More Baltimore residents died as a result of drug overdose than homicide last year, a startling fact in light of how easy it is to prevent opioid overdoses. We know how to prevent deaths, and there are effective treatment options for addiction. The question is, how we get the necessary resources to those who need them most?
This was the message at the first community update meeting of the Mayor’s Heroin Treatment and Prevention Taskforce. The meeting, an opportunity for the task force to hear community ideas on how to best address Baltimore’s heroin issue, took place April 1, and was headed by new Baltimore City health commissioner, Dr. Leana Wen.
There are about 19,000 people in Baltimore who use heroin, said Wen, which makes heroin addiction an issue that touches every facet of our city, including the economy, public safety, and, of course, public health. Two hundred twenty-six people died of drug and alcohol overdoses between January and September of 2014, a nine month total that surpassed Baltimore’s notoriously high homicide total for the entire year.
“How often do we hear about deaths from homicide? A lot, and it’s certainly a big issue . . . [but] why don’t we talk about deaths from overdose?” asked Wen.
One of the reasons we need to discuss overdose deaths is that they are highly preventable, said Wen, who then demonstrated how easy it is to administer the drug naloxone – which effectively reverses the effects of a heroin, or other opioid, overdose – with a volunteer from the audience. The simple life-saving process basically consists of putting a few sections of the delivery device together and then spraying the medication into each nostril of an overdose victim.
While preventing deaths through the use of drugs like naloxone is easy, the challenge is in getting the drug into the hands of those in the best position to save the life of someone who has overdosed, a challenge exacerbated by its price.
“If the price has more than doubled, then we can only save half as many lives,” said Wen.
The meeting was well attended by various community stakeholders, including community advocates, peer addiction counselors, doctors, researchers, and city officials working on addiction related issues, and who made suggestions regarding different strategies to best address Baltimore’s heroin problem.
Carlos Hardy, CEO and founder of Maryland Recovery Organization Connecting Communities, said that while many people have heard of NIMBY (not in my back yard), fewer people are familiar with BANANA (build absolutely nothing anywhere near anything), which is a common response when a new drug treatment center is slated to be built in any given community. Hardy said that when a new center is being planned in a community, that both the program’s concerns and the community’s must be heard, and that by working with one community at a time, memoranda of understanding and other agreements can be entered into which lay out the expectations for all stakeholders, thus smoothing the path to more treatment centers.
Dr. David Jernigan, associate professor at the Johns Hopkins Bloomberg School of Public Health, said it is not enough for the city to create neighborhoods that are compatible with recovery centers if those neighborhoods are not also compatible with recovery itself. “When we’ve got twice as many liquor stores as we’re supposed to have per population, when it is far easier to put a liquor store in this city then it is a treatment center, then we’ve got a larger problem,” said Jernigan.
Part of what has made heroin addiction difficult to curb is the easy access to other forms of opioid drugs, particularly in the form of prescription pain killers, which one person at the meeting referred to as the ‘poor man’s heroin.’ According to Wen, while the U.S. makes up only five percent of the global population, we consume 80 percent of the world’s prescription pain medications.
Dr. Suzanne Doyon, medical director of the Maryland Poison Center and an emergency room physician, said that while there are guidelines in Maryland for emergency room physicians that, if abided by, could greatly reduce the number of prescriptions for opioid pain killers in emergency departments, the bigger issue is how often primary care doctors prescribe the drugs.
“The number of prescriptions coming out of emergency departments throughout the country are really really high. But the number of tablets dispensed per prescription is very, very, very low, because [emergency doctors] tend to prescribe for three days, or something like that. What seems to be the bigger problem is the lesser [number of] prescriptions for months, and months, and months going on years that occur in other settings such as primary care,” said Doyon.
The effectiveness of peer counseling (programs that use recovering addicts to help those just entering recovery) and the need for stable housing for addicts in recovery (the lack of which can drive relapses) were other prominent themes among the community’s suggestions at the meeting.