A blanket prescription: How one community is combating opioid and heroin overdose

Apr 15, 2017

In recent years, the United States has seen an alarming spike in opioid overdoses. From prescription painkillers to street drugs like heroin, opioid abuse has led to widespread addiction and all too often, death. Today, development of the counterdrug Narcan is serving to combat the growing problem and save the lives of those affected.

To find out more about this epidemic and what’s being done about it, “Take Care” spoke with emergency medicine physician and Baltimore Health Commissioner, Dr. Leana Wen.

Opioids, Wen explains, are derived from the opium found in poppies. Heroin, for example – an illegal, schedule I narcotic -- is an opioid. But you can also find opioids behind the pharmacy counter, in prescription drugs such as Oxycodone, OxyContin, Percocet, and morphine. And despite their legality, these drugs have similar effects to heroin, including euphoria … and addiction. Prescription painkillers are meant to treat severe pain, but when abused, yield disastrous results.

Medical professionals are trained to minimize patients’ pain as much as possible, and this often means prescribing opioids. For example, Wen can recall “routinely prescribing” these painkillers for people who did not necessarily need them. In our culture, she explains, it is essentially expected to prescribe something – anything – even for moderate pain. And in order to feel completely pain free many people need a strong prescription, thus increasing the risk of abuse.

According to Wen, there are enough opioid prescriptions written annually that every American adult could have a bottle. Aggressive marketing by the pharmaceutical industry, as well as the nonchalance of physicians’ prescriptions have made it all too easy for patients to receive these drugs. And further, says Wen, patients themselves frequently request painkillers before considering rest, physical therapy, or simply waiting it out.

Credit Victor / Flickr

Sometimes, the drugs serve their purpose and the patient is fine. But other times, perhaps the individual doesn’t finish their entire bottle. Those pills are then available at a later date for them, or someone else. In fact, says Wen, many cases she’s seen were the result of someone taking someone else’s prescription.

In 2015, she says, there were 390 lives lost to overdose in Baltimore alone. That’s roughly one person per day. This number outweighs homicide, car accidents, and suicide.

Addiction, Wen stresses, has no face; it is an epidemic – a public health emergency -- and needs to be treated as such.

And, in Baltimore, it is. As the problem persists, so have the efforts to solve it. The counteractive drug Naloxone (commonly known as Narcan), which can completely reverse an overdose, is becoming increasingly available to health professionals everywhere, especially in Baltimore.

In October 2015, legislation was passed in Baltimore in which Wen became the single prescriber of Narcan to every resident of Baltimore. It was, she says, a blanket prescription issued to everyone, and resulted in more than 18,000 trainings throughout the city.

Training is required in order to receive Narcan, as it is administered through an intermuscular needle (similar to an EpiPen) or a nasal spray. The Baltimore Health Department negotiated with Medicaid so residents on the program can receive it for just a dollar, sometimes less. Prices for Narcan have skyrocketed. One dose can be roughly $100, and it’s recommended to have two doses available in case one isn’t enough.

Wen spearheaded the Narcan campaign just over a year ago, and she says since then, 620 Baltimore citizens have been saved.

Naloxone
Credit PunchingJudy / Flickr

This is so important, she says, because in an overdose, passing minutes can be a matter of life and death. To have Narcan readily available is literally a life saver. But still, unprecedented numbers of people are dying from overdoses, and Narcan does not treat addiction. It is only meant to counteract the overdose, and does not address the root of the problem.

There is a tremendous amount of stigma and misunderstanding surrounding addiction, leading many to believe it is some sort of moral failing. But addiction, Wen stresses, does not discriminate. Science tells us for certain that addiction is a chronic brain disease, and further, opioids are some of the most addictive substances out there. Treatment works and recovery is possible, but it is an investment that takes patience and time, according to Wen.

Baltimore residents, she says, are experiencing a shift in thinking regarding addiction, through education, understanding, and compassion for their neighbors. Virtually everyone knows someone affected, and after all, you wouldn’t tell someone with a peanut allergy not to have an EpiPen, or a person with cancer not to receive chemotherapy. Addiction is a disease, and addicts deserve proper treatment.

So, what is there to do? According to Wen, we need to start with the understanding that addiction is a disease, and a public health approach is important. And what’s more, treatment does work, but availability is minimal. In fact, only 1 in 10 opioid users seeking addiction treatment is able to receive the help they need. Treating addiction as a crime, Wen says, is unscientific, inhumane, and doesn’t solve anything, and all of us must treat it with the urgency and compassion we would with any other disease.