BALTIMORE, MARYLAND — If the paramedics had gotten there two minutes later, Darrin Dorsey would be dead. “Through the process you don’t even know you are about to die or you’re dead,” said Dorsey. “You only know what happened to you when you wake up and someone tells you.”
He recalled overdosing on fentanyl-laced heroin nearly two weeks ago. Dorsey’s near-death experience comes as Baltimore city officials have been trying to get naloxone, an overdose reversal medication better known by its brand name Narcan, into the hands of every person. First responders aren’t the only ones who save lives in this city, civilians can too.
The unorthodox goal is meant to address an escalating crisis. Nearly a third of Maryland’s opioid-related overdose deaths in 2016 occurred in Baltimore. That’s 694 Baltimore residents who died of drug related causes, or roughly two killed a day, according to the Maryland Department of Health.
“We’ve been dying in my community from this disease,” said Dorsey, when asked about the newly found interest in addressing overdose in Baltimore that’s plagued his city for decades. It’s just that it’s now hitting a certain demographic that everyone seems to care, he said. With wider compassion, Baltimore’s seeing a revived effort to address this public health crisis.
Officials have been doling out naloxone as part of its citywide “Don’t Die” campaign, but with high demand and increasing drug prices, the city has had to ration its dwindling supply. The thing is when Dorsey overdosed, no one around him had naloxone, illustrating just how tricky this crisis is to crack. Baltimore public health experts told ThinkProgress there’s a way to curb the death rate, the city just needs more resources to accomplish its aim. The city just needs the president to declare a national emergency.
Dorsey was expressionless and didactic when he recounted to ThinkProgress the day he overdosed. He picked up dope with a guy he met at a transitional house. Shortly after using drugs, he rode the bus. The last moment he remembers was sitting down and nodding out.
“Next thing I knew the paramedics were picking me up,” said Dorsey. “Sir, are you ok? Are you ok? I didn’t know what was going on.” The paramedics administered naloxone on scene. Just like Flonase nasal spray, they released the dose into Dorsey’s nose.
City officials have distributed more than 9,000 naloxone kits in 2016. Still no one on Dorsey’s bus had the antidote. In a similar bane, not one of Dorsey’s friends from Park Heights carries the drug either. His community is just hearing about it, he said.
“I had to wait until the paramedics came so that was time that [was] wasted,” he said. “I believe, actually, that bus drivers should carry Narcan because they deal with the community everyday and all day.”
When we spoke, Dorsey was looking to obtain Narcan nasal spray after having been saved by it.
Naloxone is not treatment
Dorsey unpacked his struggle with addiction to ThinkProgress at the Center for Addiction Medicine (CAM), a chemical dependency program affiliated with the University of Maryland Medical Center. He started using stronger drugs like heroin when he turned 29 years old. He’s 32 now and is seeking treatment. But it’s hard. He uses illicit opioids because, as Dorsey explains it, he has mental health issues and sometimes just wants his brain to shut off.
CAM caught wind of Dorsey’s struggle with opioid-use disorder when he was rushed to the University of Maryland Medical Center Midtown Campus emergency department after he overdosed. A CAM peer recovery coach reached out to Dorsey hoping to get him into treatment. CAM was persistent, and so eventually he scheduled a visit.
“If you overdose the first time and you survive — you have to survive the first one — your chances of overdosing another time is astronomical,” said Marian Currens, nurse practitioner and associate medical director at CAM. “So we need to be able to help our patients see how important it is to get into recovery.”
CAM is working on a research project to see how often its patients who overdose seek recovery and stick with it or relapse. But to be able to instigate treatment, a patient needs to be alive, said Currens.
“Some people feel that Narcan is not appropriate — that it’s not treatment,” said Currens. “You’re absolutely right, Narcan is not treatment. Narcan is only there in an emergency to save your life so it needs to be readily available.”
Baltimore City Health Commissioner Dr. Leana Wen said it’s important to think about addiction as we would other diseases. (The World Health Organization recognizes opioid dependence as a complex health condition.) Take heart disease, specifically a heart attack, she said.
“There is an acute treatment that we need to give to them right now,” said Dr. Wen. “If their heart is stopped we have to use a defibrillator, we have to save their lives right now.” Now, equate a defibrillator to naloxone.
Between January and March of this year, already 159 people died of an opioid overdose in Baltimore. When asked about this continued increase in overdose deaths, Dr. Wen contended the crisis is multifaceted, but that the experts know what works: reduce stigma around addiction, provide a combination of medication assisted treatment and counseling, and keep people alive.
