Baltimore’s Three-Pronged Strategy for Responding to Opioids
- Saving lives with naloxone
- Expanding access to addiction treatment
- Reducing stigma and preventing addiction
A Nationally Recognized Model
Baltimore’s aggressive three-prong strategy for responding to the opioid epidemic has been recognized as one of the strongest in the nation. This aggressive campaign was developed under the leadership of former Baltimore City Health Commissioner, Dr. Leana Wen. Baltimore’s efforts have been lauded by former Director of National Drug Control Policy Michael Botticelli, FDA Commissioner Robert Califf, and U.S. Surgeon General Vivek Murthy and gained national media attention as a model for the country from USA Today, National Public Radio (NPR), CNN, and other outlets.
Saving Lives With Naloxone
In collaboration with partners including Behavioral Health System Baltimore, Health Care for the Homeless, and Baltimore Harm Reduction Coalition, the Baltimore City Health Department and its Community Risk Reduction Services have held over 5,824 naloxone training’s, had 49,626 people trained to respond to an opioid overdose, and distributed over 42,626 naloxone kits for the reversal of opioid overdoses. These efforts have led to over 3173 overdose reversals in the community. When administered to an individual experiencing an overdose, naloxone can take them from near death to walking and talking in a matter of minutes. The first step in fighting the opioid crisis is the acute response and preparation. The goal is to save lives today by getting naloxone into the hands of first responders and bystanders alike.
Addiction Treatment Expansion
24/7 Phone Hotline for Behavioral Health Services
The first step to ensuring access to treatment is to make it easy for people to find services and get referrals to treatment. In Baltimore, residents previously had to navigate multiple phone lines to receive crisis services and behavioral health treatment referrals. In October 2015, we worked with partners to combine these lines into a single 24/7 hotline to create a more comprehensive resource for the community. This combined hotline enables callers to get screened and linked to the appropriate behavioral health services. The hotline receives more than 40,000 calls annually.
If you or someone you know needs help with substance use or mental health in Baltimore City, call the hotline at 410-433-5175
24/7 Stabilization Center
The most common health concern of frequent users of emergency medical services in Baltimore City is substance use intoxication or mental illness. In fact, 32 percent of Maryland Medicaid enrollees with a substance use disorder visited the emergency department three or more times in a one-year period. We secured $3.6 million in capital funds to build a stabilization center, which will be the first step toward creating a 24/7 “ER” for behavioral health.
In April of this year BCHD opened the state’s first stabilization center, which provides patients with medical screenings, referrals to treatment, and respite. The stabilization center will revitalize space at the Hebrew Orphan Asylum in West Baltimore. While that project is underway, a pilot center will open at nearby Tuerk House, which is a substance abuse center. The Stabilization Center provides short-term crisis services for individuals who are intoxicated from drugs or alcohol, links to people with substance use disorders to treatment and recovery support services such as SBIRT, first aid, food and showers.
Increasing Capacity for Medication-Assisted Treatment for Opioid Use Disorders
In order to address the increase need for treatment options that work, BCHD has convened dozens of stakeholders to develop and comprehensive opioid prevention and treatment framework including improved access to evidence based treatment. We have worked with the city’s hospital emergency departments to encourage buprenorphine induction and referrals to treatment following the SBIRT process. BCHD has also launched a mobile treatment van coined The Spot, where buprenorphine is initiated alongside other forms of care access including Hep C and HIV treatment. Similar to Vermont, we have developed a hub and spoke model of treatment ensuring that everyone who needs treatment has access to a flexible network of providers to meet their care needs. The pilot of this program operates from IBR REACH and expansion opportunities are being considered in partnership with Behavioral Health Sciences Baltimore.
Improving Relations Between Treatment Providers and Communities
To address concerns that residents have about the presence of substance use disorder treatment centers in their communities and ensure access to care across the city, BCHD recently convened a work group of community and treatment system leaders to improve distribution of substance use treatment services in the city and encourage providers to adopt practices that make them good neighbors. The work group has held public meetings to seek input from city residents and will make recommendations and work with communities to address their concerns about the presence or absence of treatment services in their neighborhoods.
Levels of Care
People suffering from substance abuse disorder move through America’s hospitals every year, and the services that hospitals do or do not provide to these patients have a significant effect on their morbidity and mortality. As a result, we launched the Levels of Care initiative, which creates a common foundation for how hospitals should be responding to the opioid epidemic. It is based on a similar initiative in Rhode Island where the number of overdose deaths decreased significantly. This is an initiative that has been developed with active input from hospitals around the city. A hospital can be ranked level 3, 2, 1 – with Level 1 hospital offering the most comprehensive response.
The protocols in the levels are evidence based and include recommendations such as:
- The ability to maintain capacity to initiate medication-assisted treatment
- The ability to offer peer recovery support services or similar support services
- The ability to screen patients that are in hospital campus outpatient clinics for at-risk substance use and substance use disorder (SUD)
HUB & Spoke
In fall of 2017, the City began piloting a “hub and spokes” model of buprenorphine treatment that builds on the work of the Baltimore Buprenorphine Initiative, increasing the availability of addiction treatment in the primary care setting. The “hub”—Institute for Behavior Resources, Inc., REACH Health Services—is a low-threshold access point. Patients can walk in and begin treatment without an appointment. Patients receive individualized, comprehensive care; all three medications approved by the U.S. Food and Drug Administration for the treatment of opioid use disorder are available. After a patient’s condition has improved, they have the option to continue their treatment at a primary care clinic—a “spoke”—where the treatment for opioid use disorder is integrated into the rest of the medical care. The hub works with each spoke to help the spoke providers feel comfortable incorporating addiction treatment into their practice.
As of April 2018, one hub and 11 spoke sites are online.