Roughly 40 miles away from the nation’s capital sits the city dubbed the “heroin capital of the United States.” Heroin has been present in this city of 621,000 people for decades.
“People [have been] dying from heroin and cocaine and other substances for decades,” said Baltimore City Health Commissioner Dr. Leana Wen. Some city officials and residents — who’ve long felt overlooked in the quest for federal support to help curb their heroin crisis — are noticing more attention on the issue now that the epidemic has spilled beyond the inner city and into the suburbs.
“I’ve heard our community say things like, ‘Well why is it that there are white people dying in suburban rural areas that suddenly we seem to care about the heroin epidemic?’ I mean this has been killing people in our city for decades,” Wen told Rare. “And I do think it’s important for us to call out that as an injustice and say that yes, it is true that all of our attention paid to heroin has come too late for so many.”
It is true that all of our attention paid to heroin has come too late for so many.
However, Baltimore’s long experience with this issue may position the city to help the entire country create a plan to tackle the national heroin and opioid epidemic.
Although opioid- and heroin-related overdose deaths continue to rise in the city, programs instated by the city’s health department aim to reduce needle-related infection and death. The programs also seek to prevent people from using initially while working to remove the stigma associated with drug use.
The hallmark of the Baltimore Health Department’s initiatives is the needle exchange program. The program places exchange vans at 16 locations during 26 time slots throughout the week, enabling people who have registered with the health department to turn in their old needles for new ones. The vans — which also provide ties, drug cookers, cotton swabs and alcohol pads — are meant to ensure that people who use drugs do so safely, in an effort to reduce HIV, Hepatitis C and other syringe-related infections.
“We were one of the first areas in the country to do it,” Wen said. “The percentage of people with HIV from IV drug use in 2000 was 64 percent. In 2014, because of needle exchanges, it’s now 8 percent,” Wen told Rare. She emphasized: “64 percent to 8 percent.”
The percentage of people with HIV from IV drug use in 2000 was 64 percent. In 2014, because of needle exchanges, it's now 8 percent.
The vans exchange thousands of needles a day. As of 2014, the program was distributing 500,000 needles a year, according to one report.
Some are in favor of the progressive public health approach to curbing addiction and user-related diseases. However, many people think needle exchanges, as well as the use of the overdose reversal drug Narcan (Naloxone), could enable opioid and heroin users.
Wen rejects that criticism: “We would never say to someone whose throat is closing because of an allergic reaction, ‘I’m sorry that I can’t give you an EpiPen because it might make you eat peanuts next time.’ Denying someone Naloxone, a lifesaving medication, is equivalent; and it’s our job to be able to save a life today in order to have any chance of that person getting treatment tomorrow,” Wen told Rare.
The same thinking goes for the medically assisted treatment (Methadone) clinics that run by the state’s health departments.
A “very dangerous misconception and myth is this idea that getting someone into treatment … with methadone or buprenorphine is somehow ‘replacing one addiction with another,’” Wen said.
“We would never say to someone, ‘Well I don’t want to give you insulin for your diabetes because it’s replacing one addiction with another,’ ” Wen said. “We have to treat addiction in the same way and overcome these dangerous myths with science.”
It's our job to be able to save a life today in order to have any chance of that person getting treatment tomorrow.
The public health approach is working alongside a new law enforcement approach in which the Baltimore Police Department is joining a national movement to focus less on low-level drug dealers and users, and instead go after the head of the food chain.
The change in policy, led by the Law Enforcement Leaders to Reduce Crime and Incarceration, is a dramatic shift away from the “zero tolerance” policy that dominated Maryland’s strategy in the 2000s. The change is meant to signal to low-level drug users and sellers that their lives can go on — and be turned around — after drug involvement.
Baltimore’s efforts are part of the “holistic” approach Maryland Governor Larry Hogan put in place, supported by a $500,000 federal grant the state received in 2015.
There has been a “sea change when it comes to attitudes about addiction,” Wen said. “There is growing recognition that addiction is a disease. There’s growing recognition that we can’t arrest our way out of it, and in fact, our historical policies around arrest and incarceration have been detrimental,” Wen added, noting her hope that the policies in place now in Baltimore will serve as a “model of recovery” for the nation.
Rare politics reporter Yasmeen Alamiri and videographers Tolleah Price and Dan Yar spent months researching and reporting this series — traveling to Maryland, New Hampshire and other heroin-torn places while talking and listening to users, police officers, public figures and devastated families all affected by the epidemic. See the full series at on.rare.us/HeroinInAmerica.