On the front line in Kent's war on drugs

CHESTERTOWN - The war on drugs has a new uniform. Deputies in Kent County have begun carrying a kit packed with a mask, a tieback suit, rubber gloves and a face shield intended to protect officers when they respond to possible heroin overdoses.

"We felt we needed to protect our people out here, responding to these calls," Kent County Sheriff John F. Price said.

In Kent County, and the entire state, heroin is becoming widespread in its use. On May 22, the county had its first death of 2017 due to a heroin overdose. There have been seven reported overdoses this year.

In 2016, five deaths and 19 overdoses were reported in the county.

Statewide, last year, there were 1,212 deaths due to heroin and 1,119 due to fentanyl, according to data from the Maryland Department of Health and Mental Hygiene.

Fentanyl, a substance that has high risk for addiction and can cause respiratory distress and death, is a large reason for heightened concern because in many cases heroin is being cut with the substance, according to the state Department of Health and Mental Hygiene.

Fentanyl started appearing in the county about a year and a half to two years ago, Price said. According to the DHMH report, fentanyl-related deaths began increasing in 2013.

Recently, a substance said to be 100 times more potent than fentanyl, carfentanil, has been seen in neighboring counties. At this time, Price said there have been no confirmed incidents of carfentanil in Kent County.

The threat of danger is real to law enforcement.

Price cited an incident May 25 when a Harford County sheriff's deputy and two EMTs received medical treatment after they responded to an overdose. The deputy was administered Narcan, a lifesaving drug that comes in the form of a nasal spray that ceases the effect of an overdose.

"After reading about those (incidents), I decided that we don't need to take any more chances with this. We need to give our people the protective gear that will protect them from any accidental exposures," Price said.

The concerns were first raised at a monthly meeting of an opioid intervention task force in Kent County, Emergency Medical Services Capt. David Rice said.

EMS personnel carry a protective equipment kit, which consists of disposable gloves, masks, a smock-type gown, foot cover and eye protection. Rice said this is used regularly for blood-borne pathogens and infection control.

"(It) basically is a barrier from getting that skin contact or the dust being blown into their mucus membranes, like their eyes, their nose and their mouth inadvertently. It allows them a little bit more protection to prevent an accidental overdose while rendering aid or otherwise," Rice said.

Because the sheriff's office responds to cardiac arrests and medical calls, there is a risk that the person is overdosing or potent substances could be on location when deputies are rendering aid.

"Every ambulance in the state of Maryland, every EMS unit, carries this same style PPE kits. So it was only prudent when the sheriff raised his concern for the EMS department to provide the sheriff's department with some of the PPE kits," Rice said.

When Gov. Larry Hogan declared a state of emergency due to the opioid crisis on March 1, he asked county directors of emergency services to take a more active role in combating what has been called a drug epidemic.

That is how Wayne Darrell, Kent County's director of EMS, became involved.

"We did some gap analysis on what we think we need here in Kent County. We're feeding that information back to the state through the Opioid Operational Command Center and coordinating that," Darrell said.

In addition to the PPE kit, last month Kent County's deputies started to carry two doses of Narcan rather than just one.

"One, in many of the cases, wasn't enough. Then also we were careful that after they administer the one, they may also be exposed and one may have to be used on them," Price said.

Additionally, addicts may not respond to one dose of Narcan due to what they may have in their system at the time, Darrell said.

This month, Dr. Howard Haft, DHMH secretary for public health services, issued a statewide standing order that allows pharmacists to dispense Narcan to anyone who is at risk for overdose or in the position to administer aid to a person experiencing an overdose.

This order replaces the one issued in 2015 that stated individuals had to be trained and certified under the Maryland Overdose Response Program to obtain Narcan.

The training is vital, said Local Addictions Authority for Kent County Tim Dove.

"We just give you basic information about it, we go over what the signs and symptoms of overdose look like, which you would not get (by going to the pharmacy)," Dove said. "The medication is great, but what happens if you don't know what to look for? That's imperative, to have that piece."

They explain what the signs and symptoms are - down to the pupil size, skin color and breathing. They also explain what comes after administration of the medication.

