The opioid drug epidemic—which is being fueled not just by illegal drugs like heroin, but also prescription pain medications—now kills more people in the United States than car crashes. In many cities, it kills more people than homicides. The question now, for many public health officials, is why everyone doesn’t have access to the simple, safe drug that almost miraculously reverses overdoses and could save thousands of lives a year.
"In modern medicine there are few diseases, few ailments that have a complete antidote," says Baltimore Health Commissioner Leana Wen, who has been among the officials nationwide leading the charge to improve access to the drug, called naloxone (or by its trade name Narcan). "It is unconscionable that if we have an antidote that we should not make it available to everyone."
Naloxone, which can be injected or given through a nasal spray, is simple for a bystander to administer when they see signs of someone overdosing and it immediately reverses its effects. Importantly, there are no side effects if it is given by mistake to someone who isn’t on opioids.
Around the country, in schools, drug courts, and on the streets, officials are working to distribute naloxone and train people to use it. In some cities, police now carry it around. Drug stores, like CVS, Walgreens, and Rite Aid, have over the last year made it available without an individual prescription in about half of U.S. states that allowed it. The manufacturer is distributing it for free in schools in the United States.
In Baltimore, where 20,000 out of 620,000 city residents use heroin—part of an epidemic that was damaging minority communities long before opioids became a national issue—Wen’s goal is that a dose of naloxone should be in everyone’s first aid kit and medicine cabinet. Last year, she issued a "standing order" blanket prescription, so that anyone in Baltimore who completes a very short training, can fill an order at a local pharmacy. "We believe in training everyone," she says. (Days before his death, Prince reportedly had to land his plane to get a dose, though presumably there would have been a first aid kit on the plane that, if Wen has her way, would have been equipped with naloxone).
So far, the city has trained 10,000 people on using naloxone and has launched a 24/7 phone line as a one-stop resource for anyone with addiction or mental health needs (six months after it launched, it gets 1,000 calls a week). The health department has tried to use data to figure out where the "hotspots" over overdoses are. Trainings have included more obvious places, like in drug treatment courts, prisons, and needle exchange sites, but also in cafes, at bus stops, public housing, and even at a country club.
On election day, it set up training sessions at polling stations so people could "learn to save a life" while they waited their turn. Finally, with its "don’t die" anti-stigma campaign, she believes the city has launched the first online naloxone training. After watching an eight minute video and taking a short quiz, I printed out a certificate that I could fill at a pharmacy in Baltimore. Though it is hard to get clear data on how much the drug is being used by people trained through the program, Wen says that several lives have been saved this year by people having greater access to Naloxone. The Baltimore police force have been carrying naloxone doses for just a few months; she says they have saved 21 lives.
Still, similar programs are controversial in some states. In Maine, Republican Governor Paul LePage vetoed legislation in April that would expand access to naloxone, echoing worries from some that too much access to the drug reduces the incentives for addicts to get treatment, knowing they have a safety net.
"Creating a situation where an addict has a heroin needle in one hand and a shot of naloxone in the other produces a sense of normalcy and security around heroin use that serves only to perpetuate the cycle of addiction," he wrote in his veto letter. (Maine's legislature quickly passed the bill over the governor's veto).
Wen believes that this is exactly the wrong approach that echoes the mistake in treating addiction for decades. "To everyone who will listen, we have said: ‘The science is clear: addiction is a disease. Recovery is possible. And treatment exists," she says. "There is no hope for getting someone into treatment if they’re dead today." Baltimore is opening a stabilization and treatment center that will function as something like an ER for people with drug issues, but more funding at the national level is clearly needed. Even for naloxone, the soaring price—at $40 a dose last July—may become a limiting factor for distributing it everywhere.
Baltimore, of course, has been dealing with drugs for many decades, but rates of addiction have increased in the last decade beyond urban areas where they have traditionally been higher.
"I hear our community saying ... people have been dying in our city from overdoses for a long time. Why is it that now that it’s no longer communities of color that are dying that we suddenly think that this is a matter of a public health emergency?" says Wen.
"I think it’s fair to acknowledge that and say it’s a little too late, actually a lot too late in our city, but that doesn’t mean we can’t start now and capitalize on the national attention that there is, recognizing that rhetoric is not enough."