Baltimore brings hospitals into the fight against opioid addiction

An epidemic of opioid addiction and overdose has swept across the country, and Baltimore has been hit as hard as any place in America. In 2011, our city saw 167 overdose deaths. By 2016, that number had more than quadrupled, reaching nearly 700. Let us make no mistake: This is an emergency.

Our response to this emergency has been aggressive. We issued a “standing order” that allows any city resident to get naloxone, the antidote that reverses an opioid overdose, without a prescription. More than 36,000 residents have been trained to use the medication, and these residents have saved more than 1,900 lives. Law enforcement and health officials teamed up to start a program that allows residents arrested for low-level drug offenses the opportunity to choose treatment and case management instead of prosecution. And in March, we announced the opening of our Stabilization Center, a first-of-its-kind 24/7 urgent care facility dedicated to issues of addiction and mental health.

Still, we have much more to accomplish. Each year, we lose more and more of our residents to this addiction.

Last summer, we presented an out-of-the-box solution to the opioid epidemic: fully connecting addiction treatment with our hospitals. That call rested on a simple premise: Addiction is a disease, and we should respond to it accordingly. No hospital would deny patients care if they had diabetes or cancer; we must treat addiction in the same way.

This week, we launched a project that will help realize this vision. The Baltimore City Health Department is working with our hospital systems to create “levels of care” that enshrine best practices for responding to the epidemic and publicly recognize hospitals that implement those practices. In launching this project, we are acting on a recommendation of the city’s Work Group on Drug Treatment Access and Neighborhood Relations — co-chaired with Don Fry, president of the Greater Baltimore Committee, and Bill McCarthy, CEO of Catholic Charities — which was tasked with identifying strategies for expanding access to treatment while addressing the concerns of community associations. The project is based on a similar initiative in Rhode Island, one of the only places in the country where the number of overdoses went down last year, rather than up.

Across the country, treatment for addiction remains cut off from the rest of the health care system. We’ve come to view this as normal. However, this is not normal, and we should not accept it. Overdose is now the leading cause of death for Americans under 50. We’ve had the gold standard of addiction treatment — a combination of medication, psychosocial support and wrap-around services — at our disposal for decades. These treatments, though, are not available in our hospitals and our doctors’ offices.

We are proud that our city is leading the nation in providing evidence-based and compassionate treatment for the disease of addiction. Through the health department’s monthly meetings, with the dedicated leadership of hospitals; the help of funding from the state and federal government; coordination with Behavioral Health System Baltimore; and the addiction prevention and treatment expertise of consultants Mosaic Group, nearly all of our 11 emergency departments now offer medication-assisted treatment on demand to patients with opioid addiction, something true of no other major city in America. These same emergency departments employ peer recovery specialists — people themselves in recovery from addiction — to engage with patients in the hospital and after discharge, using their shared experience to build relationships of trust rooted in the knowledge that treatment works and recovery is possible. To ensure that no one slips through the cracks, hospitals are screening each patient for substance use, providing any patient who screens positive with a brief intervention and linkage to treatment, including through our 24/7 phone hotline for addiction and mental health support.

This is an extraordinary achievement. In announcing the levels of care, we propose building on it. Level 1 hospitals — the highest level — should be able to treat patients with addiction, but they should also help patients get naloxone, the overdose antidote; connect more patients with peer recovery specialists or other support services and make sure that their doctors are prescribing opioid painkillers judiciously so that we can finally end this cycle of addiction and overdose death.

This is just a sketch. The details of each level will be finalized in collaboration with our hospitals and with any member of the public who wants to weigh in. We launched the proposal by opening it for public comment — we want to hear what you think.

Let’s build upon the work that’s already been done and make Baltimore City a national model for treating addiction alongside every other disease. That means treating addiction in the places where medical treatment is best delivered: in our traditional health care institutions — hospitals included.

Catherine E. Pugh is mayor of Baltimore City. Dr. Leana Wen is the Baltimore City Health Commissioner. Twitter: @MayorPugh50 and @DrLeanaWen.

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