On Monday morning, Mayor Catherine Pugh and Baltimore City Health Commissioner Dr. Leana Wen announced a new initiative to combat the opioid epidemic in the city. The Levels of Care initiative involves identifying best practices for responding to the opioid epidemic and will be based in 11 Baltimore hospitals included Bon Secours, Mercy Medical Center, St. Agnes, University of Maryland, and Johns Hopkins Bayview. 

“Among Baltimore’s greatest assets is Baltimore’s unparalleled hospital system which, arguably, is the finest in the world,” Pugh said in a statement. “I am calling on the leaders and medical professionals of our hospitals to join us in fighting the opioid crisis, which continues to claim far too many lives not only in our community, but across our nation. This is a national health crisis and it needs to be treated with the advanced medical resources that we know can be effective and which for sure will save lives.”

The levels of care were developed with input from hospital administrators and will be based on criteria like a hospitals’ ability to provide treatment to patients who screen positive for addiction, distribute overdose medication naloxone to patients, connect patients with peers or other support services, and educate how doctors prescribe opioids. The levels will range from one to three—with one being the highest—to rate a hospital’s comprehensive response to opioid treatment. Currently, the levels of care are open to the public for comment until May 31 and will be finalized this summer.

“We are in the midst of the deadliest drug epidemic in American history,” Wen said in a press conference. “And Baltimore City—with the highest age-adjusted overdose fatality rate of any metropolitan county in the United States—is one of its epicenters.”

The initiative is based on a similar program in Rhode Island, one of the only places in the country where overdose deaths decreased last year. Dr. Wen and the health department have been approaching the opioid crisis in Baltimore aggressively since the number of opioid-related deaths have increased each year. As of June 1, 2017, legislators enacted a standing order for a blanket prescription of naloxone at all pharmacies in the city.

In the spring of 2019, the Baltimore City health department will also open the state’s first-ever Stabilization Center for those under the influence of drugs to receive short-term medical and social interventions as part of the city’s plan to create a 24/7 behavioral health emergency department. Services provided will include medical screening and monitoring, connections to behavioral health and social services, and buprenorphine induction to treat opioid addiction. The Stabilization Center will be located in the Coppin Heights/Rosemont community.

“We are leading the nation to provide evidence-based treatment for the disease of addiction,” Wen said. “The only way to combat it is to ensure that resources and treatment are available.”

Every day at least two people die from opioid overdose in Baltimore City, according to health commissioner Dr. Leana Wen. There are only 4,000 doses remaining of the life-saving drug, naloxone, to last until July 2018 with no set date for replenishment.

“If we didn’t ration it, we would use it up in the next two weeks,” said Wen. “Right now, we are making the decision every day about who are the most vulnerable people, and rationing it accordingly.”

Naloxone, or more specifically Narcan, is a medication­ administered as a nasal spray or injection that reverses the effects of opioids during an overdose. Since 2015, residents administering Narcan to victims of overdose saved over 950 lives in Baltimore.

As of June 1, legislators enacted a standing order for a blanket prescription of Narcan at all pharmacies in the city. Unfortunately, the Baltimore City Health Department has run out of funds to purchase the medicine, and has been relying on the generosity of drug companies for donations.

“It’s very safe and effective. It’s got no side effects to someone who is not using opioids,” Wen said. “It’s not addictive—this is a life saving antidote that should be available to every single person.”

Back in March, Governor Larry Hogan declared a state of emergency for the opioid epidemic in Maryland. He also announced a supplemental budget of $50 million in new funding over five years for opioid overdose prevention and treatment.

Katie Kuehn, communications director for the Opioid Operational Command Center, said that as part of the first $10 million in the budget, funding would be available “soon” to local jurisdictions to purchase more naloxone.

“Recognizing the urgency of providing additional naloxone to Baltimore, Behavioral Health System Baltimore requested . . . that a portion of its current budget be allocated to purchase more naloxone to be used by the end of this fiscal year,” she said in an email. “Behavioral Health System Baltimore and the Department of Health and Mental Hygiene’s Behavioral Health Administration worked together to determine that $150,000 was needed, and it was approved the same day.”

According to Wen, Baltimore City has over one-third of all overdoses in the state, so she believes that Baltimore should receive at least one-third of that $10 million.

“We need Narcan, but we also definitely need treatment,” Wen said. “It’s important to save someone’s life if they’re overdosing, but we also need to get them into long-term treatment. That’s what will help them get their lives back.”

Kuehn said that more information about state funding would be announced in the coming days. Currently, the Baltimore City Health Department is awaiting a response from the state for the funding request, but Wen is being proactive with the fight against opioid abuse and overdose. Initiatives like the needle exchange program, which provides clean needles and substance abuse counseling, service about 3,500 people a year.

In addition, the Start Talking Act, which was passed this year, requires public schools to offer drug education as early as third grade, including the dangers of heroin and other opioids.

“Everyone has the ability to save a life. Unfortunately, in our community there are people dying who are mothers, fathers, siblings,” Wen said. “We strongly believe that everyone should have naloxone in their medicine cabinet.”