Dr. Leana Wen: Remove red tape to save lives

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The opioid epidemic continues to ravage Maryland, killing more residents every year than traffic accidents. We are in the midst of a public health emergency.

Across the state, nearly 1500 people lost their lives to drug or alcohol overdose in the first nine months of 2016. The powerful opioid known as fentanyl is driving these high rates; in Baltimore City, fatal overdoses involving the drug have increased 20 times in the least three years.

These deaths are especially tragic because there is one medication — naloxone — that is a complete antidote to an opioid overdose. As an emergency physician, I have used the medication hundreds of times and have seen firsthand that it can bring someone on the verge of death back to life in seconds. Naloxone is safe, with virtually no side effects if given to someone who is not on opioids. It is easy to administer, with two versions, one that’s a nasal spray and one that’s given like an Epi-Pen.

Naloxone gives everyone the power to save a life. And in Baltimore, it has.

Since I started as Baltimore City’s health commissioner in January 2015, we have trained more than 20,000 people to use the medication. Over the same period, naloxone has been used to save more than 800 lives. This statistic does not include the countless others saved by nurses, doctors, EMTs, and police officers whose sworn duty it is to serve the public. These 800 lives were saved by everyday Baltimoreans.

Here, neighbors are saving fellow neighbors.

To make this possible, we had to improve access to naloxone. Previously, if someone wanted access to naloxone so that they could save the life of a family member or friend, they needed to attend a training, visit their doctor, figure out their insurance, then go to a pharmacy to fill the prescription. This created significant barriers, especially to those who lack access to regular transportation or health care.

We advocated for a new law to allow for a standing order for naloxone. The law passed, and in October 2015, I wrote a blanket prescription for naloxone to the city’s 620,000 residents. This means anyone who goes through training can, then and there, receive a prescription and the medication to immediately save life.

Unfortunately, a significant barrier still remains; a person must complete training before receiving a naloxone. While the training itself takes only a few minutes, the current law creates a burdensome paperwork requirement that takes away from our community educators’ ability to reach more residents with the life-saving medication. This is particularly true in the “hot spot” areas we target, which includes street corners, bus shelters, public markets, and other places with limited space.

In this time of public health emergency, we need every tool to eliminate every barrier. That’s why we support this year’s bipartisan legislation currently in the Maryland’s General Assembly: HB 791/SB 868. This bill makes it possible for a person to receive naloxone under a standing order without having to complete unnecessary paperwork.

To be clear, training to use naloxone will still be available for anyone who wants it — both online and in person. But, just as defibrillators are available in public shopping centers, airports and grocery stores, so should naloxone. In an emergency, you shouldn’t have to prove you have training in order to save lives.

Passing this legislation would essentially make naloxone over-the-counter. This is a best practice already adopted by neighboring states in Virginia and Pennsylvania, among others.

To be sure, naloxone alone is not the answer. We must also advocate for increased long-term treatment for individuals with substance use disorders. But if we cannot save a life from overdose today, there is no chance for a person to enter recovery and lead a healthier life tomorrow. Treatment works and recovery is possible. Naloxone gives those suffering from addiction that opportunity.

The opioid epidemic is claiming the lives of thousands of fellow Marylanders every year. Expanding access to naloxone is one concrete step we can take, and I encourage our legislators in Annapolis to support HB 791/SB 868 to empower every resident to save lives.

Dr. Leana Wen is the commissioner of health in Baltimore City. Twitter: @DrLeanaWen and @BMore_Healthy. 

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