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Dr. Wen, prescriber- in-chief

At a time when deaths from drug overdoses are rising nationally, Baltimore City has seen more such fatalities than any other jurisdiction in Maryland. Last year, 303 people died in Baltimore from drug overdoses, most of them involving opiates, comprising nearly a third of all such deaths statewide. Many of those lives could have been saved had the victims been treated promptly with naloxone, a medication that reverses the effects of drug overdoses. That is why Baltimore City Health Commissioner Leana Wen's announcement last week that she will use her authority under a new law to make the drug more widely available marks an important advance in efforts to prevent overdose deaths and steer addicts into treatment and recovery programs.

Baltimore City has trained thousands of emergency first-responders, heroin addicts and their families and friends on how to administer naloxone, also known by the brand name Narcan. The medication has already saved hundreds of lives in Baltimore, and it has the potential to reduce overall overdose deaths in the city even further. But under the old law, people needed a doctor's prescription to purchase the medication if a physician wasn't present during their training. In practice, that meant making an appointment and visiting a doctor's office to get a prescription — a requirement that created barriers for homeless people and others who rarely see a physician.

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That is what led Dr. Wen to act on a provision in the new law that allows her to write a blanket prescription — called a "standing order" — covering anyone who is trained to administer naloxone. She has, in effect, become the prescriber-in-chief for Baltimore City, and as a result the medication will now be available on demand to virtually everyone with the proper training to use it. More importantly, her order will greatly increase the chances that lives that otherwise might be lost to overdoses can be saved and that addicts will enter treatment for their illness. Given the magnitude of its overdose problem, it's altogether fitting that Baltimore should be the first jurisdiction in the state to use its new authority this way.

And the change comes not a moment too soon. Overdose deaths have been rising in recent years because prescription painkillers such as Oxycontin and Percocet have become more expensive and difficult to obtain legally because of better oversight among prescribers and pharmacies. That has led people who became addicted to those medications to switch to cheaper substitutes such as heroin. But they often don't realize the risks they are taking by injecting impure or adulterated street drugs that may contain other substances, such as fentanyl, that greatly magnify the opiate's effect on the body. In the first quarter of this year there were more than three dozen overdose deaths involving fentanyl, compared to 14 during the same period last year.

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Gov. Larry Hogan's Heroin and Opioid Emergency Task Force estimates the overdose deaths from heroin and other drugs increased by 95 percent from 2010 to 2013. This is a still developing crisis, and the state is nowhere near being out of the woods yet. What's certain, however, is that Maryland will never be able to achieve its target of a 20 percent reduction in drug-related deaths by the end of this year if Baltimore City continues to be the epicenter of an overdose epidemic.

Naloxone isn't a panacea, of course. It prevents overdose deaths but doesn't cure addiction, so the state needs to expand its investment in drug treatment and recovery programs and strengthen the prescription drug monitoring program that alerts physicians and pharmacists to suspicious purchases. It also needs to continue requiring local overdose fatality review teams to examine every overdose fatality for holes in the current drug safety net.

Nonetheless, making naloxone as available throughout the state as it now will be in Baltimore would represent a crucial advance. As Dr. Wen has said, there are very few poisons in the world for which there is a complete antidote. But that is just what naloxone is for heroin, fentanyl, Oxycontin and other opioid drugs. We have the tools to save hundreds of lives each year in Maryland, and we must use all of them if we are to end this scourge.

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