How to Save 28,000 Lives A Year
By Leana S. Wen, MD MSc
She was 24, the mother of two young boys. A competitive swimmer in high school, she had back problems and became addicted to pain pills. I would treat her in the ER when she tried to get help for her addiction. When her husband found her, she was unresponsive in their bed. She wasn’t breathing when the paramedics showed up. We resuscitated her for over an hour, but ultimately, she died.
As an emergency physician, I have treated hundreds of patients addicted to opioids. Many started by abusing prescription painkillers, later switching to the cheaper, illicit form: heroin.
As a public health official, I have seen how the addiction has risen to epidemic proportions.
I think about those affected by the disease of addiction every day. But the memory of these patients and the families and loved ones left behind is particularly vivid today as the world recognizes International Overdose Awareness Day.
According to the Centers of Disease Control, more than 28,000 Americans died from opioid overdose in 2014, quadrupling from 15 years ago. Deaths from fentanyl — a synthetic opioid that is 50 times more potent than heroin — increased by 500 percent from 2013 to 2014.
In Baltimore City, where I serve as Health Commissioner, 393 people died from an opioid overdose last year, more than the number who died from homicide.
The number of fentanyl-related deaths in our city has skyrocketed — increasing ten-fold since 2013.
These statistics are all the more tragic because these deaths were preventable.
There is a single medication — naloxone, also called Narcan — that reverses the effect of opioid overdose. It is a safe, effective, and has no side effects for someone who isn’t on opioids. People can be trained to use it in just a few minutes.
Naloxone is used in hospitals across the country to save lives every day. I have administered naloxone many times, and have seen how someone who is unresponsive and about to die will be walking and talking within seconds. It is the same drug that was used to revive 8 of the 27 individuals who recently suffered overdoses in one West Virginia city over a 4-hour period.
If this antidote can save so many lives, why isn’t it available everywhere?
First, there is the dangerous myth that naloxone encourages drug use, something not substantiated by scientific evidence, or common sense. We would never deny epinephrine to a patient with a peanut allergy for fear that it might encourage people to eat foods to which they know they are allergic.
Second, some question naloxone’s use since a person who is dying of overdose cannot use it on themselves. However, no one questions the use a defibrillator when someone is dying of cardiac arrest. In Baltimore, we have trained police officers to use naloxone. Within six months, officers have administered it to save over 30 lives.
Third, some will say that overdose is not an issue that affects them. Anyone who has narcotic painkillers in their house is at risk for overdose. Over 259 million prescriptions for opioids are dispensed every year — approximately one for every adult American. Opioids kill within a few minutes; by the time first responders arrive, it is often too late. Naloxone should be available in everyone’s medicine cabinet and be part of every First Aid kit.
In Baltimore, we have been training drug users since 2004. Now, we are teaching every person in the city, with more than 14,000 individuals trained since last year who are able to save lives.
Our Health Department has implemented standing orders, which allows me to issue a blanket prescription for naloxone to every one of our 620,000 residents. Our outreach teams conduct trainings in “hotspots” across the city, including in restaurants, bars, street corners, jails, housing developments, and street corners.
To be sure, we want to prevent addiction in the first place. There are growing efforts to educate physicians about judicious prescribing of opioids, and enforcement efforts to prevent heroin trafficking are similarly important. It is also true that naloxone is only a temporary remedy. It is not a cure for addiction, which requires ongoing treatment along with mental health and psychosocial support. But these long-term solutions should not stand in the way of saving a life today.
If my patient’s family had access to naloxone, she could be alive today. We will never have a chance to find out, but we do have the chance to save the lives of thousands of other people with one simple medication.
On this International Overdose Awareness Day, let’s remember nobody should have to die from a treatable problem. Let’s ensure access to naloxone so that everyone in the U.S. has the tools needed to save a life. Let’s treat addiction as the disease that it is, with urgency, compassion and action.
Dr. Leana Wen is the commissioner of health in Baltimore City. Twitter: @DrLeanaWen and @BMore_Healthy.