As a long-time resident of Baltimore, I love and admire the collective resilience my friends and neighbors show in the face of adversity. As the opioid epidemic has deepened our city's decades-long struggle with addiction, we have used that resiliency and worked together to try to address one of the greatest challenges created by this disease: stigma. The president's recent comments about Baltimore showed how damaging stigma can be in addressing issues like the opioid epidemic. Stigma drives wedges within communities, making it harder to take collective action by treating a medical disease like a moral failing. And the results are devastating. Since 2007, Baltimore City has lost 4,565 lives to opioid overdose. In remembrance of those lost to the epidemic, Baltimore City observes International Overdose Awareness Day annually on August 31. We use this day to honor the memory of our family members, friends and neighbors who were taken too soon from us, and to publicly reject the stigma attached to the disease of addiction. Communities across the world afflicted with this disease observe this day to help raise awareness of the dangers of substance use disorders and the need to reduce stigma and remove this crucial barrier to treatment.
Public health experts, including those who have helped organize International Overdose Awareness Day, acknowledge that a successful response to overdose means that we should not try to address substance use disorders in isolation. Ideally, communities should partner with city and federal policymakers to collectively work to treat substance misuse.
When we refer to substance misuse, we are addressing an issue that we know cannot be disentangled from any other public health priority, including violence. We know we must treat the health of entire neighborhoods through increasing permanent and affordable housing, investing in job development, addressing the gaps within our education systems, emphasizing trauma-informed care, combatting food insecurity – the list continues. We also know that we cannot incarcerate our way out of the harms suffered through substance use disorders – it is a failed tactic that creates harm and increases stigma, blocking paths to treatment.
In Baltimore City, where thousands of our residents continue to suffer from substance use disorders, countless lives are affected – either directly or indirectly – on a daily basis. Here at the Health Department, we have adopted a three-pillar strategy: reversing overdoses with naloxone, increasing access to quality treatment, and increasing education and awareness in order to reduce stigma through a trauma-informed lens.
In recent years, the Baltimore City Health Department has expanded its stock of naloxone and greatly increased naloxone education and outreach. Through the city’s efforts, residents have administered 4,550 doses of naloxone since 2015 and saved thousands of lives as a result. In acknowledging that more must be done, the department’s staff is also providing additional education and awareness regarding the dangers of fentanyl, the silent killer that is now found in a vast majority of the illegal drug supply in Baltimore City.
The Health Department’s successes involving education and outreach have afforded it the opportunity to shift focus toward increasing access to treatment. We must explore every available treatment option while working to perfect the systems that already exist. Already, we have lifted many of the barriers to long-term treatment faced by residents in the community through programs such as Hospital Levels of Care, which provides a framework for hospitals looking to achieve best practices in responding to the opioid epidemic; Hub and Spokes, which increases the availability of addiction treatment in primary care settings; and the Stabilization Center, a new facility in West Baltimore that provides a place for individuals under the influence of drugs and/or alcohol to sober and receive short-term medical and social interventions.
The Health Department has also worked to expand the types of treatment available to residents suffering from substance use disorder. For example, the department now deploys mobile health care units, our “Health Care on the Spot” program, into the community, with the intent of reaching our most vulnerable populations.
Unfortunately, these efforts are still not enough. Our city experienced 888 overdose deaths in 2018, and the Health Department alone cannot end this epidemic. We need to continue working with residents, community health partners, elected leaders and other stakeholders to reduce the stigma still too often associated with FDA-approved medications used to treat opioid addiction. We need to continue working to focus resources on proven treatments that can save lives and honor the commitment of community outreach workers and first responders by ensuring that Baltimore’s residents have access to care before and after an overdose.
And so, on International Overdose Awareness Day this year, the Baltimore City Health Department reaffirms its commitment to provide holistic, person-centered support for communities plagued with overdose deaths, and to fight for resources needed for our residents to lead healthy and successful lives. Together, we will continue fighting for the lives of our family, friends, and neighbors.
Dr. Letitia Dzirasa (Twitter: @bmore_healthy) is Baltimore City heath commissioner. Brittney Spencer is the director of opioid overdose prevention at the Baltimore City Health Department.