The city Health Department is seeking funding to expand a program that distributes anti-overdose medication to heroin addicts by introducing training on how to use the medication at prisons and jails as well as to more sites around the city.
Since April 2004, the city has trained about 800 people, mostly addicts, in how to recognize heroin overdoses in others and administer the medication naloxone, an opiate antagonist used by emergency medical technicians to revive overdosed users. After completing the training session, the users are given several doses of the medication - which goes by the trade name Narcan - as well as syringes with which to inject it.
The program, called "Staying Alive" and funded by the Open Society Institute, drew scattered criticism when it began, but has since been credited with helping lower the rate of overdose deaths in the city. Last year, the city recorded 261 fatal overdoses, its lowest rate in five years. City health officials say graduates of the training program have reported more than 100 "saves" using Narcan and say they suspect there are other successful interventions they don't know about.
Addicts are recruited to take the class by outreach workers on city streets and at Baltimore's needle exchange van. The sessions, run by Health Department employees, are offered on a regular basis at five sites around the city, mostly at hospitals or social service agencies. The Health Department offers to drive addicts who don't have their own transportation.
But Health Department officials say there are likely many more addicts who would attend training sessions if they were easier to get to. That's why, starting in November, the department plans to start offering training sessions and Narcan doses in a van that will, at appointed times, park alongside the needle-exchange van, which makes weekly rounds to a dozen sites around the city.
Monique Glover Rucker, the city Health Department's senior adviser on HIV/AIDS and harm-reduction programs, said offering the training and medication at exchange sites could double or triple the number of attendees.
"This could really help us in getting the word out," she said, announcing the expansion plan last week at the Open Society Institute's office.
To further spread access to the medication, the Health Department is in discussions with the state Division of Correction to offer training in prisons and jails to inmates nearing their release dates, and then provide them doses of Narcan upon their release. Studies have found drug users leaving prison to be at a particularly high risk of overdose because their bodies' tolerance for heroin has been lowered by their time without drugs.
Giving Narcan to inmates leaving prison drew criticism from Michael Gimbel, former director of substance abuse treatment for Baltimore County and an outspoken skeptic of "harm reduction" approaches to mitigating the effects of drug use. Gimbel, who oversees substance abuse education at Sheppard Pratt Health Systems, argues that it sends a mixed message to give overdose-prevention medicine to inmates on their way out the door while, at the same time, urging them to stay straight on the outside.
"We should be trying to change behavior in prison so that [drug use] is the last thing they want to get involved in. Instead, we're saying, `We know you're going to do it, just make sure no one dies,'" Gimbel said. Health officials "may say it's a realistic attitude, but I say it's a defeatist attitude."
The city's plans for expanding the Narcan distribution are still contingent on securing funding. The Open Society Institute, a creation of billionaire George Soros, has been paying the roughly $160,000-per-year cost, but that funding expires next month.
The organization has signaled that it will continue to offer some support, but that it wants other foundations to step in as well. Expanding the program as the city hopes to do would cost an estimated $40,000 more per year, Rucker said. She said the city is looking for money it could kick in from its own budget and also had "some people express interest" about lending outside support.
If the city can secure additional funding, it hopes to use some money to hire a nurse practitioner who could handle Narcan prescriptions, which are now written by volunteer physicians. The city also is considering pushing for state legislation that would allow those running the training sessions to prescribe it themselves.