SB 705
Department of Legislative Services
Maryland General Assembly
2020 Session
FISCAL AND POLICY NOTE
Third Reader
Senate Bill 705 (Senators Carter and West)
Finance Environment and Transportation
Maryland Transit Administration – Disabled Reduced Fare Program – Opioid
Treatment Program Patients
This bill requires the Maryland Transit Administration (MTA) to make monthly transit
passes available to opioid treatment programs for use by patients of the programs who
qualify for MTA’s Disabled Reduced Fare Program. The passes may be issued to patients
on site at opioid treatment programs by staff. MTA must adopt regulations to establish the
process by which participating opioid treatment programs may issue transit passes under
the bill. In consultation with participating opioid treatment programs, MTA must submit a
report to the Governor and the General Assembly by December 1, 2021, and by each
December 1 thereafter, on the status of the bill’s implementation. The bill takes effect
July 1, 2020.
Fiscal Summary
State Effect: MTA can prepare the required annual report using existing budgeted
resources. Making transit passes available for use by opioid treatment program patients is
not anticipated to materially affect State operations or finances, as discussed below.
Local Effect: Expenditures increase for local health departments (LHDs) with
participating opioid treatment programs to purchase transit passes from MTA. Revenues
increase correspondingly as the passes are sold to patients, as discussed below.
Small Business Effect: Minimal, as discussed below.
 Analysis
Bill Summary: The transit passes must be made available to an opioid treatment program
at a reduced price that reflects the price of a monthly pass under the Disabled Reduced Fare
Program as of October 1, 2020, less any cost savings MTA experiences from having
participating opioid treatment programs issue the transit passes directly to patients.
Current Law/Background: MTA is a modal unit within the Maryland Department of
Transportation, and it operates a comprehensive transit system throughout the
Baltimore-Washington metropolitan area, including more than 50 local bus lines in
Baltimore and other services such as the light rail, Baltimore Metro subway, commuter
buses, Maryland Area Regional Commuter trains, and mobility/paratransit vehicles. MTA
offers reduced fares for various individuals, including people with disabilities and senior
citizens (age 65 or older). Exhibit 1 shows MTA’s standard fares compared to those
charged for individuals with disabilities and senior citizens.
Exhibit 1
Maryland Transit Administration Standard Fares
As of February 2020
Regular Fare Senior/Disability Fare
One-way Pass $1.90 $0.90
Day Pass/1-day Pass 4.40 2.20
Weekly/7-day Pass 21.00 -
Monthly/31-day Pass 74.00 22.00
Note: MTA does not currently offer a senior/disability fare discount for its weekly transit pass.
Source: Maryland Transit Administration
According to the U.S. Department of Health and Human Services, drug addiction,
including an addiction to opioids, is a disability under Section 504 of the Rehabilitation
Act, the Americans with Disabilities Act, and Section 1557 of the Affordable Care Act,
when the drug addiction substantially limits a major life activity. Therefore, most or all
patients in an opioid treatment program are likely already eligible for MTA’s Disabled
Reduced Fare Program under current law.
For more information about the opioid crisis, please see the Appendix – Opioid Crisis.
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State Revenues: As discussed above, most or all patients in an opioid treatment program
are likely already eligible for reduced transit fares under current law. Accordingly, the bill
does not expand eligibility for MTA’s Disabled Reduced Fare Program.
Even so, the bill likely results in more patients learning about and ultimately choosing to
purchase monthly transit passes. As passes are made available for purchase to opioid
treatment programs for patients, Transportation Trust Fund (TTF) revenues (1) decrease to
the extent that patients would have otherwise paid full price for transit passes and
(2) increase to the extent that patients would not have purchased transit passes absent the
bill. While a reliable estimate of the net effect on TTF revenues cannot be made, MTA
advises, and the Department of Legislative Services concurs, that it is not likely to be
material.
Local/Small Business Effect: There are approximately five LHDs with opioid treatment
services programs operating at this time. In addition, various treatment programs are
operated by small businesses in the State. Expenditures increase for LHDs and small
business treatment programs who choose to purchase transit passes at a discounted rate
from MTA pursuant to the bill. This analysis assumes that opioid treatment programs then
sell the transit passes to patients at the same discounted rate; therefore, revenues for opioid
treatment programs increase correspondingly. To the extent that opioid treatment programs
provide the transit passes to patients at no cost, those revenues are foregone.
