ANNAPOLIS — Samantha Kerr faced her palms upward and silently took a deep breath to calm herself as she waited to testify in front of the Senate Finance Committee on Thursday.
When it was her turn, Kerr started by telling lawmakers this was the last place she wanted to be today. Kerr, 30, has lived with anxiety her entire life and for years alcohol, cocaine and pills were the best way to make the feelings go away. She moved to Baltimore city almost eight years ago, after she was forced to leave her Pennsylvania apartment following her second DUI arrest.
“I was dying spiritually, mentally, physically. I didn’t want to live and I didn’t want to die,” Kerr said.
Kerr is now sober but knows many Baltimore and Maryland residents are not, and they need safer places to administer drugs and access a path to treatment.
She testified in the House and Senate on Thursday to ask lawmakers to pass SB 135 and HB 139, which would authorize Maryland to establish up to six “overdose and infectious disease prevention sites” where people could bring pre-obtained drugs to self-administer in the presence of health care professionals, who could medically intervene to reverse a potential overdose.
The drug users could also receive sterile injection supplies and information on counseling, treatment, reproductive care, wound care and testing for HIV, viral hepatitis and sexually transmitted diseases.
The sites would meet those with a substance use disorder — a condition recognized by the Diagnostic and Statistical Manual of Mental Disorders — where they are.
The sites would offer fentanyl testing strips and have Narcan/naloxone on hand, said Del. Joseline Peña-Melnyk (D-Anne Arundel and Prince George’s), the House sponsor of the bill.
“They need our help,” she said. “They use the drugs because they have an illness. They have to. Not because they really want to.”
No state in the U.S. currently offers medically supervised drug injection sites, though there are about 100 supervised injection sites in 11 other countries used as a harm-reduction strategy for opioid use, according to the Department of Legislative Services analysis of the bills. California lawmakers passed legislation to allow safe-injection sites, but the bill was later vetoed by Gov. Jerry Brown.
The point of Maryland’s bill is to reduce harm from intravenous drug use. Advocates for the bill, such as House co-sponsor Del. Ken Kerr (D-Frederick), point out that there has yet to be a fatal overdose at one of the established safe sites in other countries.
However, U.S. Deputy Attorney General Rod Rosenstein has threatened aggressive action by the U.S. Department of Justice against any state that tries to open a medically supervised injection site.
Sen. Katherine Klausmeier (D-Baltimore), who sits on the Senate Finance Committee, said she had concerns about the ramifications if the General Assembly moved forward with the bill. She supported the idea, but wanted to see Gov. Larry Hogan (R) and others support it too.
Despite the threat of federal prosecution, the need for these sites is clear to Owen O’Keefe, a lifelong Frederick County resident who spoke in support of the bills on Thursday.
While studying at the University of Maryland, College Park, O’Keefe found one of his roommates unresponsive in their off-campus apartment’s bathroom.
“It was terrifying. There’s no other word to describe it when you find someone in that state of emergency,” O’Keefe said.
His roommate survived, but he has peers from Gov. Thomas Johnson High School who not. O’Keefe, 23, works for the Baltimore Harm Reduction Coalition and advocates for public policy on overdose education and the distribution of overdose-reversing drugs.
Fatal drug use and opioid addiction aren’t just problems in Baltimore. Frederick County residents also use illegal drugs, and the problem is whether the community is ready to acknowledge it, he said.
“This is an issue that is most definitely impacting our population and we can’t keep ignoring,” O’Keefe said.
If Maryland were to proceed with establishing a medically supervised injection site, it could carry a high cost.
The sites — which would to the extent practicable be spread between urban, suburban and rural areas of the state not zoned for residential use — could offset some costs by billing the insurance carrier of people who use the safe-injection service as well as accept grants, donations and other financial assistance, according to the bills.
The Maryland Health Department estimates it would cost an average-size local health department $400,000 to implement an opioid-related disease prevention and outreach program.
No local health department would be required to establish a program. The bill does build in protections for site staff and property owners shielding them from arrest, prosecution and civil penalties.
There is also a four-year sunset built into the law, which would end it on June 30, 2023.
Sen. Ron Young (D-Frederick) is the sole local sponsor of the Senate bill. Frederick County Democratic delegates Carol Krimm, Ken Kerr and Karen Lewis Young are also co-sponsors on the House version of the bill.
Ken Kerr said that the two bills push for a public health approach to substance use instead of a criminal one. For this reason, the bill also has the support of the Law Enforcement Action Partnership.
It is the fourth time the House has heard a similar bill advocating for these sites. Overdose deaths have climbed over those four years, especially in 2016, when the emergence of fentanyl led deaths to skyrocket.
“Treating it as a crime is not working,” Ken Kerr said.
Starting these sites would help connect people with substance use disorder to resources to help them get into treatment or detox if they would like. Although those with substance use disorder have a disease because the drugs they are using are illegal, people often retreat into the “shadows,” Ken Kerr said.
“It brings people out of the Starbucks bathroom and the alleyway, and it brings them into a facility where there is a medical health care provider, who can not only ensure these people stay alive but can connect them with treatment centers and counseling,” he said.
Those who are against the bill have called the proposed sites “heroin dens,” such as Del. Dan Cox (R-Frederick) did on Saturday at a gathering of farmers in Frederick County. Cox did not return a request for further comment on Thursday.
These sites are medically supervised, not just a place to use drugs, Lewis Young said.
“Now I know that the critics say that it encourages drug use and brings crimes, but the studies have proved this to be wrong,” she said.
The sites would be at local community organizations, such as a hospital, a local health department or a faith-based group. The idea gives the state a chance to do something different, adding that previous tactics are not working, Lewis Young said.
“Our 50-year war on drugs has been a failure,” Lewis Young said. “We can’t keep doing the same things and expect a different result. This is a program that is certainly thinking out of the box, but there is enough data today to suggest it is working elsewhere.”