Maryland Gov. Wes Moore is putting his support behind a state bill that would require emergency rooms to include fentanyl testing in toxicology screens, an initiative inspired by the fentanyl-related death of 31-year-old Baltimore native Josh Siems.
The proposal “presents an opportunity for Maryland to adapt to the current realities of the opioid crisis — by requiring hospitals that are able to report fentanyl in their toxicology reports we can collect much-needed data that will greatly help in the fight to reduce the leading cause of overdose deaths in Maryland,” Moore spokesman Carter Elliott IV said in a statement. “The Governor looks forward to working with the legislature and other stakeholders to pass this bill.”
Siems was a child actor, rabid Baltimore sports fan and loving partner who struggled with substance use disorder most of his adult life, according to his loved ones. They knew he had been using fentanyl when he suffered a fatal overdose last fall, but they were shocked to see the drug wasn’t reflected in his medical records.
Siems’ partner, Melanie Yates, and his parents, Bob and Caryl Siems, began researching and learned that hospitals don’t always test for fentanyl. The standard toxicology screening tests for opiates, but it doesn’t pick up fentanyl, a powerful synthetic opioid.
Siems’ loved ones are now pushing for Maryland to require fentanyl testing when overdose patients are screened for drugs, a proposal that’s modeled after a new California law.
Josh Siems’ loved ones told members of the House of Delegates Health and Government Operations Committee Thursday that more fentanyl testing will result in more data about the scope of the fentanyl epidemic. It will also help medical providers treat overdose patients and alert patients that they ingested fentanyl. Often, fentanyl is cut into other drugs without users’ knowledge.
“Hospitals are the first line of defense in the opioid crisis,” Yates said. “They provide education and resources for people who knowingly and unknowingly ingest fentanyl. Not only that, but the testing that occurs in the hospitals directly informs Maryland’s opioid prevention strategies.”
“It’s a small but important step, this bill,” Caryl Siems said. “It will help us approach the epidemic of opioid use disorder. When we use words like ‘epidemic’ to describe the disease, we acknowledge the damage in our community is real.”
Bob Siems said his work as a lawyer taught him that more information is always better, and he said the state needs a more accurate picture of fentanyl use and deaths. “This is information that we’re just missing,” he said.
“This legislation is common sense,” Del. Joe Vogel, the bill’s lead sponsor, told his colleagues Thursday. “If hospitals are conducting a urine drug screening on a patient who has overdosed, the hospital should test for fentanyl.”
One recent analysis found that only 5% of emergency room overdose patients are tested for fentanyl, but among those who are tested, more than 41% are positive for the drug.
Samuel Bierman, co-founder of the Maryland Addiction Recovery Center in Towson, said of his center’s clients who test positive for fentanyl at intake, only 10% of them expected for the drug to show up on the test.
“Most people that come up positive for it don’t realize they have fentanyl in their system, because it’s cut into so many other illicit substances,” he said.
Lawmakers seemed sympathetic to the intent of the bill but had questions. Some wanted to add a requirement to the bill for hospitals to report fentanyl testing data to public health authorities; others questioned how many hospitals have the ability to test for fentanyl.
Nearly all hospitals in the U.S. have labs that can conduct toxicology tests on urine. The Maryland Hospital Association wrote in a letter to lawmakers that nearly half of the state’s hospital emergency rooms already routinely screen for fentanyl or “are moving in the direction of differentiating from other opioids.”
“Fifty percent when we’re dealing with an epidemic of this scope is just not enough,” Vogel said.
The Maryland Hospital Association did not send anyone to testify in person at the hearing.
Del. Joseline Peña-Melnyk, the committee chair, said she knew the hospital association was listening and she urged them to provide a letter promising all hospitals would adopt fentanyl testing as a routine practice.
“Sometimes you do not need a bill,” Peña-Melnyk said.
But she also encouraged Vogel to work on tweaks to the bill to ensure that data about fentanyl testing results are sent to appropriate public health authorities.
Supporters estimate the fentanyl tests cost about 75 cents each. The University of Maryland Medical System has said the cost is higher, but would not be more specific.
No one testified in opposition to the bill.