Opioid abuse in Montgomery County is “an equal opportunity” menace that has hit “businessmen, professionals, schoolteachers, nurses” and so many others, said Alejandra Munoz, the sole case manager for a County program aimed at getting drug users into treatment rather than a jail cell.
“I have middle to upper class [people] and those with low social economic status. I have two grandmothers,” she said of the users she tries to get into the program called STEER, which stands for Stop, Triage, Engage, Educate and Rehabilitate.
Opioid-related overdoses are increasing rapidly here. Last year, there were 154 nonfatal opioid-related overdoses, a whopping 175 percent increase from 2015. During that same period, there were 56 fatal overdoses, a 9 percent increase between 2015 and 2016, according to Cpt. Paul Liquorie, director of the County Police Department’s Special Investigations Division.
Last month, seven people overdosed throughout the County between March 3 and March 5, he said. Four is the most overdoses the County has had in one day. That happened twice, on Sept. 3, 2016, and again on March 3, 2017, Liquorie said.
While no community is immune, Munoz said the places with the most opioid users are the Poolesville area, Silver Spring and Wheaton.
Eighty percent of those using opioids throughout the County are white males in their twenties and thirties, she said.
“Don’t think it’s the thugs on the corner. It’s the doctors,” Munoz said, referring to doctors who overmedicate or continue to medicate even after they are told that the patient has developed an addiction.
Munoz, a Gaithersburg resident, rushes to the hospital whenever the police or fire and rescue workers bring in drug users, no matter what time of the day they overdose.
The use of STEER to help stem the opioid epidemic here began March 1, 2016. It is funded by the County government and is a collaborative program with the police, the Department of Health and Human Services, the State’s Attorney’s Office, the Department of Corrections, and Maryland Treatment Centers.
Heroin itself is a highly addictive, rapidly acting opiate. But more and more frequently, the heroin sold here is being laced with even stronger synthetics.
When drug users are given a choice of purchasing a known drug like heroin or a stronger variety when they don’t even know exactly what’s in it, the users often go for the stronger choice to reach an even more powerful and more euphoric high, she said.
“Once your brain functions as an addict,” it takes more or stronger chemicals to reach the high they seek, Munoz said.
Sometimes the heroin is laced with fentanyl or carfentanil, both of which are synthetic opioids. Carfentanil is a tranquilizing agent for large animals, like elephants. It is 10,000 times more potent than morphine and 100 times more potent than fentanyl, according to the U.S. Drug Enforcement Administration.
Fentanyl is also an anesthetic.
When police or rescue workers get to someone who has passed out, they often give them Narcan, a prescription medicine that blocks the effects of opioids and often can revive the user. There are 138 officers in the County trained in the use of Narcan, as well as many emergency rescue workers.
During 2016, Narcan was used in 85 percent of the 154 opioid-related overdoses, Liquorie said.
Whenever Munoz is with users, she strives to get them into STEER. “The whole idea of this is to offer opportunities [for drug users] to get into treatment rather than just receive citations,” she said.
Often a drug user has numerous citations for minor crimes like urinating in public or causing a disturbance. These citations can mount up and may lead to jail time. But if the person agrees to enter the STEER program, all charges are pushed aside for one year in the diversion program.
If users do not have any charges against them but police were called to the scene of their overdose, they also can participate in STEER through its prevention program.
Under the program, drug users are sent to a treatment facility after a case manager fills out a screening form to determine such things as their age when they were first arrested and the number of arrests they have.
Another part of the screening is used to determine if the users are ready to be helped.
And many are not, said Munoz.
When Munoz is in a hospital room, she tries to talk to the person who overdosed but often cannot because of their medical condition or because they refuse to talk about their problems or their need for treatment. Some have even told her they enjoy their lifestyle and don’t want to quit.
But she doesn’t give up and instead talks to the family or friends who are visiting.
“I don’t give up,” she said.
Many of the people she tries to help started with marijuana. Many were on pain medications and opted for the less-expensive heroin when their prescriptions ended.
Forget the stereotypes, Munoz said. The users are rarely gang members or poor teenagers with nothing else to do, Munoz stressed.
Between STEER’s March 2016 start and February of this year, 157 people received referrals to the program. Of those, 37 agreed to treatment.
Munoz recalled “a young lady who OD’ed six times. She’s young, with a child. Twice I have gotten her into treatment, and she’s not ready. She just leaves.”
There are two reasons people use these drugs, Munoz said. They do it to feel good and be social, or they do it to feel better and to relieve their anxiety and depression, she said.
Ninety-seven percent of those with a substance use disorder do not seek help. They are either in denial or aren’t ready to be helped, Munoz said. Another 2 percent acknowledge they have a problem but don’t want help.
It’s only the remaining 1 percent that are willing to listen to her.
“My approach is in-your-face when you are most vulnerable. When you die and you are revived, I am in your face.”
She tells them to think of her as their own personal GPS. They are still the driver, but she can show them the right path. They just have to want it.