Additional Information
Prior Introductions: None.
Designated Cross File: HB 1440 (Delegate Wells, et al.) - Environment and
Transportation.
Information Source(s): Maryland Department of Transportation; Maryland Department
of Health; Department of Legislative Services
Fiscal Note History: First Reader - February 28, 2020
mm/lgc Third Reader - March 16, 2020
Analysis by: Richard L. Duncan Direct Inquiries to:
(410) 946-5510
(301) 970-5510
SB 705/ Page 3
 Appendix – Opioid Crisis
Opioid Overdose Deaths
Maryland ranks among the top five states for the highest rates of opioid-related overdose
deaths. In 2018, the State experienced the deadliest year on record for overdose deaths, due
almost exclusively to the continued presence of fentanyl. Exhibit 1 shows the total
overdose deaths in the State since 2007 and the prevalence of prescription opioids, fentanyl,
and heroin in contributing to overdose deaths.
Exhibit 1
Overdose Deaths and Substance Prevalence
Calendar 2007-2018
100% 3,000
2,500
% of Related Overdoses
80%
Overdose Deaths
2,000
60%
1,500
40%
1,000
20% 500
0% 0
2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 2018
All Drug and Alcohol Intoxication Deaths Prescription Opioid-related
Fentanyl-related Heroin-related
Source: Maryland Department of Health
Preliminary data for 2019 suggests that 2018 may have been the peak of the opioid
epidemic. Data published by the Opioid Operational Command Center indicates that the
total number of overdose deaths in Maryland for the first six months of 2019 was lower
than the number of deaths at the same point in 2018. Exhibit 2 shows the total overdose
deaths, overdoses involving opioids, and deaths involving heroin and fentanyl for the first
six months of the last four years.
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 Exhibit 2
Overdose Deaths, First Six Months
Calendar 2016-2019
1,400
1,200
Statewide Overdose Dealths
1,000
800
600
400
200
0
Drug and Alcohol Opioid Intoxication Heroin Intoxication Fentanyl Intoxication
Intoxication Deaths Deaths Deaths Deaths
2016 2017 2018 2019
Source: Maryland Department of Health
Although the data for the first six months of 2019 shows a decrease in fentanyl-related
overdose deaths relative to 2018, fentanyl-related deaths are still well above 2017 levels.
Furthermore, overdose deaths for heroin and fentanyl are not mutually exclusive, as law
enforcement often finds fentanyl mixed into heroin. Nearly 30% of all overdose deaths in
the State in 2018 involved both heroin and fentanyl.
Maryland Actions to Address the Opioid Crisis
Legislative Response: The General Assembly has passed numerous acts to address the
State’s opioid crisis, including prevention, treatment, overdose response, and prescribing
guidelines.
 Chapters 571 and 572 of 2017, the Heroin and Opioid Prevention Effort and
Treatment Act, require the Governor’s proposed budget for fiscal 2019 through
2021 to include specified rate adjustments for community behavioral health
providers; require development of a plan to increase provision of treatment; expand
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 access to naloxone; require the Maryland Department of Health (MDH) to distribute
evidence-based information about opioid use disorders to health care facilities and
providers that provide treatment; and prohibit health insurance carriers from
applying a prior authorization requirement for certain substance use disorder
treatment drugs.
 Chapters 573 and 574 of 2017, the Heroin and Opioid Education and Community
Action Act (Start Talking Maryland Act), expand drug education in public schools
to include heroin and opioid addiction prevention; require local boards of education
to establish a policy requiring each public school to store naloxone and other
overdose-reversing medication to be used in an emergency; and require institutions
of higher education that receive State funding to establish a policy that addresses
heroin and opioid addiction and prevention.
 Chapter 570 of 2017 requires a health care provider to prescribe the lowest effective
dose of an opioid and a quantity that is no greater than that needed for the expected
duration of pain severe enough to require an opioid that is a controlled dangerous
substance, with specified exceptions.
