SOURCE: The Biltmore Banner
When Josh Siems’ loved ones gathered in the hospital, they knew exactly what had killed him: fentanyl.
Siems spent hours in a hospital intensive care unit last fall, turning 31 while suffering an overdose that ultimately took his life, following years of struggling with substance use disorder.
It started like so many of these cases do, with an OxyContin pill passed from a friend in college. Siems’ addiction spiraled from there, and despite periods of sobriety, he progressed from pills to heroin to fentanyl. He had fentanyl on him when he died.
When Siems’ partner, parents and siblings got the medical reports, they were shocked to find no evidence of fentanyl in his system.
That’s because many hospitals don’t test for the drug as part of the standard toxicology screens on overdose patients. They test for five different classes of drugs, including opiates, but the test doesn’t detect fentanyl, a powerful synthetic opioid that’s driving overdoses and deaths in Maryland and beyond.
“I sat with his parents for an hour, we were trying to figure it out and we couldn’t figure it out. We were trying to understand,” said Melanie Yates, Siems’ partner.
Yates and Siems’ parents, Bob and Caryl, threw themselves into research amid their grief and learned about the gap in fentanyl testing. They discovered that California recently passed a law — believed to be the first in the nation — requiring that fentanyl must be included when hospitals test a patient for drugs.
Now they’re taking her grief and passion to Annapolis, pressing lawmakers to make the same change to Maryland’s law. They hope that the story of Josh — a handsome, outgoing young man who was always kind to others, but not as kind to himself — will help convince lawmakers that improving fentanyl testing will make a small, but important, contribution to the fight against opioids — and just might save lives.
Yates and Siems’ family will travel from Baltimore to Annapolis on Thursday to make their case directly to lawmakers. They, and other supporters of the legislation, say that requiring fentanyl testing will capture better data about just how prevalent the drug is, help medical professionals better treat patients and help users know just what they’re taking.
“It’s a tiny drop in a big bucket, but it’s something,” said Josh’s mom, Caryl Siems. “You hope that tiny drop ripples into something bigger.”
An ‘urgent problem’ with fentanyl
The bill before Maryland lawmakers is straightforward, adding just three sentences to Maryland law. It says that when a hospital orders a toxicology screening for a patient with a known or suspected drug overdose, the screening must include fentanyl. If a hospital doesn’t have the ability to do rapid urine drug testing, then the requirement wouldn’t apply.
“I don’t think that there is a single member, Democrat or Republican, who will not join me in acknowledging that we have an urgent problem right now with fentanyl,” said Del. Joe Vogel, a first-year Democratic delegate from Montgomery County and the bill’s lead sponsor. “It’s clear that this is the drug that is the problem right now. So it’s just common sense that we’ve got to start screening for that. And that’s the argument we’re planning to make.”
Vogel said he was moved to sponsor the bill after seeing fentanyl proliferate in local schools and meeting Melanie Yates and learning about Josh Siems’ death. He’s lined up nine cosponsors in the House of Delegates, and in the state Senate, the measure is sponsored by Sen. Arthur Ellis, a Charles County Democrat, and Sen. Jim Rosapepe, a Prince George’s County Democrat.
Fentanyl was created to treat severe pain, often for cancer patients, but is frequently diverted and used by people with substance use disorder. Its use outside of medical settings has skyrocketed, both by people who know they’re using it and people who don’t know.
For a 12-month period ending in October, 2,001 people died from fentanyl overdoses in Maryland — outpacing every other type of drug, including cocaine, heroin and prescription opioids, according to state data.
Maryland’s bill is modeled after California’s law, which went into effect Jan. 1.
Dr. Roneet Lev, an emergency medicine and addictions specialist in San Diego, was one of the catalysts for the California law. She said that nearly every hospital in the nation has the ability to do on-site rapid urine tests for drugs, and it doesn’t take much effort or cost to add fentanyl to the standard order of toxicology screenings.
Lev said that it costs about 75 cents per test for the additional reagent to test for fentanyl in hospitals that already have the equipment and staff to conduct toxicology screenings.
Lev and others believe that even as documented fentanyl use has skyrocketed, it actually could be much greater because so few patients are tested for it.
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. Some people with substance use disorder willingly take fentanyl, but it’s also cut into other drugs so that users don’t know that they’re ingesting it.
“If you’re going to do drug testing, the number one drug in America now is fentanyl. Why would you not be doing that?” Lev said.
A former chief medical officer for the White House Office of National Drug Control Policy, Lev had been trying to nudge hospitals in California to add fentanyl screening voluntarily, but wasn’t getting very far. Then she met Juli Shamash, a Los Angeles mom whose teenage son died from a fentanyl overdose in 2018.
