As deaths from drug overdoses increase nationwide, Maryland Delegate Dan Morhaim, M.D. – also a practicing physician in emergency and internal medicine for more than 30 years – has introduced three bills to transform drug policy in the state. This groundbreaking legislative package, with multiple co-sponsors from across Maryland, would reduce the harms associated with substance abuse disorders, including rates of addiction, deadly overdose, the spread of infectious disease, crime, costs to the general public, and incarceration rates. H.B. 515 requires specified hospitals to establish a substance use treatment program, H.B. 488 removes criminal penalties for low-level, non-violent drug offenses under certain minimal threshold limits, and H.B. 519 permits the establishment of safe consumption programs which allow individuals to consume controlled substances in a safe space. (See detailed descriptions of all three bills below.)
“Maryland’s rising overdose death rate is an urgent public health crisis of historic proportions. We must adopt new and innovative solutions to stem the crisis and stop more families from experiencing this tragedy. Maryland has the opportunity to serve as a model for the country in treating drug use for what it is—a public health issue,” said Delegate Dan Morhaim, M.D. (District 11 – Baltimore County). “This legislation allows Maryland to adopt proven, evidence-based, and data driven approaches to best help drug users, their families, and the community,” said Morhaim.
More Americans now die annually from overdose than gun fatalities or car crashes. Over 30,000 Americans died from an opioid-related overdose in 2015, and in Maryland alone there were 1,089 opioid-related deaths. There has been a 60% rise in fatal drug and alcohol-related overdoses, and heroin deaths have increased by 186%, from 2010 to 2015 in the state. Further, a significant portion of patients who come to Emergency Departments (up to 60% in some cases) with generalized complaints have substance abuse disorders as an underlying cause. Almost two dozen countries have taken steps toward decriminalization of drug possession. The most well-known example of decriminalization policy is Portugal, which in 2001 eliminated criminal penalties for low-level possession and use of all illicit drugs. Studies of Portugal’s policy conclusively show that it reduces use and crime, reduces incidences of HIV/AIDS and overdose, increases the number of people in treatment, and reduces social costs of drug misuse. There are nearly 100 safer drug use facility programs operating in sixty-six cities in nine countries around the globe. Insite, Canada’s first safer drug use facility, has been an enormous success and has led to the expansion of such programs across that country. Numerous studies of Insite and other similar programs show that safer drug use facilities reduce overdose deaths, provide an entry into treatment, reduce public use and discarded syringes, are cost-effective and do NOT encourage or increase additional drug use, youth drug use, or crime.
"Millions have been touched by the growing opioid epidemic in our country, and policymakers in every state are urgently searching for solutions,” said Kaitlyn Boecker, Policy Coordinator for Drug Policy Alliance. “Fortunately there are innovative programs and policies that have been proven to work around the world. Maryland has the opportunity to be the first state to bring these common sense policies to the United States,” said Boecker.
Substance Use Treatment at Need in ERs and Hospitals (H.B. 515) – In Maryland, drug related deaths are on the rise. Associated harms, including drug-related crime and violence, the spread of HIV/AIDS and Hepatitis C, and the impact on health care insurance premiums and taxpayers are concerns for the state. Conservative estimates show that for every $1 spent on treatment approximately $12 is saved in criminal justice and health care costs. For a wide variety of reasons, hospitals are an excellent location to initiate treatment: hospitals are open 24/7/365; persons with substance abuse disorders frequent emergency departments for a wide variety of reasons; hospitals are well regulated and on public transit routes, and there are no NIMBY issues. This bill requires acute care hospitals to have an addiction counselor available or on-call 24/7, in person or via telemedicine, to discuss treatment options and insurance coverage with a patient that has been evaluated in the emergency department and to have defined arrangements for transfer to appropriate detoxification and rehabilitation care services.
Safe Consumption Programs (H.B. 519) – This bill permits the establishment of safe consumption programs which allow individuals to consume controlled substances in a safe space using sterile equipment, and provide opportunities to connect patients to treatment, medical care, and other social services. Similar facilities now operate in Europe, Australia, and Canada with excellent results and most recently here in the United States, the Mayor and Country Executive of Seattle/King County announced the region will open two such sites after a unanimous endorsement by the county Board of Health. Data shows that these programs lead to reduced crime and spread of disease, and increased participation in detox and treatment programs. And perhaps most importantly, overdose deaths among people who participate in these programs have been eliminated because medical staff is immediately available with rescue medications. H.B. 519 allows community-based organizations to establish such programs after obtaining approval from the Maryland Department of Health and Mental Hygiene or a local health department when specific criteria are met.
Drug Use and Possession Penalty Changes (H.B. 488) - Rather than reducing drug use, criminalizing substance abusers amplifies the risk of fatal overdoses and diseases, increases stigma, and drives people away from needed treatment and harm reduction services. Clearly our decades-old policy of incarceration and criminalization of possession of small amount of drugs has not worked. This bill would keep some drug users - those possessing minimal amounts - out of the criminal justice system, thereby saving critical resources and avoiding the costs of saddling more Maryland citizens with criminal records and their adverse consequences. The legislation would turn the first interaction with the law from a crime into a civil offense with a fine and referral for treatment. The second offense would lead to a larger fine and referral. If there were a third such offense, the person would then enter into the current criminal justice system. The bill would not change any penalties for possession of larger amounts or for drug distribution. When a person gets an arrest record, numerous doors close, making it hard to get education, jobs, housing and credit. Unfortunately, other doors open, often into the world of criminal activity. Essentially an extension of the 2016 Justice Reinvestment Act, which diverts non-violent offenders coming out of prison, this legislation would do the same thing, except that the diversion occurs before the person undergoes arrest, prosecution and sentencing.