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We must provide sustained funding proportional to the severity of the opioid epidemic
The opioid crisis is the deadliest epidemic in U.S. history. In 2017, nearly 50,000 individuals across the U.S. died from an overdose involving opioids. In my city of Baltimore, 761 people died. Those are mothers not coming home for dinner. Students not graduating from college. And grandparents missing birthdays. They are the human cost of overdose deaths. Yet, disturbingly, we have not reached the peak of this public health emergency. A new study tells an apocalyptic story - 510,000 dead in the U.S. from an opioid overdose in the next decade.
While stark statistics make the epidemic seem insurmountable, I draw hope knowing we have a toolkit that works. Every day, our women and men on the frontlines - community organizers, first responders, public health officials - are fighting to save the lives of our most vulnerable residents. In Baltimore, we have installed an uncompromising three-pillar strategy: save lives with naloxone, increase access to ethical treatment and provide education to reduce stigma and prevent addiction.
For example, when someone is dying from an overdose, we know that the antidote medication naloxone makes a life-and-death difference. That is why, in 2015, I issued a blanket naloxone prescription for all Baltimore City residents. The 43,000 Baltimoreans trained by our staff have saved more than 2,800 lives in the last three years.
But we know that access to naloxone remains a temporary solution and that addiction is a disease requiring long-term treatment. In Baltimore, we aim to make evidence-based, on-demand medication assisted treatment (MAT) - the gold standard of opioid addiction treatment - available and accessible. This year, under our mayor's leadership, we opened the state's first Stabilization Center and launched Levels of Care with all 11 Baltimore City hospitals so they begin to treat addiction as they would any other illness. And we continue to fight stigma and science through our "Don't Die" campaign.
Our evidence-based approach to combating overdose deaths is limited only by our lack of sufficient resources. There are three primary obstacles stopping the full realization of our three-pillar strategy and preventing us from ending the epidemic in Baltimore - and nationwide.
First, the price of naloxone must be substantially reduced for it to be widely accessible. Budget constraints force us to ration this life-saving medication and we go to sleep knowing that we must deliver more. Saving a life costs $75 per kit, even though the same drug is sold for pennies in other countries.
For us to supply the antidote to every Baltimore City resident - a recommendation from the Surgeon General - we would need $46.5 million every year, nearly twice the amount the city allocates for public health. We have repeatedly asked the Trump administration to enact its "government use authority," which would allow the federal government to procure generic versions of naloxone and immediately save thousands of lives.
Second, we must increase the availability of MAT to ensure treatment is available when people need it. Nowhere is this more apparent than in our prison system. Research shows that returned citizens face a risk of overdose up to 129 times greater than the general population. Recently, Rhode Island introduced FDA-approved MAT in its prisons, offering incarcerated residents with substance use disorder access to treatment. Within the first six months, returned citizens saw a decline in mortality of 61 percent.
In Baltimore City's pre-trial complex, incoming detainees receive MAT, but this is removed upon sentencing. This rapid detoxification process has no medical basis; it inflicts severe pain on the individual; and it substantially increases the likelihood of an overdose upon release. Why shouldn't Maryland and all states, follow Rhode Island's lead?
Third, we must provide sustained funding, proportional to the severity of the epidemic, directly to the hardest hit communities. At the peak of the HIV/AIDS epidemic, reducing the death toll seemed as unattainable as ending opioid overdose deaths today. Yet Americans refused to quit on their communities and the Ryan White HIV/AIDS program provided - and continues to provide - billions of dollars for treatment each year.
In April, Sen. Elizabeth Warren (D-Mass.) and Rep. Elijah Cummings (D-Md.) introduced a bill that would create a Ryan White program for the opioid epidemic. The Comprehensive Addiction Resources Emergency (CARE) Act would direct $100 billion to the opioid epidemic over ten years. This is the first proposal of its kind that would scale what works and begin reversing the spate of overdose deaths.
We must ask ourselves: When we look back at our work during the peak of this epidemic, will we say we did everything we could? Or, will we know we allowed many more thousands of people to die on our watch, because we refused to commit the resources needed to combat this epidemic?
Dr. Leana S. Wen is the Baltimore City health commissioner. Follow her on Twitter: @DrLeanaWen.