Overdose Patients Targeted for Help

By Andrea K. McDaniels, The Baltimore Sun

State health officials hope to curb overdose deaths by using hospital data to target patients who have been admitted for previous overdoses but survived.

The state Department of Health and Mental Hygiene announced plans Monday to offer rehab services and drug education to these patients—many of whom are expected to wind up in the hospital again. Doctors could also prescribe patients with the drug naloxone, an overdose-reversing drug.

"You want people to stay alive and you want to help them get the treatment they need," Maryland Health Secretary Joshua M. Sharfstein said. "Overdoses that lead to hospital visits are opportunities for both types of intervention."

Health officials using state medical records found that 59 percent of patients who died of an overdose in Maryland in 2013 had had at least one hospital or emergency room visit for an overdose in the previous 12 months. Many of the patients had suffered multiple overdoses. Some landed in the hospital more than 10 times before dying.

The initiative announced by officials Monday is to start as a pilot at five hospitals, which are to begin reporting nonfatal overdoses using electronic medical records by Jan. 15. Local health departments and addiction treatment centers are to use the data to reach out to patients.

The program starts as drug overdoses have risen to the top of the state's policy agenda. Gov.-elect Larry Hogan has promised to declare a "state of emergency" to combat a spike in heroin-related deaths and other drug addiction problems.

Heroin is a particular problem. More than 460 people in Maryland died of heroin overdoses last year—an 88 percent increase since 2011. There were 766 deaths from drug and alcohol overdoses through September of this year, including 428 from heroin, which was on a pace to surpass last year's total.

About 19,000 people in Baltimore are estimated to use heroin. One hundred and fifty suffered fatal overdoses last year, a city task force reported recently.

Not everyone is convinced the state initiative will result in fewer deaths.

Dr. Michael Fingerhood, an addiction specialist and an associate professor at the Johns Hopkins University, said the state electronic medical records system is not always accurate.

Fingerhood said he checked recently to see if a patient had been prescribed narcotics after a hospital visit. The medical records didn't show a hospital visit.

He compared the plan with prescription drug monitoring programs that many states—including Maryland—have adopted. Research has shown no correlation between monitoring drug usage and a drop in drug overdoses, he said.

A study published in the journal Pain Medicine in 2011 found that prescription drug monitoring programs are an "important tool" in preventing abuse of drugs but achieved no drop in deaths. Monitoring drug usage also didn't result in reduced drug use, the study found.

"I think the less opiates that are prescribed inappropriately the better, and overall [the new program] is the right thing to do," Fingerhood said. "But to say that it is going to reduce deaths. The evidence is not there."

Fingerhood said he supports prescribing naloxone to all overdose patients.

The state hopes to extend its initiative to all hospitals in the state by March 13. Sharfstein said they would use the experience of physicians, overdose patients, outreach workers, and others to perhaps make reporting mandatory in the future, Sharfstein said.

"One of the greatest risks of dying from an overdose is almost dying from an overdose," he said.

Click here for a printable PDF