 Chapter 149 of 2018 authorizes an emergency medical services provider or law
enforcement officer to report an actual or suspected overdose to an appropriate
information technology platform.
 Chapter 211 of 2018 requires MDH to identify a method for establishing a tip line
for a person to report a licensed prescriber whom the person suspects is
overprescribing certain medications.
 Chapters 215 and 216 of 2018 require a health care provider to advise a patient of
the benefits and risks associated with a prescribed opioid or co-prescribed
benzodiazepine.
 Chapters 439 and 440 of 2018 require a general hospice care program to establish a
written policy for the collection and disposal of unused prescription medication and
require a program employee to collect and dispose of a patient’s unused medication
on the death of the patient or the termination of a prescription.
 Chapter 532 of 2019 established programs for opioid use disorder screening,
evaluation, and treatment (specifically medication-assisted treatment) in local
correctional facilities and in the Baltimore Pretrial Complex. The programs must
conduct a screening of the mental health and substance use status of each inmate as
well as offer at least one formulation of each U.S. Food and Drug Administration
approved full opioid agonist, partial opioid agonist, and long-acting opioid
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 antagonist used for the treatment of opioid use disorders. Phase-in of the programs
begins January 1, 2020.
 Chapter 537 of 2019 established the Opioid Restitution Fund, a special fund that
will retain any revenues received by the State relating to specified opioid judgments
or settlements. The fund may be used only for specified opioid-related programs
and services.
Legal Actions Related to the Opioid Crisis
Nationwide, lawsuits have been filed against pharmaceutical manufacturers, pharmacies,
and individual providers for fueling the opioid crisis, either for aggressively marketing
opioids and downplaying the known addictive qualities of the drugs, or for failing to detect
and report suspicious orders. In December 2017, the U.S. Judicial Panel on Multidistrict
Litigation ordered the consolidation of the nearly 200 pending opioid-related cases into
multidistrict litigation in the U.S. District Court for the Northern District of Ohio. Over
2,500 jurisdictions are part of the litigation, including 32 Maryland jurisdictions
(16 counties and 16 cities). In September 2019, Purdue Pharma, one of the original
defendants named in the lawsuit, filed for bankruptcy. Purdue Pharma has proposed a
settlement worth $3 billion plus future revenues from OxyContin sales. Attorney General
Brian E. Frosh issued a statement rejecting Purdue Pharma’s proposed settlement. In
May 2019, the Attorney General filed charges against Purdue Pharma, the Sackler family
(owners of Purdue Pharma), Rhodes Pharmaceuticals (an entity with ties to Purdue Pharma
and the Sackler family), and related entities. The State’s charges allege that Purdue Pharma
and the Sackler family conducted an orchestrated marketing scheme designed to mislead
Maryland health care providers, patients, insurers, officials, and others about the benefits
of opioids while downplaying their risks. Any payments made to the State as a result of
opioid litigation will be placed in the Opioid Restitution Fund.
Funding to Address the Opioid Crisis
The fiscal 2020 budget has nearly $710 million targeted toward addressing the opioid crisis
in Maryland. Nearly $700 million is budgeted in MDH, the vast majority of which is for
substance use disorder treatment in Medicaid ($622.5 million). Also included in MDH’s
fiscal 2020 budget is the second and final year of $33 million in federal funds for the State
Opioid Response Grant. The budget also contains $3 million for the Behavioral Health
Crisis Response Grant Program as mandated by the General Assembly, which will increase
to $4 million in fiscal 2021. Additional fiscal 2020 funding includes $3 million in
Department of Public Safety and Correctional Services support for medication-assisted
treatment in State correctional facilities and $725,000 between the Governor’s Office of
Crime Prevention, Youth, and Victim Services and the Department of State Police for
various enforcement and treatment efforts.
SB 705/ Page 7


Statutes affected:
Text - First - Maryland Transit Administration – Disabled Reduced Fare Program – Opioid Treatment Program Patients: 7-712 Transportation
Text - Third - Maryland Transit Administration – Disabled Reduced Fare Program – Opioid Treatment Program Patients: 7-712 Transportation