There is a drug epidemic that’s claiming hundreds of lives. You have probably already heard of it and it is made up of three things: prescription painkillers, heroin and death.
For Dr. Leana Wen, the Baltimore City Health Commissioner, that is the biggest problem she is facing right now. Heroin and prescription pills are the main reasons that she sees many of her patients. Dr. Wen is focused on stopping heroin overdoses and saving lives, and she has come up with a plan to do just that.
Shocking Rise in Overdose Deaths
In Baltimore alone there were 104 overdose deaths during the first quarter of 2015, a 49% increase over the 70 reported during the same period in 2014. As chair of a committee that has a state mandate to review every fatal drug and alcohol overdose, Dr. Wen hears about each and every single overdose victim in the city. Each month, the health department, police department, and other agencies that are a part of the committee conduct a detailed examination of each death.
It isn’t easy.
“These are difficult meetings to attend,” Wen says. “You’re literally hearing about a person’s life, seeing their spiral downward, seeing how they did fall through the cracks … fell through our fingertips and now is dead.”
The committee’s examinations have shown that many of the people who are overdosing and dying have sought care in hospital emergency rooms, as many as 50 times. Many of them are repeat drug offenders who have been in and out of central booking and some have been to jail as many as a dozen times. And all of those times, Wen sees as opportunities, in particular, to educate them about a lifesaving drug that goes by the name Naloxone.
Naloxone – The Miracle Drug
Naloxone, also known as Narcan, is a medication that essentially reverses an opioid overdose long enough for a person to get medical attention. In a situation where the individual would have just died, Narcan brings that person back and gives them the opportunity to get medical help. The drug is so important that many cities now equip their police officers and other first responders with the drug. And a growing number of places around the country are working to make it widely available in the communities, giving it to family members and friends of drug addicts or even the drug addicts themselves.
The early studies are showing that naloxone programs do reduce overdose deaths.
As for Dr. Wen, she wants to blanket Baltimore with naloxone, and she is starting with the drug users themselves. The health department in Baltimore conducts naloxone training for inmates at the Baltimore City Detention Center. The department also offers Naloxone training and a naloxone kit to every person who visits one of the city’s needle exchange vans.
This summer, Wen herself led one of the very fist naloxone trainings inside the Baltimore City Circuit Court, for participants in the city’s first drug treatment court program.
Health workers have also taken to the streets where they set up tables at spots around the city known for drug activity. The trainers are often familiar faces in the community and can easily draw a crowd for the five-minute naloxone demonstration. There is a glass vial with medication, a syringe and atomizer. Uncap the various parts, screw them together, and spray half the medication up one nostril and half up the other. At the trainings there is always a doctor on hand to write prescriptions that Medicaid recipients can fill for one dollar.
International Overdose Awareness Day
On August 31st in Baltimore, outreach workers had a new version of naloxone to give out. They unveiled what is known as Evzio. Similar to an EpiPen, Evizio comes in a cartridge smaller than a pack of cards. Once activated, the device talks, telling you to remove the red safety guard, place the device against the thigh and press firmly for five seconds.
The whole sale price of an Evzio kit, which includes two doses of naloxone plus a trainer cartridge is 575 dollars. Which is expensive. But Kaleo, the pharmaceutical company behind it, has donated more than 3,000 kits to Baltimore.
Narcan Becoming More Available
Wen’s ambitions for naloxone extend beyond the city’s drug corners though. Earlier this year, she sent a letter to all doctors in Baltimore, urging them to prescribe naloxone any time they prescribe opiate painkillers. She’s since heard from doctors worried about liability and the message they’d be sending to patients.
On Oct. 1, a new Maryland state law takes effect that allows for standing orders of naloxone. That means a doctor won’t have to be on hand at every naloxone training session to issue individual prescriptions, as is the case now.
Wen plans to issue a citywide standing order for naloxone, essentially giving everyone in Baltimore a prescription for the medicine. She hopes that will make it easier to get the anti-overdose medicine into people’s hands.
In addition, an all-encompassing Good Samaritan law takes effect in October, extending immunity to anyone who administers naloxone to someone who is believed to be experiencing an opioid overdose.
Still, Wen recognizes that naloxone has its limits as a public health tool.
“For everything that we’re talking about with naloxone, as big a fan as I am obviously for it, that we’re about to prescribe 620,000 people in our city with it, we know that we’re just going to be treading water unless we have treatment that immediately follows saving someone’s life.”