Tyler Shamash’s drug use began around age 13 or 14 with marijuana, and he moved on to abusing codeine and then smoking heroin. Throughout his teen years, Tyler was in and out of treatment centers, schools and sober-living facilities, his mom said.
Tyler was 19 when he died in a sober-living facility, having used what turned out to be fentanyl in a bathroom and hitting his head. Just one day earlier, though, Tyler was in an emergency room complaining of a stomachache and other possible overdose symptoms. But he swore he hadn’t been using and his toxicology report came back clear, so he was sent to another facility.
After the fatal overdose, the Shamashes investigated and learned Tyler had indeed used fentanyl. They wondered: What if the hospital had caught the fentanyl the day before? Could they have taken different actions? Should he have been sent to a treatment facility?
“I wouldn’t have sent him back to a sober-living [facility],” Shamash said. “I would have sent him to a detox or residential treatment with a higher level of care where they watch you more closely.”
Like Lev, Shamash began lobbying hospitals to start testing for fentanyl. Eventually, their paths crossed and they banded together to get “Tyler’s Law” through California’s legislature.
“Everyone was like, ‘Are you so happy?’” Shamash said. “I’m happy, but my son, at the end of the day, is still dead. I’m glad it will save other people’s lives. It’s better than not being a law, but it’s sad that it wasn’t around before.”
A lasting legacy
The loved ones of Josh Siems are hoping that his story, like Tyler’s, motivates lawmakers and hospitals to act.
Josh grew up in Baltimore, acted in local theater productions and school plays, was passionate about sports and grew interested in politics. He graduated from the Gilman School and later from Dickinson College in Pennsylvania. After college, Josh had a series of jobs, his final one training people for the ZoomInfo software company, where so many of the women clients fell for him, Yates said.
Josh’s mother said he had a warmth that drew people to him.
“His superpower is making everybody feel like they were special. ... He really rejoiced in other people’s accomplishments,” Caryl Siems said. “Sadly, I think he never gave himself that same acknowledgement. I think he was just harder on himself or didn’t believe in himself as much as he believed in everyone else.”
Josh and Melanie Yates fell for each other fast after meeting one night while waiting for the restroom at Claddagh Pub in Baltimore’s Canton neighborhood. So sure Josh was that the two would stick together, he put Yates in his phone as “Melanie Wife.”
“Those relationships where you take three months to figure out if you like the person? It wasn’t that,” Yates said. “We just met each other, and he was home.”
By the time Josh died, he was living in Washington, D.C., and Yates was living in Baltimore. Yates and Josh’s family sensed something was wrong, and perhaps that he was using again. They called police for a well-being check, and they found him unresponsive. He died in the hospital on his 31st birthday, Oct. 14.
Once Yates and the Siems family learned of the lack of fentanyl testing, Yates turned to the University of Maryland, where she is studying behavioral health. She’d previously worked with the law school, and reached out to a professor who connected her with the school’s Justice for Victims of Crime Clinic.
Yates was assigned to law student William O’Malley, who in true “Smalltimore” fashion, had actually met Josh years before when they both worked on a political campaign. O’Malley has helped Josh’s loved ones navigate the legislative process and lined up support for the bill.
“I’ve met few people in my life that are strong as Melanie and Josh’s family have been,” O’Malley said. “I could never imagine suffering a loss of this magnitude and then turning around this quickly and talking to legislators about why they need to propose a bill this session, how it will save lives.”
The team isn’t sure what the prospects are for their legislation, but they’re hopeful.
The Maryland Hospital Association, which represents the interests of the state’s hospitals, submitted a “letter of information” to lawmakers, meaning it’s neither taking an official position for or against the bill.
Erin Dorrien, the hospital association’s vice president for policy, wrote in the letter that more than half of hospital emergency rooms already routinely screen for fentanyl or “are moving in the direction of differentiating from other opioids.”
She added, however, that: “In general, we do not believe clinical practice should be legislated.”
The University of Maryland Medical System — which does fentanyl screenings in some, but not all, of its hospitals — estimates the cost is more than the 75 cents per screening the bill’s sponsors claim.
Still, UMMS has seen the value of fentanyl testing and plans to have it in place in all hospitals by the fall, said Michael Schwartzberg, a spokesman for the medical system. One study conducted at the system’s Midtown Baltimore campus found that among a sampling of patients tested for fentanyl, 83% were positive for the drug, but only 5% knew they had taken it.
In California, advocates had to agree that the fentanyl testing requirement would expire after five years in order to get the bill passed.
Josh’s loved ones are hopeful they can get the Maryland bill approved as it has been drafted. And though Josh’s name isn’t on the bill, they know it would be a positive part of his legacy to help others.
“It doesn’t make us less sad. It doesn’t make it it less hard,” Caryl Siems said. “But it gives us something concrete that could help.”