Alarmed by a stubbornly high and rising number of heroin overdose deaths, officials in Baltimore are looking to put the overdose antidote naloxone into as many hands as possible by expanding its availability and eliminating the need for in-person training on how to use it.
Dr. Leana Wen, the city health commissioner, issued a standing order in October that allows anyone instructed on the use of naloxone, also known by the brand name Narcan, to get it without a prescription. More than 8,000 people attended training sessions last year.
Now the health department has developed a quick online tutorial, available at DontDie.org, for those who can't get to the city health department or other demonstration locations.
The battle against heroin has taken on new urgency in recent months as more quantities of the drug have been found to contain fentanyl, a synthetic painkiller that is 10 times more potent.
"The staggering increase in fentanyl-related overdose deaths in our city is a public health emergency," Wen said Wednesday at a news conference to announce the online training program. "Nearly every day in Baltimore, one person dies from drug overdose. It is our obligation to educate and save lives. By offering this new online training we will be able to put this lifesaving medication in the hands of more Baltimoreans."
The city reported that there were 14 deaths related to fentanyl in October, the most recent month for which data is available. That's a 133 percent increase over the same month a year earlier.
The health department said 39 overdose reversals were reported from January through October of last year. Officials say many more cases might have gone unreported.
In Baltimore, heroin overdose deaths jumped 28 percent from 150 in 2013 to 192 in 2014, the most recent year for which officials had figures. Statewide, they rose 25 percent last year to 578.
The surge in fentanyl-related deaths began in 2014, federal officials say. In Maryland, fentanyl-related overdose deaths more than tripled from 58 in 2013 to 185 last year.
Providers say the goal for heroin users is treatment, but until they want or can get help, there needs to be a way to keep them from dying.
"It's a Band-Aid," said Kathy Westcoat, president and CEO of the nonprofit Behavioral Health System Baltimore, which acts as the city's mental health and substance abuse authority.
"It's keeping people alive," said Westcoat, who attended the news conference. "It's not treatment, but hopefully it's a wake-up call for some people."
Paramedics have been carrying naloxone for decades. But heroin users — particularly those who are inexperienced, or have inadvertently taken fentanyl — can overdose and stop breathing in seconds.
Mark Fletcher, the city's EMS deputy chief, said it's important to get the antidote into the hands of people who may already be on the scene because the ambulance may not get there in time.
Fletcher said paramedics carry cards with referral numbers for treatment and try to counsel people to get help.
"We don't accept or condone use of heroin," he said. "But, on the other hand, people are going to use. It's really sad when you see young people especially die."
Fletcher and others believe an education campaign waged by the city will persuade friends and family, and especially users, to carry naloxone. Officials are getting the word out through their needle exchange program, billboards and other advertising, word of mouth and the website.
The online training module was developed with a small grant from the Open Society Institute. The overall budget for the naloxone program this year was $200,000, which came mostly from the state and largely pays for the cost of the drug given out during training.
In August, the manufacturer Kaleo provided 3,000 units of Evzio, an auto-injector version of naloxone. Those doses were given out to active users.
Those who buy naloxone at a pharmacy pay $1 if they are enrolled in Medicaid in Maryland or by co-pay through their private insurance. The cost to governments has risen, with one leading manufacturer increasing the price last year for 10 doses from $97 to $370.
Not everyone believes that the push to arm the public with naloxone will be effective in turning the tide against overdoses.
Mike Gimbel, a former heroin addict who headed Baltimore County's substance abuse office, said those who promote naloxone "don't understand the behavior of an addict who only wants more and more drugs and isn't concerned about their health or the law."
He said officials need to put as much effort and money toward treatment, especially long-term residential programs that allow addicts to get off the street and away from drug-using friends.
"My biggest concern is that we are convincing the public that Narcan is a solution to the heroin epidemic, and it is not," he said. "Bottom line is, every new program we come up with depends on the ability to refer addicts to an appropriate, affordable residential drug treatment program."