We can save lives now

By Leana Wen, Op-Ed, The Baltimore Sun

Heroin is not a new problem to Baltimore. Like many cities across the U.S., we have struggled with the heroin epidemic for years. Heroin ties into the very fabric of our city and cannot be separated from the problems of violence, mass incarceration and rampant health disparities.

This week, a new report came out that shows we are going in the wrong direction with overdose deaths. Last year, 303 people died from drug and alcohol overdoses in Baltimore City. This is a 23 percent increase from 2013. That year, the number of people dying from overdoses — 246 — was already higher than the number who died from homicide.

The reasons for this increase are complicated. All across the U.S., there is a worsening epidemic of heroin addiction that is in part fueled by prescription drug abuse. One-third of people who used drugs for the first time began by using a prescription drug; many turn to heroin because it is a cheaper alternative. People with addiction also face overwhelming stigma and barriers to treatment, along with legal problems, unemployment and homelessness.

As health commissioner, I chair our city's Overdose Fatality Review, a state-mandated process in which we look into every overdose death in Baltimore. Every meeting is tragic because we see people who died from a preventable illness. Heroin and other opioids like morphine, fentanyl and oxycodone kill by slowing and stopping breathing. Without oxygen, a person suffers brain damage and dies within minutes.

There is a complete antidote — naloxone — that is safe and effective. As an emergency physician, I have given naloxone to dozens of patients and have seen how someone who was about to die begins to talk and walk within seconds.

Last fall, Mayor Stephanie Rawlings-Blake convened the Heroin Treatment and Prevention Task Force to address our city's heroin epidemic. The task force's full report is due this summer, but the mayor and I saw that we cannot wait to address the issue of escalating overdose deaths. Last month, the health department developed and is implementing the Baltimore City Overdose Prevention and Response Plan.

Our citywide plan engages our partners at Behavioral Health System Baltimore and a wide range of public and private groups including academic centers, faith leaders, foundations, police and fire departments and peer recovery groups. We have the following three guiding principles:

Make naloxone available to all. It used to be that naloxone could only be given to people at risk of overdose. The problem is that those who are overdosing cannot save themselves. We successfully advocated in Annapolis for a change in legislation so that everyone can save a life. You can get trained today; learn how to use naloxone.

Go to where people are. We use geomapping to identify high-risk populations, then we target naloxone trainings in "hotspots": jails, treatment centers and shooting alleys to train those who are most at risk and their family members. We are also targeting doctors, who have a responsibility to curb the prescription drug epidemic and to prescribe naloxone to every patient who is at risk of overdose.

Provide treatment for addiction. Saving someone from an overdose is a necessary first step, but addiction is a chronic disease and requires ongoing treatment. We are organizing peer-recovery networks and anti-stigma campaigns to combat misconception and encourage people to seek treatment.

There are those who oppose our efforts. Some say that making naloxone available encourages opioid use. This argument is just as problematic as saying that having an Epi-Pen will encourage people to eat foods they know they are allergic to. Doctors and public health professionals should never hesitate to do what is necessary to reduce harm. Others claim that they don't understand why it takes so long for addicts to recover; are medications like methadone or buprenorphine really needed? Yet, hundreds of scientific studies have shown that addiction is a chronic disease — just like cancer or diabetes, it needs to be treated with medications and requires integrated treatment including mental health treatment and community support.

In the wake of the civil unrest last month, we have additional impetus to address the root causes of poverty, crime and health disparities. It is a public health crisis that so many people are dying from a preventable and treatable illness. We have seen the call to action that all lives matter. Let's start with preventing overdose deaths.

Dr. Leana Wen is the Baltimore City health commissioner. She can be reached at health.commissioner@baltimorecity.gov. Twitter: @DrLeanaWen and @BMore_Healthy.