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Education, treatment at heart of opioid-epidemic legislation

Cecil Whig - 3/22/2017

ANNAPOLIS - Two pieces of legislation in the State Senate aim to initiate comprehensive reform in the way the state handles education and treatment relating to the ongoing opioid epidemic.

Maryland's opioid epidemic has taken center stage in the General Assembly's legislative session this year. On the session's opening day, lawmakers identified the crisis as one of their top priorities, and last month, Gov. Larry Hogan declared a state of emergency to address the crisis, increasing the number of available resources to deal with the epidemic.

In the Senate, two bills in particular have taken hold: Senate Bill 1060: the Heroin and Opioid Education and Community Action Act of 2017, introduced by Senate President Thomas V. "Mike" Miller Jr. (D-Calvert, Charles & Prince George's), and Senate Bill 967: Heroin and Opioid Prevention Effort (HOPE) and Treatment Act of 2017, introduced by State Sen. Kathy Klausmeier (D-Baltimore County), who serves on the state's heroin task force.

At press time, both bills had progressed through their first readings and received public hearings, but they had not advanced to their second or third readings.

The Cecil County Council decided Tuesday send a letter of support for Senate Bill 1060.

Miller's legislation would address the opioid epidemic by revamping educational resources related to drug abuse and by potentially expanding drug court programs across the state.

If passed, Senate Bill 1060 would require the State Court Administrator to assess drug court programs in circuit courts and the District Court of Maryland to determine how to ensure that drug court programs are sufficient to serve their county's needs.

Across the country, drug courts have risen in popularity as they rise in effectiveness. Offering alternative sentencing, treatment and education as alternatives to a typical jail sentence, drug courts have been shown to reduce recidivism rates. However, though they may be successful, they are labor-intensive and costly, requiring sufficient manpower to adequately serve those in the program.

On the education front, the Maryland State Board of Education would be tasked with developing a drug addiction and prevention program that includes information on heroin and opioids for students in elementary, middle and high school. Higher education institutions would also have to provide educational resources on the subject.

Additionally, school nurses must be trained to administer naloxone or another drug that reverses an opioid overdose. Local school boards must also hire community action officials to coordinate with local law enforcement, host forums and boost public relations efforts.

"What this is about is education," Miller said in a bill hearing, noting that while Maryland is fifth in the country in overdose deaths, its schools are also rated fifth in the nation. "It's about rehabilitation, and it's about treatment."

"This also requires funding. It requires the government putting money into the courts and it also requires the administration to put money into the Maryland State Board of Education for education dealing with this issue."

According to a policy analysis by the department of legislative services, the bill would increase the state's education spending by at least $3 million. Judiciary spending to expand the scope of drug courts would increase by $2 million in fiscal year 2019, according to the bill.

In preparing this legislation, Miller looked to other states, as well as within the state to Calvert County, to find policies that are successfully addressing opioid epidemics. He said the Calvert County Health Department's plan "could be a role model for everybody."

At the bill's hearing, Dr. Larry Polsky, director of the Calvert County Health Department, touted the health department's collaboration with schools to provide ongoing, repeated education on the topic.

Gene Ransom, CEO of the Maryland State Medical Society, testified in favor at a bill hearing.

"This is a really important issue and a really important step in the right direction," Ransom said. "We have a crisis. It's a public health crisis, and it's serious. According to preliminary data, it looks like for 2016, we're going to have a 72 percent increase in heroin deaths in Maryland."

"If we can educate children in public school ? it can save the system a lot of money and the people a lot of pain," he said.

Ransom said he sent every opioid epidemic-related bill to the American Medical Association to determine which would be most effective. This bill, as well as Senate Bill 967 - the HOPE Act - were identified as the two bills that would bring the most "comprehensive" approach in the country, Ransom said.

The AMA confirmed this exchange and called the bills "meritorious."

"This, combined with the HOPE Act, can make a real difference for Marylanders who are faced with this horrible crisis," Ransom said.

The HOPE Act would enact a number of sweeping changes, including the creation of a toll free hotline and 10 crisis treatment centers - with at least one in each geographic region in the state - that are open 24 hours a day and seven days a week.

The legislation also requires that every health care system and every health care facility has at least one doctor who can prescribe buprenorphine, an opioid treatment that is rising in popularity, for every 100 patients seen by the facility.

"With heroin and opioid deaths still rising in Maryland, I felt the overwhelming need to sponsor legislation to implement a system to effectively treat the users that need help and prevent others from falling victim to this terrible drug," Klausmeier said, explaining that expanding access to treatment is one of the bill's focuses.

Under the legislation, certain healthcare benefit plans must also provide residential treatment center benefits and outpatient and intensive outpatient benefits. Certain higher education institutions would be required to offer credits related to substance use disorders and pain management, a move that would better equip the state's medical workforce to deal with this issue.

Dr. Nancy Rose-Cohen, executive director of the National Council on Alcoholism and Drug Dependence, spoke in favor of the bill but requested amendments to further expand the number of clinicians who can prescribe buprenorphine and to require that hospital discharge plans use naloxone and peer support systems to improve recovery success rates.

Mark O'Brien, director of opioid overdose, prevention, and treatment for the Baltimore City Health Department, testified in favor of both bills. Like Rose-Cohen, he asked for amendments to improve the bill further. One amendment he suggested would be to have immediate treatment options ready for those who need it.

According to Senate Finance Chair Thomas Middleton (D-Charles), nobody opposed the bill, but the bill may require some refining.

"It's a good bill," he said, but "it needs some work."

Both bills have counterparts in the House of Delegates, where a host of other bills have been introduced to address the epidemic. One bill, introduced at the request of Hogan, would impose a 30-year sentence on anyone who distributes an opioid that results in an overdose death.

Another bill, the Prescriber Limits Act of 2017, would prohibit prescribers from prescribing more than seven days' worth of any opioid unless it is being used to treat cancer, substance abuse or another significant situation, while the Patient-Centered Opioid Addiction Treatment Act requires that opioid treatment programs meet federal standards.

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