Pubdate: Fri, 17 Jul 2015
Source: Baltimore Sun (MD)
Copyright: 2015 The Baltimore Sun Company
Contact:  http://www.baltimoresun.com/
Details: http://www.mapinc.org/media/37

THE DISEASE OF ADDICTION

The Baltimore Health Department's Plan to Expand Drug Treatment to 
Everyone Who Needs It Is the First Step Toward Reducing Overdose 
Deaths Statewide

If you have a heart attack, the ER physician doesn't just give you an 
aspirin and send you home. If your kidneys fail, doctors don't throw 
up their hands and discharge you because they're short on dialysis 
machines. But if you're lucky enough to survive a heroin overdose, 
you might have to wait weeks to get an appointment at a drug 
treatment center, and even then you're as likely as not to be told 
there are no beds available.

Heroin addiction is an illness, but we respond to it differently than 
we do almost any other disease.

Cities like Baltimore pay a high price for that failure because 
prompt access to substance abuse treatment is essential if lives are 
to be saved.

That is why city Health Commissioner Leana Wen this week unveiled a 
comprehensive plan to combat the epidemic of drug overdose deaths in 
Baltimore based on around-the-clock treatment options for addicts 
that ensures everyone who needs help can get it without delay.

Dr. Wen's proposals are contained in the report of a mayoral task 
force charged with recommending a broad, multifaceted effort to stem 
the city's heroin epidemic.

It includes teaching the families and friends of addicts to 
administer the anti-overdose drug naloxone as well as equipping first 
responders with the medication; targeting interventions at the 
neighborhoods and groups most at risk for overdose deaths; and 
launching public health information campaigns to educate people about 
the risks of addiction and their options for treatment.

It's often said that the city suffers from a perennial shortage of 
facilities where addicts can seek treatment, but some question that 
assumption. Nationwide, only about 11 percent of addicts get the 
treatment they need, and Baltimore may actually be ahead of many 
other cities in that regard.

Health officials estimate there are some 19,000 heroin addicts in the 
city. But it's hard to know how many treatment slots exist at any 
given time because there are so many different kinds of facilities - 
hospitals, inpatient centers, outpatient clinics, etc. - that offer 
different kinds of programs and services.

Acrucial element of Dr. Wen's strategy is the development of a 
"dashboard" for monitoring the availability of treatment beds in real 
time so that emergency room doctors and addiction counselors can 
quickly determine where overdose victims can go to get the 
appropriate follow-up care when they leave the hospital.

The goal is to provide immediate-access to treatment on demand for 
everyone struggling with addiction in order to reduce their chances 
of eventually falling victim to a fatal overdose.

People who have overdosed at least once are at highest risk, but the 
pool of vulnerable individuals also includes recently incarcerated 
people and people with behavioral health disorders.

If an addict who is being treated with the anti-addiction drug 
buprenorphine, for example, is incarcerated, jail officials are 
likely to administer methadone, which is cheaper, as a substitute - 
even though it may not be as effective at managing the prisoner's 
illness or may produce side-effects that leave him or her 
disoriented. It's another example of the way we treat addiction 
differently than other illnesses, often to the detriment of the very 
people the system is supposed to help.

Dr. Wen acknowledges that it will cost money to expand access to 
treatment for addicts and reduce overdose deaths.

The city has already begun to implement some of the task force's 
recommendations, but others, particularly the development of 24/7 
access to treatment and initiatives specifically targeting those at 
highest risk of overdose, will require state and federal support to 
get off the ground. Dr. Wen estimates the cost at about $20 million 
over the next three years but insists the effort is worth it if it save lives.

Gov. Larry Hogan has also created a task force to advise on ways to 
reduce overdose deaths statewide, and we hope its members will look 
carefully at Baltimore's plan and support its goals.

The city has more overdose deaths than any other jurisdiction in 
Maryland, and if officials here are successful in reducing those 
numbers the effects will be felt across the state.

But by the same token, the Hogan administration won't get very far in 
achieving its goals if it doesn't find ways to help Baltimore first.
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MAP posted-by: Jay Bergstrom