Teaching addicts to stay alive

Death toll drops as Baltimore instructs inmates how to deal with overdoses

April 15, 2007|By Jonathan Bor | Jonathan Bor,sun reporter

CLARIFICATION

A photo caption accompanying an article on the cover of today's Ideas section says that two inmates at the Baltimore Detention Center told a reporter about their experiences with overdosing. One of the inmates talked about his own overdose. The other, Antonio Jones, talked about dealing with two family members who had overdosed.

Standing before 50 men dressed in red jumpsuits, drug educator Nathan Fields belted out the question of the hour: What are the street remedies for a heroin overdose?

"Burn their fingertips," said one inmate.

"Walk them around," cried another. "Put ice on the genitals," a voice rang out.

"Throw them in the backyard," someone said, eliciting a round of laughter.

"Guess what?" shouted Fields, addressing a rapt audience of inmates. "All those street remedies are more dangerous than the overdose itself."

Busting myths was a central point of the call-and-response that recently engaged a group of "street scholars" at the Baltimore City Detention Center. So was doing the right thing - calling 911, performing rescue breathing and, when possible, injecting a dose of Narcan, an antidote that can reverse an addict's downward spiral by blocking the brain's opiate receptors.

For the last several weeks, the city health department has been holding a series of overdose prevention classes there, hoping to arm drug offenders with tools to save lives on the streets where most will return.

The program is part of a larger effort to further reduce a death toll that for many years rivaled that of homicide in Baltimore. Between 1999 and 2005, the last year for which figures are available, the number of city residents dying of drug overdoses dropped by about a third, to 218. That compares with about 270 homicides a year.

Nationally, the trend has been quite the opposite. Between 1999 and 2004, the number of overdose deaths rose 77 percent to almost 20,000, according to the U.S. Centers for Disease Control and Prevention. Accidental poisonings, of which overdoses were the largest part, were second to automobile accidents as a cause of death from unintentional injury. Nationally, the increase has been blamed on rising abuse of oxycontin and other narcotic painkillers, as well as cocaine and sedatives.

In Baltimore, where heroin remains the chief culprit, officials credit the decline in overdose deaths to the expansion of drug treatment slots and to the city's Staying Alive program. Launched in 2004, the program teaches addicts to avoid overdosing themselves and to recognize and treat others in the throes of doing so.

Overdose education is one of the latest wrinkles in a philosophy of harm reduction - others are needle exchange and methadone maintenance - which recognizes that some people will never shake drugs but seeks to minimize the damage of their addictions.

Until recently, Staying Alive focused its efforts on the city's bustling outdoor drug markets. Though officials haven't abandoned that, they decided it also made sense to bring the program into the detention center, where an estimated two-thirds of inmates are addicted to heroin when they enter. The city joined a short list of jurisdictions around the country to do so.

"It's forward thinking to do this because it deals with the reality of where people are as opposed to where we want them to be when they get outside," said Susan Sherman, an epidemiologist at the Johns Hopkins Bloomberg School of Public Health who played a leading role in starting Staying Alive three years ago.

New Mexico was among the first states to educate inmates about overdoses, establishing its "Blue Project" two years ago in the Metropolitan Correction Center in Albuquerque. A nonprofit called Prevention Point Pittsburgh began a similar effort in the Allegheny County Jail.

New Mexico hasn't yet evaluated the impact the program is having on overdose deaths. But Bernie Lieving, the state's harm reduction coordinator, said he senses that the program "empowers people to feel like they're able to take care of themselves and each other." He said he's also encouraged that over half of the inmates have gotten prescriptions filled for Narcan.

In Maryland, Staying Alive was invited into the prisons by the Maryland Department of Public Safety and Correctional Services. For several years, the agency has been offering acupuncture, drug education and counseling to a limited number of offenders sentenced by the city's drug court.

In the recent class were 50 men sentenced to six-week terms in a military-style barracks tucked within the hulking stone walls of the downtown prison. Taught separately were 19 women housed elsewhere in the same low-lying building. Over the course of a year, 650 male and female inmates pass through the alternative sentencing program.

"If there's anything we can do to educate them not to die, that's something we want to do," said Gregory Warren, director of substance abuse treatment services for the Maryland Department of Public Safety and Correctional Services.

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