Fighting the disease of addiction - Why do we treat addiction differently than we do almost any other disease?

Editorial, The Baltimore Sun

If you have a heart attack, the ER physician doesn't just give you an aspirin and send you home. If your kidneys fail, doctors don't throw up their hands and discharge you because they're short on dialysis machines. But if you're lucky enough to survive a heroin overdose, you might have to wait weeks to get an appointment at a drug treatment center, and even then you're as likely as not to be told there are no beds available.

Heroin addiction is an illness, but we respond to it differently than we do almost any other disease. Cities like Baltimore pay a high price for that failure because prompt access to substance abuse treatment is essential if lives are to be saved. That is why city Health Commissioner Leana Wen this week unveiled a comprehensive plan to combat the epidemic of drug overdose deaths in Baltimore based on around-the-clock treatment options for addicts that ensures everyone who needs help can get it without delay.

Dr. Wen's proposals are contained in the report of a mayoral task force charged with recommending a broad, multifaceted effort to stem the city's heroin epidemic. It includes teaching the families and friends of addicts to administer the anti-overdose drug Naloxone as well as equipping first-responders with the medication; targeting interventions at the neighborhoods and groups most at risk for overdose deaths; and launching public health information campaigns to educate people about the risks of addiction and their options for treatment.

It's often said that the city suffers from a perennial shortage of facilities where addicts can seek treatment, but some question that assumption. Nationwide, only about 11 percent of addicts get the treatment they need, and Baltimore may actually be ahead of many other cities in that regard. Health officials estimate there are some 19,000 heroin addicts in the city. But it's hard to know how many treatment slots exist at any given time because there are so many different kinds of facilities — hospitals, inpatient centers, outpatient clinics, etc. — that offer different kinds of programs and services.

A crucial element of Dr. Wen's strategy is the development of a "dashboard" for monitoring the availability of treatment beds in real time so that emergency room doctors and addiction counselors can quickly determine where overdose victims can go to get the appropriate follow-up care when they leave the hospital. The goal is to provide immediate access to treatment on demand for everyone struggling with addiction in order to reduce their chances of eventually falling victim to a fatal overdose. People who have overdosed at least once are at highest risk, but the pool of vulnerable individuals also includes recently incarcerated people and people with behavioral health disorders.

If an addict who is being treated with the anti-addiction drug buprenorphine, for example, is incarcerated, jail officials are likely to administer methadone, which is cheaper, as a substitute — even though it may not be as effective at managing the prisoner's illness or may produce side-effects that leave him or her disoriented. It's another example of the way we treat addiction differently than other illnesses, often to the detriment of the very people the system is supposed to help.

Dr. Wen acknowledges that it will cost money to expand access to treatment for addicts and reduce overdose deaths. The city has already begun to implement some of the task force's recommendations, but others, particularly the development of 24/7 access to treatment and initiatives specifically targeting those at highest risk of overdose, will require state and federal support to get off the ground. Dr. Wen estimates the cost at about $20 million over the next three years but insists the effort is worth it if it saves lives.

Gov. Larry Hogan has also created a task force to advise on ways to reduce overdose deaths statewide, and we hope its members will look carefully at Baltimore's plan and support its goals. The city has more overdose deaths than any other jurisdiction in Maryland, and if officials here are successful in reducing those numbers the effects will be felt across the state. But by the same token, the Hogan administration won't get very far in achieving its goals if it doesn't find ways to help Baltimore first.