But to do this, Baltimore needs Washington D.C.’s help.
This is an emergency
President Donald Trump is expected to formally declare a national emergency this week, fulfilling a months-long promise. Dr. Wen has been anxiously awaiting the declaration since mid-August when ThinkProgress first spoke to her.
She, and other members of the Baltimore City Health Department who are on the front lines of this epidemic, are hoping he specifically declares this crisis a public health emergency, a kind of state of emergency. This would give the Department of Health and Human Services (HHS) secretary broad authority. She’s hoping the declaration prioritizes naloxone availability, and that it allows the HHS Secretary to negotiate drug prices for the opioid antagonist.
The price for some brands of naloxone has been steadily increasing for years. Two easily-administered brands are on the pricier side. A naloxone auto-injector called Evzio, made by Kaleo Pharmaceuticals, went from $288 per dose when it was first introduced in 2014 to more than $2,000 in 2017. The list price for Narcan nasal spray, made by Adapt Pharma, is $125 since 2015. A company spokesman told National Public Radio that Adapt sells Narcan to emergency responders and other public agencies for $75 for a two-pack.
Dr. Wen did say state and federal officials have done a lot to increase the city’s supply of naloxone. Even pharmaceutical companies directly donated medication. “But we should not be relying on the good will of drug companies in order to get access to a lifesaving medication,” she said.
If Baltimore wants to continue to dispense naloxone to everyone, the city needs more help.
“So we have enough money for I think about 5,000 units of Narcan, from now until July of 2018,” she said. “If you gave me 5,000 units of Narcan today, I’ll be able to pass them out by the weekend. That’s how much demand there is.”
Evidence suggests Dr. Wen’s instincts are right. A recent paper from the National Bureau of Economic Research found that the adoption of a naloxone access law is associated with a nine to 11 percent decrease in the opioid-related deaths in a state. A recent evaluation of Massachusetts’ naloxone program, which trained over 2,000 potential overdose bystanders, observed that opioid overdose death rates were significantly reduced in communities that implemented the program compared to those that did not.
Dr. Wen has been rationing the city’s supply of naloxone, and prioritizing at-risk communities. People who utilize the community’s risk reduction van are high risk because they’re actively using drugs. So, the city makes sure the van has naloxone.
Nevertheless, the van — that’s been around since 1994 as a response to the HIV and syphilis outbreak — is feeling the city’s shortage. Lifelong Baltimore resident and the van’s assistant program manager Lisa Parker told ThinkProgress that high demand and short supply has really strained the program.
Dorthea Grant used the Narcan she got from the needle exchange van to save a person’s life. As Grant explained it to ThinkProgress, she saw a non-coherent man one day near Collington Square Park, just 50 feet away from a police officer. The police officer didn’t do anything, so she went up to the man and threatened to use Narcan on him if he didn’t respond. The man didn’t, and so she did. She saved his life.
“There are just not enough government officials, police officers, [emergency medical technician] people to combat this alone,” Grant said. And in Grant’s experience, sometimes it’s hard to depend on first responders for immediate assistance.
It’s so easy, it’s hard
Baltimore residents could purchase their own naloxone. In 2015, Dr. Wen issued a jurisdiction-wide standing order for naloxone to be dispensed to overdose response employees or volunteers and pharmacies. Two years later, she issued a new standing order, dismantling any and all barriers to naloxone. Residents can now get the antidote at 114 different pharmacies, no prescription needed.
But are people taking advantage of this? No, said Fibus Drug Store owner and pharmacist Norman Levin. Most don’t know about this standing order, from physicians to everyday people. Levine targets people most at risk of overdosing. When people come in his pharmacy for Suboxone, medication assisted treatment for opioid-use disorder, he or his employees make sure they leave with naloxone.
With Medicaid insurance, Narcan costs $1. If the customer is on private insurance, the cost fluctuates. Sometimes costs, as cheap as they seem, act as a barrier. Most patients don’t think they need naloxone as overdosing is an abstract. Is it worth, let’s say, $20? To some, no. If a customer refuses to pick up Narcan because of the cost, Levin will usually give it to him or her for free, and then get reimbursed by the city later.
“To have in their hands is better than sending the family down to the morgue to identify them,” Levin told ThinkProgress. “If they’re living there’s still the chance that they’ll get into a program that will be able to help them.”