Legislation by District 19 Del. Vaughn Stewart (D-Rockville) to improve the practices of hospital emergency rooms across Maryland in responding to opioid overdoses is a short procedural step away from being sent to Gov. Wes Moore (D) for his signature.
Both Stewart’s bill, HB1155, and companion legislation sponsored by Sen. Mike McKay (R-Allegany County), SB1071, cleared their respective chambers by unanimous votes earlier this week, just before so-called Crossover Day. That’s the deadline by which most legislation must clear either the House or the Senate to have a chance of passing this year.
With adjournment of the 2024 General Assembly session scheduled for April 8, final approval of the legislation could occur as soon as next week. The Maryland Department of Health submitted testimony in favor of the Stewart-McKay measure during the legislative process, making it highly likely that Moore will sign it when it reaches his desk.
“I would be shocked if he didn’t sign it,” Stewart said in an interview this week.
In large part, Stewart crafted the bill in response to the circumstances surrounding the death last October of a boyhood friend, Brad Haynes, at a hospital near Anniston, Alabama, where both Stewart and Haynes grew up.
In addition to McKay, Stewart’s legislation was co-sponsored by another western Maryland Republican legislator, House Minority Leader Jason Buckel — helping the proposal to attract support from legislators across the partisan and ideological spectrum.
“I think the subject matter is one that everyone understands as not just emotional, but [also] as such an urgent social problem,” Stewart said.
Meanwhile, an opioid-related bill introduced by another Montgomery County legislator, District 17 Del. Joel Vogel (D-Gaithersburg), HB1268, did not fare as well: It failed to emerge from committee by Crossover Day, and will not see further action this year.
Vogel’s bill sought to take a Montgomery County Public Schools policy in effect for the past year –- under which students are permitted to carry the opioid overdose reversal drug naloxone — and extend it to school districts statewide. In addition, his bill would have provided legal immunity to students who administer naloxone to a classmate “assuming it’s been administered in good faith,” Vogel said, while also “incorporating the benefits of naloxone into the drug prevention curriculum” in schools.
The measure fell short despite having the backing of Emily Keller, the state’s special secretary of opioid response. “I think there is concern that if we give the students more naloxone, then they’re somehow going to be encouraged to do more drugs,” Vogel said in an interview, while insisting, “That’s not the case.”
He added: “Students are already dying from overdoses. Naloxone can save their lives… . Unfortunately, naloxone is now an equivalent of CPR because of the prevalence of the overdoses we are seeing, especially among younger people.”
While naloxone –- often marketed under the brand name Narcan –- saves lives, it also can trigger severe withdrawal reactions in whom it is administered. That’s what happened when Stewart’s friend, Haynes –- who had developed an opioid dependency in recent years –- was admitted to an Alabama hospital last fall suffering from a fentanyl overdose.
According to Stewart, Haynes was given Narcan, but then was quickly discharged from the hospital. Suffering from withdrawal symptoms, Haynes went out and purchased more fentanyl. That triggered a second overdose within hours of Haynes’ departure from the hospital: The second overdose was fatal.
Stewart believes Haynes’ life could have been saved had he been offered a remedy with the generic name of buprenorphine, better known by the brand name of Suboxone – which eases the withdrawal symptoms. As he conducted research before drafting his bill, Stewart found that current “best practice” in hospital emergency rooms involves the use of so-called “opioid agonists” such as buprenorphine – “which means if you take another opioid, your body rejects it and you become very sick, but it’s almost impossible to overdose,” he explained recently.
Although most hospitals in Montgomery County voluntarily comply with such practices, compliance in rural areas – where opioid abuse has been at epidemic proportions for the past decade — is more uneven, Stewart said. And, even in suburban counties such as Montgomery — where compliance by hospitals is more widespread — some emergency room physicians in those hospitals are not complying, he added.
His bill would make mandatory the offering of remedies such as buprenorphine in all hospitals in the state and among the emergency room physicians that practice in them –- while also requiring good faith efforts by emergency room personnel to refer those treated for overdoses to outpatient programs before they are discharged from the hospital.
Referring to Mosaic, a group that has worked with hospitals in Montgomery County to voluntarily adopt such practices, Stewart said: “It’s one thing for a hospital administration to work with Mosaic or any group – and I think Mosaic has done really yeoman’s work in the area to try to save lives. But it’s a different thing altogether to actually require each physician at each hospital to do this.”
Stewart’s bill originally contained a $500,000 appropriation to help underwrite this new mandate; the money would have come from the state’s Opioid Restitution Fund – derived from its share of legal settlements with opioid manufacturers. But the money was taken out of the bill at the request of the Maryland Department of Health, and replaced with a study in which the department will survey hospitals around the state and recommend an appropriate level of funding by the beginning of 2025.
The one bit of resistance to Stewart’s legislation came from the Maryland Hospital Association (MHA), one of the state’s more influential lobbies, which submitted written testimony outlining its concerns during consideration of the bill in committee. “While we appreciate the intent behind HB 1155, in general, we do not believe clinical practice should be legislated,” the MHA said, while contending the emergency room procedures required by the bill “already have been widely adopted.”
The MHA has since dropped its objections, with Erin Dorrien, the organization’s vice president for policy, saying: “MHA now supports the legislation as recent amendments make it more consistent with current practice and leave room for future advancements in treatment.”