Al Jackson has been addicted to heroin since he was a young teenager, growing up in South Baltimore.
These days, he says, it's hard to find heroin that's doesn't have the extremely deadly and cheap opioid, fentanyl mixed in.
And so, at the age of 56, he's desperate to kick his opioid addiction before it takes him under.
Luckily for him, medicaid patients have more treatment options available. But, the clock is ticking like never before with fentanyl on the streets.
When Maryland expanded Medicaid roughly six years ago, the number of opioid treatment programs increased. But, today there are more fatal overdoses from opioids than ever.
And it’s all related to fentanyl, says Yngvlid Olsen, the director of Baltimore Institute for Behavior Resources, an opioid treatment program.
“Baltimore City had experienced a significant reduction in heroin related overdose deaths,” she said. “And fentanyl has really changed the game.”
Maryland state health officials say while heroin deaths decreased, opioid overdoses about doubled from 2016 to 2018. And the vast majority of those deaths were related to fentanyl.
In response to the decades-old opioid epidemic, the number of treatment programs in Baltimore has doubled since 2013, the year the General Assembly expanded Medicaid in conjunction with the federal Affordable Care Act. With that expansion came drug treatment - in patient, out-patient, medications, counseling - all of it could be paid for with Medicaid.
“Between 2010 and 2014, when the ACA really kicked in, the number of people who were able to access effective addiction treatment really expanded in Baltimore as well as across the state,” said Olsen. “So that by the time 2014, 2015 the waiting lists that had been months long was really pretty much down to maybe a week, if that.”
Not every part of the treatment puzzle was solved, but hundreds of thousands of people with a heroin addiction were coming into treatment, she says. And the overdose numbers dropped.
Now, with the rise of fentanyl, Olsen says, people who have been addicted to heroin for most of their lives are desperate for help and seeking treatment, because suppliers are mixing fentanyl with heroin.
“We now have patients now who are in the late 50s, 60s, even 70 – who have been using heroin for a long time – who have never been in treatment, but they are now coming and asking for treatment because they are terrified," she said, “terrified because their friends are dying or the younger people around them are dying.”
They are folks like Al Jackson, who says, "Everyday, somebody calling me and telling me somebody died off fentanyl. Every. Day."
He and Darryl Burrell, a childhood friend who works for Bmore Power, an opioid addiction outreach group, were meeting at Lexington Market one day in early spring, waiting for word on a friend of theirs who was being treated for an opioid overdose at the nearby University of Maryland Medical Center.
"Same way my buddy is in there fighting for his life...could be me," Jackson says as he leans against a fence.
He says he’s tried treatment a couple of times; abstinence when he was in jail, methadone, and buprenorphine, also known as suboxone, without much success.
“I didn’t want to take the suboxone like I was supposed to,” he recalled. “I wanted to be out here with the drugs.”
But now he says he's done.
“I’m tired. I don’t even know how I lasted this long. I’m doing this every day. I’m scared to death.”
That’s why he called Burrell, who had found his way out of addiction and into a job counseling others as an outreach worker.
“I cried on the phone,” Jackson said. “'Please, man, help me, man.' I mean I was torn up. I said, 'I don’t care where you take me.'"
Luckily, they find out their friend is in stable condition.
Jackson is still feeling desperate.
Burrell calls someone he knows at a treatment facility in Fells Point and hands the phone to Jackson.
“I want to come over and get myself back together,” he tells the woman at the facility.
She says she has a bed for him right then. Jackson says he wants to come over within 48 hours.
But 48 hours is a long way off.
Tomorrow: Al Jackson’s journey to get treatment.