Fighting Opioid Addiction from Baltimore to Garrett County: University of Maryland School of Medicine Rises to the Challenge

The opioid epidemic has been deadly for Maryland. In 2016, more than 2000 people in the state died from overdoses; in 2017, deaths rose another 40 percent, and deaths from the powerful synthetic opioid fentanyl were up nearly 140 percent. Last year, Gov. Larry Hogan declared a state of emergency in response to the opioid epidemic, saying the state needs an “all-hands-on-deck approach.”

For more than a decade, the University of Maryland School of Medicine (UMSOM), in collaboration with the University of Maryland Medical System (UMMS), has been dealing with the epidemic, and has developed a range of innovative and successful efforts to help those who are struggling with opioid addiction.

UMSOM faculty are working in the community, and also doing key research on new ways to help those dealing with addiction and their families. Among the school’s projects in Baltimore and the state:

• Working with Emergency Department patients who come in with addiction problems;
• Developing viable needle exchange programs; 
• Setting up programs to prevent overdose, using buprenorphine and other approaches;
• Providing support to doctors who prescribe buprenorphine to ensure they use it safely and effectively;
• Setting up programs that expand access to buprenorphine treatment in rural areas;
• Working with the VA to help addicted veterans;
• Training police officers, firefighters and members of the wider community to administer naloxone to patients who have overdosed.

UMSOM has been a pioneer in studying and using evidence-based approaches to opioid addiction treatment. This effort includes clinical treatment and education. These endeavors include several long-standing clinical service and research grants, as well as work on committees and task forces dealing with the opioid problem. This includes work with overdose prevention groups, Baltimore City’s Baltimore Buprenorphine Initiative, the state’s buprenorphine expansion committee, and national groups addressing substance abuse education. Faculty have testified often to legislators in Annapolis about Medication-Assisted Treatment (MAT), drug overdose and naloxone availability, as well as needle/syringe exchange and safe consumption spaces.

Clinical initiatives

As the first hospital-based MAT program in the state of Maryland (started four decades ago), UMMC’s drug treatment center has long embraced a tradition of combining rigorous approaches with comprehensive treatment.

Expanding Treatment in Rural Areas: Once limited largely to urban areas, the epidemic has spread to rural counties across the state. Generally, these areas have little access to treatment. In 2015, faculty members from the department of psychiatry launched a new initiative to increase access to treatment. Faculty work with the Wells House program in Hagerstown to provide buprenorphine treatment to patients by way of telemedicine, using videoconferencing calls. The program has expanded from four hours per week at one site to 14 to 16 hours a week at three different sites, each in a different county (Washington County, Garrett County and Caroline County). Preliminary data shows the approach works. The program hopes to expand these services, and is preparing an NIH proposal to expand to other states with rural addiction issues, such as West Virginia and Ohio.

Maryland Addiction Consultation Service (MACS): UMSOM faculty have received a $1 million award from the Maryland Department of Health to develop telephone support for clinicians using buprenorphine to treat addiction.

UMSOM will also expand its services for deaf patient struggling with addiction. This program, which has been in existence for 16 years, is the only one in the country.

MSOM also recently received funding from the state to help establish a program that provides universal screening, brief intervention and referral for treatment for patients at the University of Maryland Medical Center Emergency Department. The funding funds three peer recovery coaches, who help patients with signs of substance use disorders and refer them for treatment and follow-up.

Emergency Department Buprenorphine Initiative: UMSOM researchers recently received a $200,000 Open Society Grant to develop ways to engage patients in Medication Assisted Treatment (MAT) in Baltimore hospital emergency departments. So far, the program has been initiated in six hospitals, including University of Maryland Medical Center, with plans to expand to all city EDs by the end of the fiscal year. This work has been done in collaboration with the Mosaic Group.

Collaboration with VA addiction services: In the past year, UMSOM faculty have worked closely with the VA to take referrals of veterans in need of MAT. The VA programs are filled, and cannot offer MAT services to everyone who needs it.

‌Christopher Welsh, MD, associate professor in the Department of Psychiatry, Eric Weintraub, MD, associate professor in the Department of Psychiatry, along with two other UMSOM clinicians, Jewell Benford, LCSW-C, and Denisha Pendleton, RN, work with the UMSOM Institute of Human Virology (IHV) and the Center for Disease Control (CDC) to develop MAT for opioid addiction in Kenya. The team established the Nairobi’s first methadone clinic, which has been operating for more than a year, and has treated more than 500 patients.

Education

The Addiction Medicine/Psychiatry Fellowship program, the only one of its kind in the state, has graduated 48 fellows.

Several faculty members played a key role in city and state initiatives to reduce heroin-related overdose fatalities by delivering naloxone administration training to police officers, firefighters, and members of the community.

Tuerk Conferences: Every April, UMSOM co-hosts the Tuerk Conference on Addiction Treatment. This is the largest single-day addiction conference in the country, with 1,600 attendees. The conference is the main educational event for the Maryland region on addiction treatment.

UMSOM faculty have also held free meetings discussing issues surrounding mental health and substance abuse. In June, more than 450 people attended a UMSOM symposium, “Not All Wounds Are Visible: A Community Conversation about Mental Health and Substance Abuse.”

Research Programs

‌UMSOM is also involved in several important clinical trials relating to opioid addiction.

Faculty are currently conducting a long-standing research program exploring psychosocial interventions to augment MAT. UMSOM scientists will also soon begin research to investigate markers of molecular stress in people diagnosed with opioid addiction.

‌Policy

In 2015, Gov. Hogan established the Maryland Heroin and Opioid Emergency Task Force, appointing as a member Bankole A. Johnson, MD, DSc, professor and chair of the Department of Psychiatry. The task force released a report calling for increased support for programs that target drug traffickers, Vivitrol options for people in treatment for addiction, more training for law enforcement, campaigns to increase public awareness of opioid use, and naloxone training and distribution.

UMSOM faculty have also provided advice to state legislators on harm reduction strategies to reduce the opioid epidemic, including offering recommendations for safe consumption spaces.