"Those are paramount things to look at because if you administer the medication and don't put somebody in rescue position, and they regurgitate and aspirate, then you've done something wrong, and then they could end up dying from the aspiration," Dove said. "So the information we provide is crucial, also, not just administering medication, but allowing them a greater chance of survival after the fact."

The training is not a lengthy process, Dove said, and the Kent County Health Department provides free access to the medication.

"All they have to do is contact myself, and we will come to them free of charge," he said.

Dove said they have been dispensing the medication at an alarming rate because "we're having people overdosing quite a bit," he said.

This week, Baltimore health officials announced they were running low on Narcan and have been rationing, according to a Baltimore Sun article.

The Chestertown Police Department has scheduled training for Narcan with the health department, to be completed at the end of the month.

Police Chief Adrian Baker was aware of the opportunity two years ago but said he declined at that time because, within Chestertown, the response of the Kent-Queen Anne's Rescue Squad is almost immediate.

"If we're on the scene of an overdose, or something that ends up being an overdose, they're there within minutes, also. The expediency didn't seem to be a necessity," Baker said.

That was until fentanyl and carfentanil became more prominent.

"The incidental exposures are of great concern," Baker said. "I just think it's a ?better safe than sorry.'"

For safety, too, Price and Baker said for the past year, they have ceased field testing drugs because the risk of exposure to fentanyl is too significant.

"It's something we're taking very serious. We'll do everything we can to mitigate the risk," Baker said.

The accessibility of Narcan skews the statistics depicted on signs in Chestertown, Rock Hall and Millington that are updated monthly with the number of overdoses and deaths.

Price acknowledged the overdoses go under-reported, as families have been able to obtain a prescription for Narcan from a physician if they, or a family member, is addicted to an opioid.

"We know the signs don't reflect a true picture of overdoses in our county because some of these folks are overdosing and then being Narcan-ed at home by a family member or a partner," Price said.

There are two reasons for the signs, he continued.

"The first is to increase awareness of the problem. (Then) there's a number to call for treatment or intervention. It's not to belittle or shame - it's to create awareness," he said.

Kent County State's Attorney Harris Murphy said the awareness exists now, but he and Price agreed the drug abuse problem is getting worse.

In Kent County, residents can access treatment through the A.F. Whitsitt Center, which has 40 beds and four crisis beds.

There are also three private providers within the community that are dual-licensed, providing mental health and substance abuse services, Dove said.

"(This) has opened up a brand new scope of services for residents. ... If they have an underlying bipolar disorder, or anxiety, or depressive disorder, they are able to see a psychiatrist, a therapist and have also their addictive disorders treated under that one umbrella," he said.

In 2015, Murphy helped launch PAST - Post Adjudication Supervision and Treatment - a program that is meant to help criminal offenders who have an addiction. Murphy screens individuals with substance abuse problems who have been charged with nonviolent offenses and have no significant criminal record.

The individual enters a guilty plea and the courts defer sentencing, while establishing conditions that must be met. With successful completion of the program, the state dismisses the charges and there is no conviction on their record.

A total of 25 people have enrolled in PAST, with nine successfully completing it, Murphy said.

"Our goal was to reduce recidivism or re-arrest by 40 percent and as a result, we've done even better than that. ... It is beyond our expectations," said Dove, who is affiliated with the program.

There were millions of pain prescriptions written in 2015, Murphy said. Abusing prescription drugs is how many heroin users start.

"Yet, for some reason, it seems to be the criminal justice system that has been primarily tasked with addressing the fallout," he said. "Fortunately, I believe this reality is finally sinking in. We see a lot more attention at the state and federal levels to more comprehensively and effectively deal with this multifaceted problem."

The phone number on the bottom of the awareness signs in Kent County directs the caller to the health department, but Price said anyone suffering from an addiction can call the sheriff's office at 410-778-2279 and ask for him personally.

"We're not going to arrest our way out of this problem," Price said. "If someone needs help, we're not going to turn our back. We're going to try to direct them and help them along the way within our ability to do so."