Looking back, it was obvious to Taylor Sprague's family that she used heroin. She often nodded off, her skin broke out and she lost pride in her appearance. There was even a pair of tweets posted publicly for anyone to see.
"Will someone tell me when I became an addict I seem to have missed that part of my life??" Sprague wrote on Twitter in December 2014. "I guess I was just too ... high, right?"
But the family didn't realize she was an addict until New Year's Eve morning 2015, when a police officer arrived at their home in Eldersburg. The officer said Sprague, the 21-year-old UMBC student who had interned at the Library of Congress and served as a page in the General Assembly, overdosed and died.
"She doesn't have a heroin problem," Kerri Sprague, Taylor's mother, recalled thinking. "How could this happen?"
Taylor Sprague was among the last of 1,089 people in Maryland to die from an opiate overdose in 2015, and as the new year rolled around, the epidemic's death toll continued to mount. Final data for 2016 is expected to show that some 2,000 people in Maryland died after overdosing on heroin or other opiates.
Researchers at Johns Hopkins Bloomberg School of Public Health recommend that Baltimore turn to an unorthodox way of dealing with its heroin epidemic by opening two facilities that provide people a safe place to do drugs.
In a report published and commissioned by the nonprofit Abell Foundation,...
Researchers at Johns Hopkins Bloomberg School of Public Health recommend that Baltimore turn to an unorthodox way of dealing with its heroin epidemic by opening two facilities that provide people a safe place to do drugs.
In a report published and commissioned by the nonprofit Abell Foundation,...
Opioid overdoses now rank among cancer, strokes and heart attacks as the top killers in Maryland. State health officials say their goal for the next two years is to slow the rate at which the problem is worsening.
"Unfortunately the resources aren't there," Kerri Sprague said, echoing a conclusion reached by many officials and medical professionals. "The people outside of these families don't like that resources would go to that — they think 'why would we put money towards junkies?'"
Gov. Larry Hogan and members of the General Assembly are now scrambling for fresh ideas. Amid a $544 million state budget shortfall, Hogan plans to announce funding Wednesday to fight the heroin epidemic. On Monday, legislators launched a work group to study 25 bills that would address opioid and substance abuse.
There is little consensus on how to use the state's limited resources. And there could be even less money available if Congress and President Donald Trump follow through on a promise to repeal the Affordable Care Act.
"We know what people need. Money is going to keep us from being able provide everything that people need," said Del. Eric Bromwell, a Baltimore County Democrat who has put together a package of legislation to address the epidemic.
Doctors and advocates for addicts say the most pressing need is boosting the number of people able to get into treatment. Dr. Leana Wen, the Health Commissioner for Baltimore, called the overdose death figures "horrific" and said they won't come down until more people are helped.
"We know that treatment works, that recovering is possible," she said. "We desperately need funding for treatment."
There's a yawning gap to fill. A study conducted for the state Department of Health and Mental Hygiene late last year found Maryland can provide methadone or buprenorphine — drugs widely considered critical to treating heroin addiction — to 30,000 patients. That's half of what is needed, the study concluded.
The department says the number of people receiving buprenorphine has grown dramatically in recent years and that steps are being taken to increase the availability of treatment. A new federal rule is expected to allow nurses and physicians assistants to prescribe buprenorphine, a measure the department endorses, and the state recently obtained federal permission to use Medicaid to pay for more inpatient treatment for addicts.
The federal government is also expected to provide the state $10 million for drug treatment under a law passed last year.
But potential repeal of the Affordable Care Act and the resulting loss of funding to expand Medicaid to poor, childless adults looms over everything.
That money — a projected $215 million for the coming year — accounts for three quarters of federal contributions to Medicaid for substance abuse treatment, according to state budget analysts.
"Some of the changes that they're suggesting would definitely decimate the good work that's being done," said Del. Kathleen Dumais, a Montgomery County Democrat who is vice-chair of House Judiciary Committee.
