One Bill Creates a Safe and Supervised Space for People to Use Drugs; The Other Would Establish a Pilot Program to Treat Opioid Dependence with Poly-Morphone Therapy
Proposals are Part of Groundbreaking Package of Harm Reduction Drug Policy Bills That Would Also Decriminalize Small Amounts of All Drugs and Provide Treatment-at-Need in ER’s and Hospitals
Tuesday at 1pm, the Maryland House of Delegates will hold legislative hearings on two progressive legislative proposals aimed at treating drug use as a health issue. House Bill 1212 permits the establishment of safe consumption programs, which allow individuals to consume controlled substances in a safe space, provide sterile equipment, and connect patients to treatment, medical care, and other social services. House Bill 1267 tasks the Department of Health and Mental Hygiene with creating an advisory committee to review research proposals and support the establishment of a 4-year poly-morphone-assisted treatment pilot project in Maryland. Testimony on both bills will be heard in the Health & Government Operations Committee at 1:00 p.m.
The University of Maryland Department of Psychiatry has already stated its support for these bills and said, “If the legislation is passed, the Department would seriously consider establishing pilot programs to evaluate these interventions.” Christopher Welsh, a physician at the University of Maryland specializing in addiction treatment and behavioral health and who will be testifying in support of the bills, further stated: “Safe consumption programs and poly-morphone-assisted treatment have been shown to help reduce opioid overdose and to engage 'harder-to-reach' individuals in various forms of medical and social care as well as more 'traditional' drug treatment.” He continued, “We at the University of Maryland School of Medicine Department of Psychiatry are interested in supporting various measures that might help individuals using opioids as well as the general public.”
HB 1212, introduced by Delegate Dan Morhaim, would permit the establishment of safer drug use facilities which provide a hygienic and safe space for drug users to consume pre-obtained drugs under the supervision of trained staff. Facility staff members would not directly assist in consumption or handle any drugs brought in by clients, but are present to provide sterile equipment and supplies, answer questions on safe consumption practices, administer first aid if needed, and monitor for overdose. Staff also offer general medical advice and referrals to drug treatment, medical treatment, and other social support programs.
Safer drug use facilities aim to reduce health and public order issues by targeting high-risk, socially marginalized drug users who would otherwise inject in public spaces, including on the street or in public restrooms. There are approximately 100 such programs operating in 66 cities around the world in nine countries (Switzerland, Germany, the Netherlands, Norway, Luxembourg, Spain, Denmark, Australia, and Canada).
“Though it may seem counterintuitive, providing the most hard-to-reach users with a supervised space to consume their drugs actually provides immense public health benefits, including increased rates of entry into detoxification services and treatment, as well as public safety benefits, like decreased crime and public nuisance, including reduction of open-air drug markets, public injection, and improperly discarded syringes,” said Delegate Morhaim.
Indeed, hundreds of evidence-based, peer-reviewed studies have proven that safer drug use facilities reduce overdose deaths, do not encourage additional drug use, provide an entry to treatment and even abstinence, reduce risky injecting and transmission of infectious diseases, including HIV, hepatitis C, and hepatitis B, improve public order by reducing discarded syringes and public injecting, reduce crime, and are cost-effective.
Fareen Karachiwalla, a family doctor from Canada (home to Vancouver’s Insite, the most extensively studied safer drug use facility in the world) who recently completed her Master’s in Public Health at Johns Hopkins University, supports the bill. “I am a family physician that works primarily with street involved drug users, and so I know the power of a strong, therapeutic relationship. Every day our nurses visit community drop-in centers to provide clean drug use equipment and chat with users—similar to what a nurse would do at a safer drug use facility—but there are still many users we simply cannot reach,” said Karachiwalla, “Being able to engage these users at a safer drug use facility will provide opportunities for them to build a trusting relationship with healthcare providers, and hence lead to increases in the uptake of addictions counseling, detox, and treatment.”
Poly-morphone-assisted treatment refers to the administering or dispensing of pharmaceutical–grade heroin, hydromorphone, or other opioids to a small and previously consistently unresponsive group of chronic heroin users under medical supervision in a specialized clinic. The most widely studied form of poly-morphone assisted treatment is heroin-assisted treatment, which has been scientifically proven as an effective and cost-saving strategy for reducing drug use and drug-related harm among long-term heroin users for whom other treatment programs, like residential rehabilitation or methadone, have failed.
Though heroin-assisted treatment programs currently serve nearly 3,100 patients in over 50 clinics in five different countries (including in the United Kingdom, Switzerland, the Netherlands, Germany, and Denmark), with additional clinical trials currently operating in Belgium and Canada, Tuesday’s hearing marks a significant step toward the development and implementation of a similar pilot project in the United States.
“Giving people who struggle with addiction access to pure, legal heroin may sound radical at first, but there are good reasons why it’s now official policy in many European countries,” said Lindsay LaSalle, staff attorney at the Drug Policy Alliance. “It cuts crime, and overdoses, and helps people addicted to heroin for whom nothing else has worked – and even saves taxpayers money. That’s why it’s supported not just by public health officials but police chiefs as well.”
Virtually every published evaluation of heroin-assisted treatment has shown extremely positive outcomes: major reductions in illicit drug use, crime, disease and overdose; and improvements in health, well-being, social reintegration, and treatment retention. HB 1267, introduced by Delegate Morhaim, would simply allow researchers in Maryland to test whether poly-morphone assisted treatment, including heroin-assisted treatment, would yield similarly positive outcomes over a four-year pilot project study.
“As an emergency medicine physician and faculty at the John Hopkins Bloomberg School of Public Health and University of Maryland, I believe everyone should have access to scientifically proven medical interventions like poly-morphone-assisted treatment,” said Delegate Morhaim. “We can no longer allow politics to trump science when it comes to addressing the addiction crisis we are facing in this state and the nation at large.”
Beth McGinty, Assistant Professor in the Department of Health Policy and Management and Co-Deputy Director for the Center for Mental Health and Addiction Policy Research at the Johns Hopkins Bloomberg School of Public Health, who will be testifying at the hearing, agrees: “Strong research-evidence shows that poly-morphone assisted treatment reduces the negative consequences of injection drug use and increases rates of engagement in treatment and other social services that lead to recovery. Such a treatment program is a critical piece of an evidence-based approach to addressing opioid use, addiction, and overdose in Maryland.”
Addiction Treatment-at-Need and on Demand in ERs and Hospitals – 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. This bill requires acute care hospitals to have an addiction treatment counselor available or on-call 24/7 to patients in emergency rooms and in-hospital and to have defined arrangements for transfer to appropriate detoxification and rehabilitation care services. The bill also calls for the State’s hospital regulatory agency (HSCRC) to develop cost-effective strategies to support hospital capital and operating expenses.
Decriminalization of Small Amounts of Drugs for Personal Use - 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. 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. In 2001 Portugal became the first nation to eliminate criminal penalties for low-level possession and use of all illicit drugs. The Cato Institute studied the results of Portugal’s policy and stated “none of nightmare scenarios…from rampant increases in drug usage among the young to the transformation of Lisbon into a haven for drug tourists has occurred.” Furthermore, “decriminalization has had no adverse effect on drug usage rates”, and the level of drug trafficking has also declined. And the incidence of other drug-related problems, including sexually transmitted diseases and deaths from drug overdoses, has “decreased dramatically.”