Pill bottles lined up on table

Jane Smith,* 39, struggled with opioid addiction after being prescribed Percocet for chronic pain that arose after major surgery.

"My prescription made me feel better emotionally," Smith says. "I felt that I wasn't doing drugs because I wasn't touching the street stuff. It was just the medication that the doctors gave me."

Over time, Smith needed more Percocet to function normally. "If I didn't have four to six Percocet every four hours, I'd feel so sick that I couldn't get out of bed," she says. As a mother of seven, Smith needed to be able to take care of her kids—even if it meant taking more Percocet.

After building up a tolerance to her prescription, she began buying opioids off the street and was eventually arrested and incarcerated. "My children were separated. My marriage suffered. I lost my house. I lost everything," she says.

While incarcerated, Smith committed herself to entering treatment for her addiction disease. When she was released from prison and returned to her family, she enrolled in a program at the Center for Addiction Medicine (UM CAM) at the University of Maryland Medical Center (UMMC) Midtown Campus. She currently takes buprenorphine, a medication that blocks opioid cravings, and attends counseling.

"I'm finally going back to the person that I used to be," Smith says. She has been in recovery since entering UM CAM's program in 2017.

Smith's story is familiar to many Marylanders. The opioid crisis touches every part of the state. Harford County saw a 173 percent increase in opioid-related deaths from 2013 to 2017, and Baltimore City saw a 69 percent increase. Similar statistics are found in counties across Maryland. Opioid overdose is among the state's top four causes of death.

UMMC has taken many steps to combat Maryland's opioid epidemic.

*Not her real name

Looking Inward

For many, addiction begins in the doctor's office. UMMC's Opioid Stewardship Task Force was established in 2017 with this in mind. One of the task force's top priorities is to educate physicians on how to responsibly prescribe opiates.

"We produce a monthly report that shows providers what medications they're prescribing. If someone utilizes opiates more than their colleagues, we address their prescribing practices and work to cut down on their opiate prescribing," says Christopher J. Welsh, MD, associate professor of psychiatry at the University of Maryland School of Medicine (UM SOM) and medical director of Outpatient Addiction Treatment Services. "We're increasing our training of all clinicians across the board," he says. To bolster this effort, the task force has streamlined processes so doctors can better understand patients' opioid histories.

The task force has also created processes within the emergency department (ED) at both campuses to address opioid abuse.

"We screen all ED patients for their risk of opioid abuse disorder," says Janine L. Good, MD, associate professor of neurology at the UM SOM and chief medical officer at UMMC Midtown Campus, who established the task force. "If they come into the ED with an opioid overdose, we engage a trained 'peer recovery coach' to intervene and guide them to treatment. These are people in recovery themselves who engage with patients in the ED and, based on the patient's risk, encourage them to enter a treatment program."

The peer recovery program has seen great success. By December 2018, UMMC's provides campuses had referred 4,480 patients to treatment.

The pipeline from the ED to treatment engages patients when they need help the most. Unlike many other U.S. hospitals, UMMC's doctors can prescribe buprenorphine in the ED.

The task force also makes an effort to influence state policy. "We are at the table advocating on behalf of the complex pain patients we treat at our hospitals and on behalf of our doctors caring for patients," Dr. Good says.

The task force also collaborated with the Baltimore City Health Department's formation of a ranking system to measure each hospital's capability and resources to combat the opioid epidemic. UMMC's campuses are the only two hospitals in the city that were awarded top ranking. "We are leaders in the state for dealing with opioids," Dr. Welsh says.

A Medical Approach to Addiction

Maryland has one of the five highest opioid-related death rates in the U.S. Despite this number, the stigma surrounding addiction continues to be an obstacle to treatment. "People are ashamed. Sometimes they refuse evidence-based treatments because they are pressured by people in their lives to avoid taking the medications that can help," says Eric Weintraub, MD, associate professor of psychiatry and director of the division of addiction research and treatment at the UM SOM.

To combat this stigma, UMMC offers addiction treatment centers that take a medical approach. A combination of counseling, detoxing or taking medications that curb opioid cravings helps patients recover.

"The medical model that we follow affords more respect for our patients' medical issues and diminishes some of the stigma," says Marian Currens, NP, director of UM CAM.

Each clinic works to treat the entire patient, not just the addiction. Aside from counseling services, some clinics offer additional health services. One clinic partners with the Institute of Human Virology to treat infectious diseases such as hepatitis C and HIV, which are more common among people with an addiction disorder. They have recently expanded the practice to offer primary care services. They also established a drop-in center that provides a safe place for clients to relax with snacks and games.

Another UMMC clinic focuses on female patients and pregnant women with opioid use disorders. "The clinic has a play center where women can leave their children while they're in counseling. It removes a barrier to treatment," Dr. Welsh says.

Fostering Awareness

Public awareness is essential to fighting the opioid epidemic. UMMC's Community Health Improvement Team fulfills this need by circulating information about opioids at community events throughout West Baltimore.

"We have a handout that helps the general community understand the types of drugs that are out there, how they can identify if their loved one has an addiction problem and where they can go for help," says Anne D. Williams, DNP, director of community health improvement.

"One of the main things people can do to get drugs off the street is to remove old medications from their homes and dispose of them appropriately," Williams says. To facilitate this, the team provides information about drug take-back locations across Maryland. UMMC pharmacies have their own drug take-back bins.

"This problem has so many facets, and the community should take this seriously," Williams says. "They should try to get themselves or their loved ones help. Dispose of your medications properly, and if you're actively using pain medications, then make sure they are locked up."

"This is a deadly epidemic. It cuts across all segments of society. We all need to pull together to combat this disease," Dr. Weintraub says.

If you or a loved one has an opioid addiction, please call:

UM Center for Addiction Medicine: 410-225-8240
UMMC's Outpatient Addiction Treatment Services: 410-328-6600
UMMC's Women's Mental Health Program: 410-328-6091