Pubdate: Sat, 26 Mar 2005
Source: Baltimore Sun (MD)
Copyright: 2005 The Baltimore Sun, a Times Mirror Newspaper.
Contact:  http://www.baltimoresun.com/
Details: http://www.mapinc.org/media/37
Author:  Alec MacGillis

CITY OVERDOSE DEATHS FELL BY 12% LAST YEAR

Fatal overdoses in Baltimore reached their lowest level in five years
in 2004, a drop the city health commissioner and some experts
attribute to an expansion in drug treatment and distribution of an
anti-overdose medication to heroin addicts trained to administer it in
emergencies.

City officials will announce today that Baltimore recorded 261 fatal
overdoses from illicit drugs last year, down 12 percent from the
previous year, and 22 percent below the highest total of the past five
years, 336 deaths in 2002. It is the first time in five years that the
number has been lower than the homicide total -- 278 in 2004.

Baltimore, which still far outpaces most other cities in its overdose
rate, is not releasing an exact breakdown of the drugs involved. But
Dr. Peter L. Beilenson, the city's health commissioner, said that in
keeping with past years, the vast majority involved heroin or heroin
in combination with cocaine.

While there was no way of knowing for sure what caused last year's
drop, Beilenson said he believes the city's Staying Alive initiative
- -- paid for by billionaire George Soros' Open Society Institute -- was
a big factor. The year-old program, which initially attracted
criticism, trains addicts to recognize an overdose, do mouth-to-mouth
resuscitation and administer Narcan, an antidote that can revive a
person near death from a heroin overdose.

Heroin addicts who complete a course and score over 80 percent on a
final quiz are given a vial of Narcan to inject if someone suffers an
overdose. So far, the program has distributed Narcan (known
generically as naloxone) to 562 people, many of whom were told about
the program during visits to the city's needle-exchange sites.

Beilenson said participants have reported 52 successful Narcan
interventions to 911 operators or needle-exchange personnel, and he
speculated that there had been other "saves" that were not reported.
(Addicts are instructed to call 911 after injecting Narcan because
overdose victims still require attention after receiving the antidote.
Some addicts do not call for fear of being arrested, though Beilenson
says authorities have refrained from arresting those reporting
overdoses in which Narcan was administered.)

"It's very encouraging," said Beilenson. "It's not coincidental that
the number of saves is about equivalent to the amount that [overdoses]
have dropped."

Dr. Robert Schwartz, a psychiatrist who oversees the Open Society
Institute's drug treatment programs in Baltimore, said the institute
has drawn a similarly upbeat conclusion from the overdose numbers. It
hopes to find other donors to help sustain the program after the
institute's two-year, $340,000 grant runs out next year.

"This is a very good sign," Schwartz said. "We want to see what impact
[the program] has had, and so far it looks good."

Beilenson and Schwartz speculated that the expansion of drug treatment
in the city contributed to the overdose decline. About 25,000 people
underwent treatment last year in Baltimore, up from 11,000 in 1998 --
though the number has remained relatively stable in the past two years
as state funding leveled off.

Beilenson said it was unlikely that the drop in overdoses was related
to changes in drug purity, because the heroin available locally has
generally become more pure in recent years. (Some in the Police
Department differ, saying that after increasing in recent years,
heroin purity may have fallen last year.)

When the city announced the Narcan program two years ago, Baltimore
County's then-top health officer, Dr. Michelle A. Leverett, said the
county would watch closely with an eye toward implementing one there.
Last week, the new acting health officer, Ellen R. Clayton, said the
county -- which is still compiling its overdose numbers for 2004 -- is
continuing to gauge the city's results and has no immediate plans to
follow suit.

Though Narcan has been widely distributed to heroin addicts in several
European countries, only a few U.S. cities have adopted programs,
including Chicago, San Francisco and Santa Fe, N.M. The practice is
regarded warily by some public officials and substance abuse experts,
who worry that it might encourage heroin use by removing a deterrent,
the threat of overdose.

Among those who questioned Staying Alive when the program was
announced two years ago was the former director of Baltimore County's
bureau of substance abuse, Michael W. Gimbel. Last week, Gimbel
applauded the city's drop in overdoses, but said he didn't think it
proved that distributing Narcan was the right approach.

"I still feel strongly that giving Narcan ... is not the best way to
get addicts clean and sober and back into society," said Gimbel, a
former heroin addict who now directs substance abuse education at the
Sheppard Pratt Health System. "If they're claiming that people took a
class and were trained [in using Narcan], I'd love to see those people
get trained in how to seek a job and go back to school. I'm still a
skeptic."

Program proponents argue that heroin users are clearly not being
deterred by the threat of overdose, and that cities with high overdose
rates should do whatever they can to prevent them.

"It's really staggering if you think of the number that die [in
Baltimore] every year," Schwartz said. "It's really a lot of people,
and it's preventable -- that's the tragedy."
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MAP posted-by: Larry Seguin