Baltimore's health commissioner didn't just tell legislators Tuesday how to save a person who has overdosed on heroin. She showed them.
In an Annapolis committee room, Dr. Leana Wen leaned over her deputy, Olivia Farrow, who slumped back in her chair as if unconscious. As lawmakers watched, Wen simulated the act of administering a dose of the anti-overdose drug naloxone by nose. She also showed how to use the form of the medicine that is injected into a muscle.
"You have now been trained," Wen told the delegates and senators.
That was all that was needed for Wen to start writing prescriptions for members of the Joint Committee on Behavioral Health and Opioid Use Disorders so they can keep the drug on hand.
"It's literally that miracle drug that can save people's lives," Wen said. She said Baltimore police officers have used the drug — sometimes known by the trade name Narcan — to save the lives of two people within the past month
The commissioner appeared before the panel to spread the word about naloxone, a medicine that physicians credit with pulling back users of heroin and other opioids from death's door. But she also came with policy prescriptions, telling lawmakers the state should learn from Baltimore's long history of dealing with drug addiction and support its efforts to get drug abusers into treatment.
"We hope they will learn from our best practices and use the methods we have already developed," Wen said. "We would like to have funding to expand, not just in Baltimore but statewide."
One of the "best practices" Wen is hoping to expand is making naloxone — and training on how to use it in an emergency — more available. She said Baltimore has already trained about 5,000 people, including police officers and family and friends of addicts, to administer the drug to someone who has overdosed.
"I think I can handle it based on the simplicity of it," said Del. Christian J. Miele, a Baltimore County Republican.
Sen. Thomas M. "Mac" Middleton, a Charles County Democrat, was among those who got a naloxone prescription from Wen after the hearing so he could keep some on hand for emergencies. He said heroin use "is just epidemic proportions in Southern Maryland in the rural areas."
Mayor Stephanie Rawlings-Blake, a Democrat, and Gov. Larry Hogan, a Republican, both set up task forces to study the burgeoning problem of heroin use and other painkillers as well as the resulting overdoses. The city issued its report this summer, while the state task force headed by Lt. Gov. Boyd Rutherford is expected to issue a final report by Dec. 1.
Hogan spokesman Matthew A. Clark said Rutherford has met with Wen and will meet with her again next month as part of an "ongoing dialogue" with city health officials. Clark said the state task force "is committed to working closely with local government officials in every part of the state to take action to address the epidemic."
"The goal of the governor's task force is to develop the right combination of prevention, treatment and law enforcement tools to turn the tide against the devastation that heroin wreaks on our communities," Clark said.
Wen told the committee she wants to see increased funding for a city initiative called dontdie.org, a website where people can learn where to get training on how to use and obtain naloxone. But she said naloxone is only one part of her department's plan for dealing with the heroin epidemic in a city with an estimated 19,000 addicts.
If health officials simply treat a person's overdose without follow-up care, she said, the city's approach would just be "treading water."
The other parts of the city's strategy are to provide access to high-quality care for those who are addicted and education to prevent drug abuse in the first place.
As part of that, Wen said she is seeking operating money for the city's planned "stabilization center" for people with substance abuse symptoms that don't need to be treated in an emergency room. She said the state has provided the $3.6 million the city will need to build the center, but she needs funding to run it.
City health officials say they see the center as a way station where people intoxicated by drugs or alcohol can rest for an estimated six to 10 hours while they recover. Before they are released, they would be given information about how to receive treatment.
Farrow said people brought to emergency rooms for drug-related symptoms often don't get the follow-up care they need. She said the stabilization centers would be staffed with nurse practitioners and social workers around the clock and on weekends.
"We want to see people taken to a facility that can really help their needs," she said. "We know we want to continue to follow these folks" whether they want treatment or not.
Wen said the next challenge is to see that beds are available in treatment centers so patients don't have to wait for weeks for space in a program. Nationally, only 11 percent of addicts seeking treatment are able to get it when they need it, she said. In some cases, Wen said, patients know the only way to get a bed is to claim to be suicidal.
One of the strategies the city has adopted to prevent addiction is to contact Baltimore physicians to ask them to consider how often they prescribe powerful painkillers. While Americans make up less than 5percent of the world's population, they receive 80percent of its opioid prescriptions, Wen said.
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Wen said giving prescriptions to lawmakers is more than a gimmick. She said legislators are leaders in their communities who frequently attend public meetings where they can spread the word about naloxone.
"We want to show that everyone can learn to use naloxone," she said.