Doctor wants overdose antidote in every medicine cabinet
[This story was first published on March 4, 2016.]
BALTIMORE — Physician Leana Wen has trained heroin addicts, first responders and drug court officials in how to administer the antidote for an opioid overdose. So why not a group of wealthy white women gathered at a stately clubhouse in Baltimore’s toniest neighborhood?
Wen is Baltimore City’s health commissioner, and she has emerged as one of the most aggressive and innovative public health officials in the nationwide fight against opioid addiction. Naloxone, a medication that reverses the effects of an opioid overdose, is a centerpiece of Wen’s crusade — something she says “should be part of everyone’s medicine cabinet.”
Her approach to the epidemic is not without controversy. But controversy doesn’t seem to bother Wen, a petite Chinese immigrant who took the stage at the Woman’s Club of Roland Park last month after the ladies ran through announcements about their gardening club, bridge lessons and other business.
For the next 45 minutes, Wen, 33, held her well-heeled audience transfixed with a mix of emotionally gripping tales from her days as an emergency room doctor, staggering statistics about everything from lead poisoning to infant mortality, and inspirational accounts of how seemingly small health policy changes can transform lives. As she pivoted to the health department’s approach to Baltimore’s addiction crisis, she made sure her audience understood this wasn’t about someone else’s problem.
“The fastest-growing demographic of people is not what you might imagine: It’s not the African-American youth in the inner city,” Wen said, as she called her assistant to the stage and readied a dose of naloxone. “It’s actually white, middle-aged, middle-class suburban women.”
Having just described many of the women in her audience, Wen proceeded with the demonstration, as her aide played near-dead and she showed how to spray the antidote into his nostrils.
“So,” she declared afterward, “you are all able to save a life now.” It was both empowering and unsettling, and that may have been Wen’s intention.
Last fall, Wen helped persuade Maryland legislators to give her blanket authority to prescribe naloxone to every one of Baltimore’s 620,000 residents, as long as they undergo a few minutes of training. So far, she and her deputies have trained more than 8,000 people — on street corners and in needle-exchange vans, at pharmacies and in the city’s drug court. Within the first month, newly trained officers saved four people who had overdosed.
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Mark Fletcher, deputy chief of the Baltimore Fire Department’s emergency medical services, said Wen has brought a new energy and consensus to the city’s public health agenda with her campaign for broad distribution of naloxone and other initiatives. “She is very innovative, very forward-thinking,” he said.
But some critics say Wen’s emphasis on naloxone is misguided, and they argue it could backfire by diminishing the fear among addicts that they risk dying of an overdose.
“What harm-reduction does is reinforces the addict’s behavior,” said Mike Gimbel, who served as the “drug czar” for Baltimore County for 23 years. “Talk to any paramedic. They bring back the same people (from an overdose) every week.”
Even more worrisome, Gimbel said, is that making naloxone widely available could give policymakers a false sense they are addressing the opioid epidemic.
“Politicians want a quick, fast solution to a problem, and she gave it to them,” said Gimbel, a former heroin addict who now works as a substance abuse counselor. “The only thing that changes the behavior of an addict is long-term treatment.”
Long-term treatment is expensive and a more difficult sell politically, he said, but it’s desperately needed. Gimbel said he scrambles day-in, day-out to find treatment slots for his clients — something echoed by other substance abuse experts across the country.
Nationwide, more than 23 million Americans are addicted to alcohol and drugs, but only 11% are receiving treatment.
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Wen knows that grim statistic as well as anyone. Her family left China when she was 8, seeking political asylum in the U.S., and they settled in a rough neighborhood outside Los Angeles. There, her parents worked a series of menial jobs — dishwasher, hotel maid, newspaper delivery man — to scrape together money for rent and other bills.
She saw her friends and neighbors cope with violence, and the physical and emotional trauma that went with it. And she watched as a close family member struggled with addiction.
“The issues of poverty … are very acute to me,” Wen said
As a child, Wen decided that if she became a doctor, she could fix all the health problems that accompany poverty. She enrolled at Cal State University at age 13 and graduated with honors at 18. She went to medical school at Washington University in St. Louis, then on to Harvard and Oxford. By the time she was done, she had her M.D., along with two master’s degrees, one in modern Chinese studies and the other in economic and social history.
She began her career working as an ER doctor at Boston’s Brigham and Women’s Hospital and Massachusetts General Hospital and then moved to George Washington University. But she found herself frustrated in those jobs. She could treat a patient who showed up with a gunshot wound, but couldn’t save the victim from returning to a dangerous neighborhood. She could treat a child with acute asthma, but couldn’t help that boy’s mother find a place to live free of toxins and other triggers.
She could bring an overdosing addict back to life, but couldn’t connect that person with treatment. In her off-hours, she found herself looking for ways to intervene “upstream,” before a patient reached the ER.
When the Baltimore City health commissioner job opened up, Wen saw it as a chance to pursue two of her passions at once — coping with immediate health crises and pushing for broader policy changes. Now, instead of treating individual patients, she is treating an entire city. As she buzzes from a news conference to a meeting with the mayor, Wen juggles everything from the city’s preparations for the Zika virus to questions about a controversial program to stem gun violence.
But it’s her efforts to combat the opioid epidemic that have gained her the most attention recently, as she implemented one of the most aggressive overdose-prevention campaigns in the country. In February, Wen unveiled a new place for residents to get trained: online, after watching a short video of her showing viewers how to administer the medication. She has also sent letters to every doctor in Baltimore calling on them to co-prescribe naloxone to any patient they’re also treating with opioids.
Wen has ready answers for the critics who question her push to make naloxone widely available.
For one thing, she says she’s pushing just as hard for treatment as she is for naloxone. She recently urged lawmakers in Washington to fund a national campaign to destigmatize addiction and talked about the need to dramatically expand treatment.
“We cannot just talk about treating overdoses,” she said. “That would be like treading water.”
In Maryland, Wen is trying to persuade state legislators to fund a “24/7” urgent care center for people with addiction and mental health problems — a community-based emergency room that would provide addicts with immediate care and connect them to inpatient and outpatient treatment and other needed services. And she has started a crisis hotline for people looking for help with substance abuse or mental health problems.
But naloxone has to come first — or at least hand-in-hand with a push for treatment, she says. “There’s not going to be any treatment if the person cannot survive today,” Wen says. “It’s my training from the ER … and in public health that we have to save a life today to enable a better tomorrow.”
Plus, for Wen, naloxone is about more than reviving someone from an overdose. She sees it as a way to change the debate around addiction.
When she talks about addressing the heroin epidemic, Wen said, “many conversations veer toward ‘not having methadone clinics in my backyard’."
She uses naloxone to “change the conversation.” she says. “When we educate on overdose, we’re talking about saving someone’s life, which very few people can really disagree with.”
“… Then we say ‘OK, now we need to not only save their life today, we also have to make sure this doesn’t happen again, and the way to do that is to get somebody into treatment’,” Wen says.
If the response at the women’s club was any indication, her campaign is working. Audience members flocked to get their naloxone certification after Wen’s speech. And they gushed about Wen’s stewardship of the city’s health department.
“You’re at the forefront of leadership. … You’re at the forefront of everything,” retired nurse Joanna Kann told Wen. “Now if you could just run for mayor.”
Wen quickly brushed off the compliment and changed her own conversation — back to curbing the opioid epidemic.