Baltimore’s Three-Pronged Strategy for Responding to Opioids
- Naloxone training and distribution
- Expanding access to addiction treatment
- Education about opioids
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. Dr. Leana Wen, Baltimore City Health Commissioner, has given testimony about these efforts before U.S. Senate and House committees and discussed them on a panel with President Barack Obama at the National Rx Drug Abuse and Heroin Summit in March 2016. 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.
Naloxone Training and Distribution
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 trained 22,000 people to respond to an overdose and distributed over 17,000 naloxone kits for the reversal of opioid overdoses. These efforts have led to over 800 overdose reversals in the community.
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.
The center will provide voluntary care for adults who are intoxicated. In addition to first aid, medical monitoring, hydration, food, clothing, and showers, the Stabilization Center will provide Screening, Brief Intervention, and Referrals to Treatment (SBIRT) as well as case management for up to 30 days after a visit to ensure linkage to treatment, shelter, and health care.
Increasing Capacity for Medication-Assisted Treatment for Opioid Use Disorders
We have convened dozens of stakeholders ranging from city agencies to behavioral health service providers to develop a comprehensive opioid prevention and treatment framework that includes improving access to evidence-based treatment as a core pillar. We have engaged in a months-long strategic planning process with providers to identify strategies for increasing access to medication-assisted treatment for opioid use disorders with buprenorphine. BCHD has worked with our city’s hospital emergency departments to encourage buprenorphine induction and referrals to treatment. We plan to implement a mobile treatment capacity to bring treatment with buprenorphine to hard-to-serve patients who may not seek treatment in the traditional health care system. Similar to Vermont, we are developing a hub-and-spoke model to ensure that everyone who needs treatment has access to a flexible network of providers to meet his or her care needs.
BCHD is collaborating with NIDA and other partners on a pilot to provide methadone through pharmacies in Baltimore City. This model will increase access to treatment in underserved parts of the city and further integrate medication-assisted addiction treatment into the health care system.
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.
Baltimore’s Opioid Education Actions
The Don’t Die Campaign
Baltimore City’s Don’t Die campaign, of which this website is a part, is a successful public health campaign focused on reducing stigma, promoting substance use disorder treatment, and educating the public to recognize and respond to an overdose. This first-of-its-kind campaign has included billboards, posters at bus stops and metro stations, and even in Baltimore’s Pratt library system. We’ve distributed fliers, posters, and post cards across the city. Through this website, we offer a short online training for anyone to learn to administer naloxone.
Working with Prescribers
In the past, physicians and other providers have not received as much education as they should have about opioids, addictions, and ways to reduce the risks of both. As part of our education efforts, the Baltimore City Health Department regularly reaches out to physicians and other prescribers across the city with a number of recommendations. We attend gatherings at hospitals and medical schools, deliver grand rounds, and send letters to all providers about these issues.
- Safe Prescribing of opioids. The CDC recently release guidelines on opioid prescribing, and I encourage all of you to review and follow them. The quick version is that they call on prescribers to avoid prescribing opioids when pain can be managed in other ways. Prescribe the lowest effective dose when opioids are required. And write prescriptions for a short period of time. Be prepared to refer patients to substance use disorder treatment if they show signs of needing it.
- Asking prescribers to co-prescribe naloxone for every patient receiving opioids. People may misuse their medication; they may take more than prescribed or forget that they have already taken a dose. Their children may get ahold of their medication. It’s critical that patients who have opioids in the home also have the overdose antidote.
- Encouraging prescribers not to prescribe patients both opioids and benzodiazepines. Combining these medications makes overdose significantly more likely. Thanks to advocacy from the Baltimore City Health Commissioner, Dr. Leana Wen, and other local health officers, the FDA added a black box warning to the combination of benzodiazepines and opioids in August 2016. This is the FDA’s strongest risk warning, and it applies to over 400 medications.