The wrong approach to Maryland's opioid overdose epidemic

At a community meeting last month, a middle-aged woman came up to me. She told me her son, Andrew, is alive today because of the opioid antidote, naloxone. He has been in treatment for his addiction and is now employed as a peer outreach worker.

“Andrew would have been dead 10 times by now,” she said. “He is alive because of the paramedics, the police, even our neighbor who gave him naloxone. I have my son back, and his kids have their father back.”

Everywhere I go, I meet people like Andrew’s mother who tell me about the direct effect of programs to reverse overdose and provide addiction treatment. In Baltimore, we have made great strides to get naloxone (also called Narcan) to every resident. Since I issued a “standing order” that essentially made naloxone an over-the-counter medication that can be obtained in any pharmacy without a prescription, residents in our city have saved over 1,600 lives. Under Mayor Catherine Pugh’s leadership, Baltimore is expanding addiction treatment by opening a Stabilization Center and engaging with our hospitals. We have launched multiple initiatives with community groups and public safety partners like Law Enforcement Assisted Diversion (LEAD) and the Don’t Die campaign to fight stigma with science.

This week, a bill will be heard in the Maryland Legislature, House Bill 771, that will turn back the clock on this progress. Its chilling effect is described by the primary sponsor, Del. Andrew Cassilly, in a recent op-ed in the Harford County Aegis: “If this bill becomes law, an addict who has overdosed and been revived with Narcan three or more times would be required to seek treatment from a qualified facility or reimburse the cost of the Narcan. If the addict fails to meet these requirements they would be subject to a court hearing and a potential brief incarceration period. This 30-day commitment would include a drug detox program.” He adds as justification: “Many addicts are now using Narcan, funded by taxpayers, as a safety net while they continue to abuse these drugs.”

This bill reflects a fundamental misunderstanding about the nature of addiction. Scientific studies have demonstrated unequivocally that addiction is a disease. Research shows that naloxone distribution reduces fatal overdoses without increasing drug use. People who use drugs do not want to die, nor do they want to suffer through the pain of being revived with naloxone. Denying someone naloxone because it might make him use drugs is just as absurd as withholding an Epi-Pen because it might make someone eat more peanuts.

Every major medical organization agrees that the gold standard of treatment is naloxone to save lives, then connection to medication-assisted treatment combined with psychosocial counseling and wrap-around services. Detox programs do not work, and in fact are associated with higher rates of relapse. Predictably, people who are forced into treatment fare significantly worse than people who choose it. Addiction should be seen as any other chronic disease: Treatment exists, relapses are part of recovery, and society must be ready to treat people when they seek help.

Consider the analogy to a patient with heart disease. Following scientific guidelines, his doctor recommends a combination of medications and lifestyle changes. Let’s say that he skips medications or eats an unhealthy diet and ends up with a heart attack. We would never make resuscitation contingent on his agreeing to the doctor’s every recommendation. We wouldn’t require him to pay back the taxpayer contributions to his care. And we would never propose incarceration as treatment to his disease.

This bill also shows a woeful lack of knowledge about the community resources available for addiction. The Surgeon General’s 2016 report found that nationwide, only one in 10 people with addiction are able to obtain treatment. Despite our efforts in Baltimore, we are nowhere close to treatment on demand. Patients come to us begging for help and are often told to wait days, weeks or even months.

If the bill sponsors truly wish to make a difference in the opioid epidemic, they can introduce legislation to fund evidence-based treatment-on-demand through 24/7 crisis centers and support efforts to protect and strengthen the Affordable Care Act.

If they are concerned about the availability of naloxone, they can join our push for additional funding directly to areas hardest hit and sign on to efforts to ensure prescription affordability so that local jurisdictions are not rationing this medication.

If they wish to impact the criminal justice system, they can increase funding for diversion programs like LEAD and urge the state to bring treatment into our jails and prisons.

If they wish to reduce the rate of overdose deaths, they should focus on reducing stigma, including changing their own language from “addict” to “individuals with the disease of addiction.”

Andrew’s mother knows that naloxone alone is not the answer. But if you don’t get naloxone when you’re dying today, there’s no chance for a better tomorrow. At a time of a public health epidemic, we must do everything we can to save lives. We must use science to fight stigma. And we must treat everyone with compassion, dignity and humanity.

Dr. Leana S. Wen is the Baltimore City health commissioner. Twitter: @DrLeanaWen @BMore_Healthy.

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