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33-Year-Old Doctor Leads Baltimore's Anti-Heroin War
12:03 a.m. EDT October 10, 2016
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BALTIMORE - Dr. Leana Wen is famous among addiction experts across the nation for taking the helm against heroin.

"Nobody wants to be an addict," she says flatly.

The Baltimore health commissioner has an estimated 19,000 residents addicted to heroin in her city of 620,000. This city knows its numbers, figured by an epidemiologist, so that it can better understand and react to the heroin threat.

She's known nationally for her efforts to fight the heroin crisis in her city. "You need a commitment from public health leadership to prioritize this," said Daniel Raymond, policy director for the national Harm Reduction Coalition in New York City.

Wen, 33, who was appointed Baltimore health commissioner in January 2015, says that anyone who sees addiction as a moral failing is wrong. "Science is clear that addiction is a brain disease," she said.

Wen's approach to combat drug overdoses and deaths, backed by Baltimore City Council, is straightforward: Prevent; increase access to on-demand treatment and long-term recovery support; educate.

There's a lot more to that than what it may seem. She is determined to have her city show people how to restore breathing in overdose victims. She insists that people with opioid or heroin addiction be treated according to the standard of care for this type of addiction, medication-assisted treatment.

She is arming people with the truth about addiction and about heroin and opioids and disease. Wen wants every city employee and elected official as well as every resident to take part in reducing the deaths. She is starting a stabilization center that will take in people who are intoxicated or leave emergency rooms so that they can be assessed, stabilized and then linked with treatment. And there's so much more.

Wen is lucky: She has a strong medical community behind her and a mayor and state officials willing to throw in resources to combat a nationwide epidemic.

In June 2015. Wen declared opioid overdose a public health emergency. The avowal is critical, the health commissioner says, and for her, it's also personal.

Doctor on the front lines

An emergency-room doctor, Wen has seen overdose deaths up close.

She often speaks of a young heroin-addicted woman who came to her as an emergency-room physician repeatedly ask for health checks and help with her addiction.

“I watched her whole life spin out of control,” Wen said.

“I had to tell her, ‘I’m sorry, I can’t find you treatment today,’ ” Wen said. “I would never tell someone who came in with chest pains that.”

The last day she saw her young patient is emblazoned on Wen's mind.

“She’d fatally overdosed," Wen said.

“It seems unconscionable that we don’t save lives from overdose as much as we can,” she said.

Mobilizing "first responders" with naloxone

Among her aims: Get everyone in Baltimore armed with the opioid and heroin overdose antidote naloxone.

She means everyone: injection drug users, inmates leaving jail, drug-court participants, public officials, public employees, folks standing at bus stops, you name it. Wen wrote a standing order in October 2015, that made prescriptions for naloxone that is available to all of the city's 620,000 residents. Everyone who is trained by the health department in naloxone use is given a certification card that, when presented at a pharmacy, gives them Wen's prescription authority to get naloxone.

Since January 2015, more than 15,000 people have been trained through the city health department on how to save lives of those overdosing on opioids or heroin under Wen's plan. Some Baltimore buses have billboards directing the general public to the health department's Don’tDie.org site, where they can learn about naloxone and sign up for training sessions.

“Residents have saved hundreds of lives,” Wen said.

The health department has been able to track more than 400 times that someone used naloxone on a person in overdose.

Treating the sick with medication

Wen is firm in her stance on treatment: It must be science- and evidence-based.

Her mantra for medication-assisted treatment (MAT) falls in line with addiction experts across the country and beyond. “Clearly, I have heard anecdotes of abstinence programs working,” Wen said. “In most cases, they do not.”

Drug court judge Ellen Keller said Wen has shown up in her court to show participants how to use naloxone to save lives and support the court's use of medication for heroin and opioid users. "Part of our treatment is the use of MAT. We use both buprenorphine and methadone most frequently," Keller says.

Taking her fight to the streets

Wen is highly public in her fight.

Her calendar for 2015 and this year so far included the drug-court stop, meetings with media, speaking engagements on the subject of opioid and heroin addiction, legislative hearings, conferences and panels with local, state and national officials, including President Barack Obama, and more.

Wen pushed for freedom of doctors to prescribe to as many buprenorphine or Suboxone patients as they wanted to treat. The U.S. Department of Health and Human Services in July raised the cap of 100 patients per doctor to 275.

Wen will take the improvement, but she says that's not enough: “We want it eliminated. There’s no limit on any other medication. It doesn’t make any sense.”

Wen has issued letters to doctors, nursing and pharmacy students on best practices for prescribing opioids. Overprescription of painkillers is blamed for much of the heroin epidemic. When prescribers cut back, people turned to heroin.

She is doubling down on efforts of the Baltimore Buprenorphine Initiative, which provides medication assisted programs to people in the city. It's run by Behavioral Health System Baltimore, a nonprofit that funds all levels of treatment in the city. Wen chairs the board.

Among Wen's plans that raise addiction experts' thumbs is the stabilization center. Wen is fortunate that Maryland takes the opioid and heroin crisis seriously: The city has received $3.6 million in state funding to help create the center. It’s a “no-wrong-door” concept for people to go to or be transferred to detox and other services.

Wen has had some push-back on the plan: “Nobody wants that stabilization center in the city,” Wen said. But she says she will find a location "by some point next year.”

Law enforcement is behind the efforts, and all police officers are trained to administer naloxone. They're also gearing up for the Law Enforcement Assisted Diversion program, copying the program in Seattle that lets police officers redirect people with low-level drug offenses to community services. The idea is simply: Why jail people for using heroin when they're just going to come out of lockup and use again?

Wen is trusted in her community. She's been approached by many desperate, bewildered people who find hope in her.

"They come begging. Their families are begging for help," Wen said.



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