finding across the government.
“The chair and I have had this ongoing conversation for the last few years, and a lot of it is about where do we need to invest greater dollars as we move forward in the county?” she said. “And the shortfalls, for me, oftentimes seem to be in health, social services, family services. Part of what we need to think through is how do we have a more robust prevention system?”