Effects of fentanyl
Meanwhile, the problem is getting worse. Officials blame fentanyl, a powerful opioid being mixed with heroin. Health authorities in Maryland began warning in 2014 that the drug was causing a spike in overdose deaths.
Officials say fentanyl is almost irresistible to heroin dealers. They estimate that a kilogram of Mexican heroin costs $64,000, and acquiring it means dealing with dangerous drug cartels. Fentanyl, which is 50 to 100 times stronger than heroin, can be bought for as little as $2,000 a kilogram and is shipped through the mail from China.
China has moved to crack down on suppliers of the drugs at the urging of the U.S. Drug Enforcement Administration, but suppliers have tweaked their chemical formulas to evade the rules.
Van Mitchell, the former state health secretary, said fentanyl caught everyone by surprise. The drug's sheer potency challenges the usual ideas about how to battle overdoses.
"You can have all the treatment you want but if they're taking fentanyl ... they're not going to be in treatment," said Mitchell, who departed as health secretary in December. "They're going to be dead."
The night Taylor Sprague died, her boyfriend bought a bag of fentanyl-laced heroin in Baltimore. He overdosed on his first hit.
Sprague then called paramedics, who adminstered the life-saving drug naloxone. As her boyfriend was transported to the hospital, she was left alone in the middle of the night with the rest of the deadly batch of heroin.
When her boyfriend was released from the hospital the next morning and returned to the lot where they had parked, he found Sprague dead.
Kerri Sprague points to the episode as an example of how well-meaning policy changes could contribute to harm. She worries that a new law shielding addicts from legal consequences if they report an overdose left her daughter vulnerable.
She wonders if a more aggressive police response might have gotten her daughter out of a dangerous situation.
"I don't think she was trying to overdose," Kerri Sprague said. "I think she was just trying to escape the moment."
Other policy changes could also have unintended consequences, medical professionals say. The Turning Point methadone clinic in Baltimore has worked with addicts since 2003 and now serves some 3,000 people. Its director, the Rev. Milton Williams, said the center could be hurt by a new rule that lets clinics earn more money by offering more counseling services, which doctors say is an important element of treatment.
Previously, clinics would receive a flat rate for providing patients with methadone and minimal counseling each day. Starting in April, those clinics can bill separately for the drugs and counseling.
So, while Williams can make more money by providing more counseling, he worries that some addicts unwilling to do more will be alienated.
"We want to get not the cream of the crop," he said, "we want to get the worst of the worst."
Treatment alternatives
Without significant sources of new money to boost treatment efforts, Hogan and Democrats in the General Assembly have crafted legislation addressing the problem in other ways.
While their ideas are not incompatible, Bromwell said there is a difference in emphasis.
"I think we're more focused on prevention of people becoming addicts, not necessarily what to do with drug dealers," said Bromwell, who is vice chairman of the Health and Government Operations committee.
The Democrats' most sweeping proposal would create 24/7 crisis centers across the state, publicize a hotline number for people seeking help with addiction and mandate increased payment rates for treatment in line with inflation — a step advocates say is vital if treatment providers are to retain well-qualified staff.
Several other bills have also been introduced in Annapolis, proposing everything from rewriting rules for recovery homes to creating centers where addicts could safely use illegal drugs.
Hogan signed an executive order this year creating a new command center designed to better organize the state's response and proposed bills that would limit how many pain pills doctors can prescribe to new patients and mandate stiff prison terms for people who sell drugs that lead to a fatal overdose.
Republicans and Democrats agree something must be done.
"We have to be all in," said Del. Nic Kipke, the House Republican leader. "We have to put our politics aside and do everything possible to, one, step up our law enforcement and, two, break down the barriers to effective treatments."
Overdose deaths continue in the meantime.
Kerri Sprague said she still has so many questions about what happened to her daughter. The one person who might have known the whole story was her boyfriend, but Sprague said she put off asking him.
Then last summer, during a trip to Montana, he overdosed and died.
"There's a ton I don't know," Sprague said. "Maybe I'm not supposed to know."
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