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Md. opioid emergency requires unconventional approach

The final figures are still coming in, but it is anticipated that the number of fatal drug-related overdoses in Maryland for 2016 may top 2,000 for the first time in state history. This is likely what led Gov. Larry Hogan to declare a "State of Emergency" around the opioid crisis in Maryland and propose to spend $50 million over five years to "to beef up enforcement, prevention and treatment services." These funds are critical, and we commend the governor for taking action.

However, as we truly are in a state of emergency, we must acknowledge that traditional courses of action, even if intensified, are not enough to address the current crisis. That's why it was disappointing to also hear the governor refer to a proposal to create legal "safe spaces" in Baltimore, where drug users can get proper medical attention during and after injecting drugs, as "absolutely insane." Historically, states of emergency have been used to order government agencies to implement emergency plans and alert citizens to change their normal behavior because of some imminent danger. In order to address Maryland's opioid emergency, unconventional but viable options such as safe consumption spaces must be considered — particularly when we have impressive data from 10 countries that currently operate nearly 100 safe consumptions spaces.

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These programs have shown amazing reductions in overdose rates, HIV and Hepatitis C transmissions and costs related to emergency room visits. The safe consumption space in Vancouver, for example, has had nearly 3.5 million visits since 2003 and not one fatal overdose. Given Baltimore's opioid crisis, the positive impact of a safe consumption space could be even more profound.

Safe consumptions spaces are not the only response that should be considered to address the overdose crisis. There are several other strategies that could decrease the negative impact of drug use and lessen the unnecessary loss of lives in Maryland. Increasing funding to identify and place community health workers in "hot spots" where high numbers of overdoses are taking place would allow for real time interventions. Officials and outreach workers could also encourage people who use drugs to use in the presence of others. Another unconventional but viable harm reduction strategy would be to provide users with kits that allow them to test their drugs and appropriately manage their use. Since 2013, there has been more than a twenty-fold increase in fentanyl-related overdose deaths, resulting in more than 400 deaths in Baltimore in 2016. If people who use drugs could be alerted to the proportion of the drug that is fentanyl, which is much stronger than heroin, then many overdose deaths could be averted.

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Safe consumption spaces predictably and understandably raise moral concerns about supporting substance use. Many of the arguments proffered against safe injection sites, however, sound similar to the thinking that caused this country to delay its response to the HIV/AIDS epidemic. The judgmental stance that we took toward those contracting HIV in the 1980s allowed the AIDS epidemic to grow and ultimately impact every age, gender, race and religious group in America. We cannot afford to make the same mistake with the opioid epidemic. This epidemic is everywhere, and if we do not act swiftly and decisively — and even unconventionally — the loss of life and good health will only get worse.

Maryland is indeed in a state of emergency. If this were a hurricane or a flash flood, we would not be blaming victims for their predicament or arguing about whether we should use all means necessary to save people who are stranded on the top of their homes. In a state of emergency, the top priority is the preservation of life. And, in those most horrific moments, we come together as a community and work creatively with the resources we have to keep our neighbors alive because we all understand that tomorrow's emergency could put us in harm's way.

Scott Nolen is director of the drug addiction treatment program at Open Society Institute-Baltimore. His email is scott.nolen@opensocietyfoundations.org.

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