During the 2020 Maryland legislative session, the Overdose and Infectious Disease Prevention Services Program (HB464/SB990) was not passed. This bill would have authorized up to six overdose prevention sites that use a multifaceted public health approach to combat the opioid crisis. At these sites, people can use pre-obtained substances with immediate access to life-saving interventions, medical care and supportive services.
Over the past few years, the number of drug overdose deaths has increased dramatically in Maryland.
In 2018, nearly 90% of drug overdose deaths involved opioids with a total of 2,087 deaths.
Many of the existing programs for recovery are short-term and have strict abstinence requirements that make it difficult for individuals with substance use disorders to follow through with treatment. Overdose prevention sites use harm reduction interventions that focus on decreasing the negative consequences of substance use by providing an environment for safer use with medical staff onsite to administer overdose reversal if needed. Additional supportive services are provided that include but are not limited to recovery counseling, education about substance use treatment, basic medical care, housing referrals, applications for public benefits and legal services.
These concepts were first applied when sites opened in Europe in the 1990s, and there are now over 120 locations worldwide. In 2003, a pilot program called INSITE was implemented in Canada and after operating for three years, it was reported that 336 overdose events were prevented and that there was not one overdose death that occurred at the site.
Abstinence-based programs aimed at preventing misuse of drugs in youth have resulted in no effects or potentially harmful effects among that population. Meanwhile current research establishes that harm reduction interventions such as overdose prevention sites are a demonstrably effective approach to combat substance use disorders. These interventions are also effective in recruiting people with substance use disorders that other conventional treatment programs have difficulty reaching such as individuals experiencing homelessness.
There have been concerns in the past regarding the opening of these sites in the U.S. However, studies in other countries have found that these sites reduce the number of overdose deaths, reduce transmission rates of infectious diseases, and increase the number of individuals initiating treatment for substance use disorders. It has also been found that sites established in the past have not increased issues with public order such as drug-related crime, public injection, loitering or drug use in the areas where the facilities are located.
There are also various medical costs that are associated with injection drug use such as treatment of infectious diseases and soft-tissue infections as well as ambulance calls, emergency room visits and hospital stays related to overdose.
The Harm Reduction Journal published a report in 2017 that looked at the cost effectiveness of a potential overdose prevention site in Baltimore City. The report found that the annual cost of running a facility would be about $1.8 million while the savings generated from preventing medical costs associated with injection drug use would be $7.8 million. The study estimated that for every dollar spent on the facility would return $4.35 in savings and the annual net savings of $5.98 million was equal to 28% of the Baltimore City Health Department’s budget for harm reduction and disease prevention.
Although the Overdose and Infectious Disease Prevention Services Program was not passed in the 2020 legislative session, there has been more support and understanding from the Maryland General Assembly than in the previous five years the bill was introduced.
Health care providers, social workers and other advocates should continue their educational efforts in communities around overdose prevention sites to build a stronger foundation to pass the bill in the 2021 session.
— JUDITH PARK
The writer is a masters in public health and masters in social work student at the University of Maryland, Baltimore.