Soaring overdose rates. Front page stories. Baltimore getting a national reputation as a a city succumbing to heroin.
It was the year 2000, and the city took action.
A new mayor, Martin O’Malley, made state funding to expand drug treatment his top legislative priority. A health commissioner, Peter Beilenson, who had identified barriers to drug treatment by posing as a person in need, fiercely advocated for more resources. Foundations funded a landmark study showing that addiction treatment reduces drug use and crime.
What followed were major expansions in innovative models of outreach, clinical care and harm reduction. During the next decade, fatal overdoses would fall by more than half, making Baltimore a national model cited by federal officials in the New England Journal of Medicine.
But the progress did not last.
The prescription drug epidemic exploded, both in the city and its surrounding counties, with consequences hitting Baltimore hard. Millions of pills flooded city streets. Then highly potent and lethal fentanyl took over drug markets in Baltimore and around the country. As now documented by The Baltimore Banner and New York Times, Baltimore has surged again to the front of the nation when it comes to drug overdoses.
The reporting is powerful and difficult to read. Stories of people dying in senior apartments, rowhomes and back alleys reflect the human toll of a devastating disease. But addiction in Baltimore is not today, and has never been, an insurmountable challenge. Baltimore can do much better, again.
It was both unfortunate and understandable that overdoses receded from the spotlight. In 2020, a global pandemic threatened to decimate the city. Extraordinary leadership made possible innovative programs, model partnerships and deep community engagement to fight COVID. These efforts worked.
Then a surge in homicides captured the city’s focus, leading to major shifts in policy. Now, multiple lines of evidence are documenting that Baltimore’s streets are getting safer.
With two terrific leaders in place — Mayor Brandon Scott and Health Commissioner Dr. Ihuoma Emenuga — the time is right for a sustained effort to address addiction and overdoses. Five steps can contribute to making progress.
First, the city can adopt a strategy that cuts across domains to help people who use drugs. Innovative policing strategies can reduce unnecessary criminalization of addiction and provide greater access to treatment and other services. New approaches to emergency response can dramatically increase connection to effective treatment and support services following overdoses. New housing efforts can address the twin challenges of addiction and homelessness. The mayor’s promising plan for an overdose prevention cabinet can be the linchpin of these efforts.
Because as many as one-third of overdoses in Baltimore are to non-Baltimore residents, surrounding counties in the region need to engage in this work, too.
Second, the region’s health care organizations can make effective treatment easily available at every opportunity. This effort can start with addiction treatment programs, which should embrace new flexibilities in federal law, alongside best practices to address trauma and welcome people into care. It can extend to area health systems, which, as Johns Hopkins Medicine is demonstrating, can offer effective treatment in emergency departments, staff addiction consulting services to help hospitalized patients, and hire peers to engage people who use drugs. And it can embrace home-grown innovation by expanding such services as the Baltimore Health Leadership Institute, the SPARC Center and the SPOT van, which bring effective harm reduction and treatment services to neighborhoods across the city.
Third, Maryland jails and prisons, including the Baltimore City Detention Center, can provide universal access to effective addiction treatment. Unfortunately, despite a big push from the Maryland General Assembly, several have been slow to embrace providing access to life-saving medications, which have been shown to reduce overdose following discharge by as much as 60%.
Fourth, the city and state can use data effectively to spotlight areas of challenge and identify what’s working. The state Health Department’s efforts to establish a comprehensive overdose dashboard are a critical step forward. Also key is the mayor’s plans for an “overdose-stat,” which can ask and answer key questions to manage the response. The city must have the ability to make sure its interventions are working. These efforts can be coordinated with the city’s formidable cadre of researchers who can analyze data and work with communities to answer critical questions and inform the response.
Fifth, in doing all this work, the voices of people affected by the overdose crisis can be brought to center stage. The Banner and New York Times series has highlighted the challenge of addiction and overdose among older adults. Adolescents are also experiencing higher rates of opioid use than in many other cities. Involving people who use drugs, along with their friends and family, is a way to design a system with the greatest chance of success for the greatest number of people.
These efforts can be accompanied by the availability of grants for community-based organizations to implement local projects. The city’s ongoing litigation against opioid manufacturers can be a vital source of this funding. The recent announcement of a $45 million settlement with Allergan reflects the importance of holding companies accountable for the harm they have caused — as well as the enormous potential of the city’s bold strategy to opt out of existing settlements and sue on its own.
Public engagement also brings the opportunity to listen to feedback on important ideas, such as the creation of overdose prevention centers, which have proven successful in reducing overdose and helping people find a path to recovery in other places across the nation and the world.
As Baltimore moves forward, the news media has a vital role to play. In addition to finding and sharing facts about the problem, this role should include informing understanding of the solutions. There is a tendency for national media to leave the impression that ours is a city beyond redemption, piling up stories of misery in Baltimore while assuming little can be done. This approach isn’t just unfair to the many people working every day to save lives from overdose. It’s simply untrue.
When a bridge collapses in Baltimore, the city’s response is not defined by regret and fatalism. We build back the bridge. That civic spirit, applied to overdoses, will make all the difference again.
Joshua Sharfstein is director of the Bloomberg American Health Initiative at the Johns Hopkins Bloomberg School of Public Health and a former health commissioner of Baltimore. Beth Blauer is the associate vice provost for public innovation at Johns Hopkins University.
