James T. Yoe, director of the Office of Applied Research and Evaluation at the Maryland Department of Health’s Behavioral Health Administration, is the “keeper of the data” about opioids in the state, presented much of that data to attendees in a preconference workshop at the American Association for the Treatment of Opioid Dependence (AATOD) conference in Baltimore October 31. Data is essential for the operation of the State Opioid Response (SOR) funding, he said. “Data is integral to the way we’ve been managing our SOR missions,” he said.
Sources of data include:
- Unintentional intoxication death data 2007 – 2022
- Public Behavioral Health System (PBHS) service claims
- CRISP (health information exchange) public health dashboard tool
- PDMP (prescription drug monitoring program)
- National Survey on Drug Use and Health
- US census bureau 2020
- SOR progress report from program providers
- OTPs in Maryland needs assessment report September 2022
- Maryland State Opioid Response-Stimulant use focused data study
Yoe puts the whole data picture together, to come up with the many many statistics: here are a few.
- Of the 6 million people in Maryland, 3.5%, or 208,587, were estimated to have misused opioids in 2020; of these, about 46,000 have an opioid use disorder (OUD)
- There were 2,499 opioid related overdose deaths in 2020 ,representing 5.4% of people with OUDs
- There are 33,836 people in OTPs (public only, the state didn’t have data on proprietary programs)
- OTP capacity in Maryalnd can treat about 34,545 individuals a year (this includes some of the office based opioid treatment programs)
Most of the OTP capacity is in Baltimore and Anne Arundel counties (these are the areas where the need is greatest, so that is good).
Methadone and buprenorphine treatment, naloxone
Treatment for OUD with medications is increasing. According to the PDMP, which only records treatment with buprenorphine, there has been a 55% increase. Buprenorphine is more likely to be going to a younger group or individuals under age 25.
Peer support has been a big component of the SOR initiative, with many peer workers involved in naloxone distribution (the biggest part of harm reduction according to data).
OD deaths
Despite some of the good news, the trends in overdose deaths until recently have been rising, more than doubling in the state from 2015 to 2021. This is due to illicit fentanyl, which is so lethal. Half of the deaths have been in people who are 45 years of age or older, according to Yoe.
Male deaths outpaced female deaths by three to one, and Black OD victims were more likely to die than White OD victims.
Many people who died had received treatment. In fact, deaths among PBHS service recipients increased by 87% since 2016, said Yoe, many of whom had received treatment within the last 30 days before their death. Those receiving both mental health and substance use disorder (SUD) services had the greatest increase in deaths.
More than 80% of the stimulant-involved deaths involved opioids, added Yoe.
Asked why people with OUD who were in treatment were more likely than those with OUD who weren’t in treatment to die from an overdose, Yoe speculated that “we may not have targeted those groups that really needed treatment the most.” It is those groups who are driving the deaths, he said. “We need to do more outreach, and there’s a lot of work now looking at how to do outreach with those populations.”
Also, on a more hopeful note, the trend in overdose deaths is down especially after the third quarter of 2021, almost down to 2019 levels, Yoe added.
Stay tuned for Part 3 of SOR in Maryland.