By Alison Knezevich
The Baltimore Sun
BALTIMORE — Inmates finishing their time at Baltimore-area jails will leave with something public health officials hope will save lives — kits containing the overdose antidote naloxone.
The plan is part of a statewide push to teach people to recognize signs of an opiate overdose and increase access to naloxone.
Health officials say recently incarcerated people are particularly susceptible to overdosing — without access to drugs in jail, their tolerance has dropped. And they often associate with drug users.
“We’re trying to make sure that the naloxone is in their hands when they leave,” said Mary Viggiani, a program manager with the Baltimore County health department. “A very high percentage of people incarcerated are substance users.”
Five counties, including Baltimore County, are receiving state funding to pay for naloxone kits as an expansion of a pilot program the state Department of Health and Mental Hygiene launched in Southern Maryland jails this year. Anne Arundel, Frederick, Harford and Washington counties are also getting new funding.
The idea is to target a high-risk population, said Erin Haas, local programs manager for overdose prevention at the state Behavioral Health Administration. Many local health departments already provide services within jails.
The state is encouraging counties to consider having “peer recovery specialists” — those in recovery who are trained to help others — teach inmates about naloxone, she said.
Distributing naloxone to inmates being released was among the recommendations made last year by the state’s Heroin and Opioid Emergency Task Force. The state is now spending about $150,000 annually to do so, health officials said.
In Baltimore, the city health department has held naloxone training in the detention center for years. The New York state prison system is also trying the idea, having launched a pilot program last year.
Baltimore County plans to train about 300 inmates beginning in January, Viggiani said. Each will receive an overdose response kit with two doses of Narcan nasal spray, a form of naloxone.
Calvert County was among the jurisdictions that participated in the state’s pilot program. Dr. Larry Polsky, the county’s health officer, said about 60 percent of inmates at the detention center over the past six months have a history of opioid use.
He said the county has trained more than 230 inmates to administer naloxone. A key part of the program is that inmates can receive a naloxone kit when they leave the jail, he said.
“They don’t have to go to a pharmacy, they don’t have to come to the health department,” Polsky said. “They already have the naloxone ready for them.”
The program is open to all inmates, he said. Those with sentences longer than 30 days are automatically enrolled in training.
Even if someone has not said they have a history of opiate abuse, they may know people who do, Polsky said. Or, they may not have admitted to drug use during evaluations.
The training sessions give staffers an extra opportunity to discuss behavioral health services within the jail and in the community, he said. About 90 percent of inmates with substance-abuse disorders also have other mental health issues — including depression, post-traumatic stress disorders, anxiety and schizophrenia.
The Anne Arundel County program began this year at the Ordnance Road Correctional Center.
“An awful lot of people come in the door with an addiction,” said county jails superintendent Terry Kokolis. “We try to take a target audience and provide the training and hope that they can make the difference to save somebody’s life.”
Mike Gimbel, former director of the Baltimore County Office of Substance Abuse and now a private consultant, said he worries the government has placed too much emphasis on the heroin antidote.
“Narcan does not change the behavior of a drug addict,” he said. “It does not get to the root cause of why they’re using drugs.”
Gimbel, who abused heroin before getting sober more than 40 years ago, said naloxone “is an amazing drug” that saves lives. But “until we beef up the treatment system, having Narcan is a temporary solution at best,” he said.
The jail programs are part of a larger effort to train Marylanders to administer naloxone.
Over the past few years, more than 39,000 people in the state have been trained to administer the drug, according to the state health department.
Last year, the department issued a statewide standing order to allow all Maryland pharmacists to dispense naloxone without a prescription to anyone who’s been trained under the state’s Overdose Response Program.