In 2013, 464 people died of heroin overdoses in Maryland, an increase of 88 percent since 2011. Sadly, Maryland is not alone. Newspaper headlines show a dismal trend across the country.
In Pennsylvania: “‘Killer heroin’ overdose deaths on the rise in York County.” In North Carolina: “Heroin use, and deaths, on the rise.” In Cincinnati: “Families suffer as heroin overdoses rise.” In the Great Lakes: “Michigan heroin use, OD deaths increase.”
In cities and suburbs across America, we are seeing the dire consequences of increases in opioid use, and national leaders are clamoring for answers. The national conversation that has been created by the spikes in opioid overdose is increasing our awareness that addiction is happening in every part of our cities, suburbs and rural areas. Addiction does not differentiate between the young or old, black or white, working class or white-collar professional.
Recognizing the ubiquity of the problem, U.S. Attorney General Eric Holder said, “Opiate addiction is an urgent—and growing—public health crisis,” and he vowed to fight it “aggressively.”
Addiction to opiates, a class of narcotics including heroin, has long been a major concern in Baltimore.
Since its inception, OSI-Baltimore has been working to address the complex and deep-seated problems that contribute to and stem from drug addiction. We believe a multi-pronged, strategic approach is critical to address drug addiction, including the overdose crisis, in the state. This approach includes building on opportunities created by health care reform, supporting the availability of addiction services still not covered by insurance, decreasing the harms of drug use, creating access to innovative treatment that has been used effectively elsewhere, and reducing the stigma associated with addiction.
An important component of our work has focused on preventing overdose deaths. Over a decade ago, OSI-Baltimore partnered with the Baltimore City Health Department to reduce opiate overdose deaths by training people at risk of overdose to administer Narcan (also known as naloxone), which can revive a person near death from an overdose. As most overdoses are witnessed, access to Narcan and training in administering the antidote can save lives. Since 2004, over 11,600 people have been trained, and the program has since saved over 200 hundred lives and while helping many survivors begin treatment.
More recently, several of our grantees have collaborated to make this prevention approach available statewide: the Maryland Chapter of the National Council on Alcoholism and Drug Dependence, Baltimore Student Harm Reduction Coalition, and the Drug Policy and Public Health Strategies Clinic at the University of Maryland Carey School of Law advocated successfully for the passage of a “Good Samaritan” law that protects individuals who secure medical assistance for a person experiencing an overdose from certain types of criminal prosecution. Our grantees also recently won policy changes that make naloxone more readily available to lay persons trained to identify overdose symptoms and administer the medication.
There are many factors contributing to recent increases in opioid overdoses. One factor has been the marked increase of physician prescription of opioids for pain management. A recent study found that from 2001 to 2010 the percentage of overall emergency department visits where an opioid analgesic was prescribed increased from 20.8 percent to 31 percent. For Dilaudid, which is one of the most potent yet addictive medications, the prescription rate increased 668.2 percent. Yet, the percentage of visits for painful conditions during this period only increased by four percent. Once individuals do become dependent on powerful prescription narcotics, such as oxycodone, Vicodin or morphine, they find it harder over time to obtain those prescribed painkillers from doctors. In some cases, they turn to heroin, which is cheaper and more readily available. But the strength and quality of heroin are unpredictable, and overdoses result.
A second contributing factor is that societal assumptions about who is at risk for opioid addiction decrease the likelihood that physicians will conduct proper screens during primary care visits for all who would benefit from them. Further, stigma associated with addiction, including misconceptions that addiction results from a lack of will power, inhibits some individuals who might otherwise seek treatment.
An additional factor that contributes to the drug overdose epidemic is that the treatment system is not properly aligned to address the chronic nature of the disease of addiction, which requires ongoing and varying types of interventions over time. And, until the recent enactment of health care reform, lack of insurance created financial barriers to accessing treatment, leaving many people at risk of overdosing.
Although television and movies portray overdoses as dramatic and sudden, such deaths are preventable. Opiate overdoses often take several hours leaving significant time to provide life-saving measures.
We know that we must—and can—minimize the number of people who die from opiate overdoses.
That’s one reason why OSI-Baltimore has long advocated the use of Narcan. That idea has caught on over the years, as Attorney General Eric Holder recently urged federal agencies—including the FBI, the Department of Justice and the Bureau of Alcohol, Tobacco, Firearms and Explosives—to review policies and train personnel to carry Narcan kits.
We are encouraged to witness national leaders taking a strong stance about heroin overdoses. Although this problem has long been with us, some of this new interest by the media and policy makers, no doubt, has to do with the fact that many of the recent deaths have occurred in suburban areas, affecting people who don’t fit the stereotype of a “typical” heroin abuser.
Stereotypes have long suggested that low-income African Americans are the most frequent users of heroin in America—these stereotypes greatly underestimate heroin use among other racial groups. And now, the Centers for Disease Control report that the recent increase in heroin-related deaths nationwide “has occurred almost entirely among whites.” It is unfortunate that this implicit bias has painted an inaccurate picture of drug use in America, but we can, and should, use this recent increased attention and sense of urgency to put solutions in place.
Here in Maryland, with helpful policies to prevent overdose now in place, opiate overdose numbers could be decreased by incorporating a few simple interventions:
- Encourage friends or family members to get proper training and certification to administer Narcan.
- Ensure that properly trained individuals obtain a prescription for Narcan from a doctor and have it readily available.
- Train police officers and emergency workers to carry and administer Narcan.
- Educate community members about the Good Samaritan law, which protects people from certain criminal liabilities if they call 911 to report an apparent overdose.
Heroin addiction and overdose are important public health concerns for all of us—and that is why OSI-Baltimore will continue to fight to ensure that individuals and families have access to comprehensive substance use treatment and overdose prevention programs so they no longer suffer from the devastating effects of drug addiction.