As counties work to reduce overdose deaths, experts warn that continued progress depends on long-term, flexible investment, not short-term solutions.
At a recent National Association of Counties (NACo) event, Dr. Joshua Sharfstein of Johns Hopkins Bloomberg School of Public Health highlighted the growing threat of polysubstance use, where fentanyl is mixed with drugs like cocaine or methamphetamine. These cases are harder to treat, as no approved medications exist for stimulant use. One promising strategy is contingency management, offering incentives like cash for negative drug tests, which has proven more effective than punitive approaches.
Demographic disparities remain a challenge. While overall overdose rates may be declining, certain groups, including older Black men, Native Americans, and, in Maryland, young Hispanic men, are seeing increases. Dr. Sharfstein recommended counties use local data to guide outreach and tailor interventions to the communities most in need.
Sharfstein also called on counties to rethink how and when treatment begins. Administering buprenorphine immediately after an overdose can dramatically increase follow-up treatment rates. Jails and emergency settings should serve as entry points for care, not missed opportunities.
In the 2025 legislative session, Maryland passed a bill establishing the Buprenorphine Training Grant Program. This program aims to assist counties with offsetting the cost of training paramedics to administer buprenorphine. From MACo’s testimony:
Counties, Local Health Departments, and public safety employees serve as the front-line responders to the opioid epidemic, using settlement funds to expand public health and safety interventions. Programs like Frederick County’s Community Outreach And Support Team (COAST) have demonstrated the profound impact of such interventions. The COAST team includes community paramedics and peer recovery specialists who provide medical care and emotional support. COAST not only provides free initial doses of buprenorphine but also helps patients transition into long-term treatment, addressing both immediate and systemic needs.
Ultimately, declining overdose rates are the result of intentional action. State and local governments must continue investing in programs that save lives and ensure recovery is supported well beyond the crisis point.
