CASE STUDY

Baltimore‘s “Blanket Prescription” for Naloxone Helps to Address the City’s Opioid Addiction Crisis

Problem: The number of people dying from overdose has quadrupled nationally since 1999. Baltimore City continues to see more people dying from overdose than from homicide. This is particularly tragic because there is a medication, naloxone, which can completely reverse the effect of an opioid overdose, and has been proven to save lives. Further, tens of thousands of people across the country die from what is generally the preventable illness of addiction.

Dr. Leana Wen, M.D.

Dr. Leana Wen, M.D.

Leana Wen, M.D. Baltimore City Health Commissioner, says, “As an emergency physician, I have personally administered naloxone and seen patients who would otherwise die be revived within seconds.” The science is clear: naloxone can save lives, but in order to do that, it must be accessible to those who need it.

Solution: Baltimore’s program to address opioid addiction is a comprehensive solution that has made a significant impact to stem the high rate of deaths due to opioid addiction in the city.

Addiction does not discriminate and Baltimore officials believe that all citizens should have the capacity to save a life. The program is built on the belief that naloxone should be part of everyone's medicine cabinet and everyone's first aid kit. That is why the Commissioner issued a standing order— a blanket prescription—that made this medication available to all 620,000 residents of the city. Since 2015, they have trained over 10,000 people to use naloxone, including members of the police force, who have in turn saved the lives of 30 residents in the past six months.

Those who oppose naloxone argue that using it to save someone’s life only fosters addiction. Dr. Wen believes  this argument is unscientific, inhumane, and ill-informed, arguing that, “No one would refuse an EpiPen to someone who has a peanut allergy for fear that it would encourage them to eat more peanuts.”

Dr. Wen recognizes that if she does not increase access to quality treatment options for this preventable disease, her department is merely treading water with an unacceptable status quo. Nationwide, only 11 percent of patients with addiction get the treatment they need. Dr. Wen asserts, “There is no physical ailment for which this lack of care would be acceptable—imagine if only one in ten cancer patients, or one in ten patients with diabetes, were being treated?”

In Baltimore, they are working to ensure access to on-demand treatment for all of residents. Last year the department started a 24/7 "crisis, information, and referral" phone hotline that connects people to addiction treatment programs. It now fields over 1000 calls every week. They are also in the process of opening a “stabilization center” for those in need of temporary services related to intoxication. They are also piloting a Law Enforcement Assisted Diversion Program (LEAD), which establishes criteria for police officers to identify eligible users and connect them to necessary services such as drug treatment, peer supports, and housing– rather than to central booking for arrest. By taking an interdisciplinary approach to this multifaceted epidemic, the department is ensuring that there is individualized treatment for anyone ready to begin their recovery.

“In addition to increasing treatment availability, we must reduce the stigma associated with addiction and assist those in long-term recovery to assimilate into healthy lives,” says Dr. Wen. To do this, the Baltimore City Health Department launched the “Don’t Die” initiative, a citywide effort to educate the public on the nature of addiction. The initiative spreads the message that the condition is a disease, recovery is possible, and that everyone must play a role in saving lives. They have used this platform to further reduce barriers to naloxone by introducing a first of its kind online training module, where Baltimore residents can now go online and become certified to administer and receive naloxone.

Summary: Baltimore identified opioid addiction as a top health threat to its community, and took action. 

·       Addressing this problem required the health department to implement a comprehensive program that enables all city residents to gain access to the life-saving drug, naloxone. 

·       Free training and support facilities support city emergency personnel by educating the public to use the medication properly. 

·       To help opioid addicted residents recover, Baltimore is working to make on-demand treatment available to all residents. Widespread education on the epidemic helps residents accept opioid addiction as treatable and makes recovery possible.