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Opioid Reversals Remain Underreported, say Public Health Experts

Dominique Maria Bonessi


Karen Holliday says she has something in common with Billie Holiday, Baltimore’s famous jazz singer who died in July 1959 from illness related to drug and alcohol abuse, beside the last name.

“Drugs have always been in this family of mine,” says Holliday. “I was the person who slept right there in the park across the street from the War Memorial. I was also a person that used there.”

Just two years ago, Karen Holliday almost died from an opioid overdose. She remembers waking up in Sinai Hospital alone.

“When I woke up I had a band on my arm that said unknown person,” says Holliday. It’s still a struggle every day. It is because I deal with this every day. I deal with addiction every single day.”

As she works through her own addiction, Holliday says she’s reaching out to others.

In 2017, the Baltimore City Health Department reported that more than 700 lives were lost to opioid overdoses while 979 lives were saved by using Naloxone—more commonly called narcan—to reverse the effects of an opioid overdose.

A recent audit of the department found that opioid overdose reversals with narcan doubled from 2016 to 2017, but public health experts say the number of lives saved remains underreported.

In one part Holliday’s struggle, she’s helping teach city employees how to use narcan, the drug that reverses opioid overdoses. Here she is with city Health Commissioner Dr. Leana Wen, explaining how to administer the drug to 50 city employees inside the War Memorial.

“When you administer any dose of this narcan, you have to be really careful when administering any of this medication because when people come around they can be very violent,” Holliday tells the city employees.

And in another part of the struggle, Holliday has joined Bmore Power, a community group that uses narcan to reverse opioid overdoses. She estimates she’s saved 47 lives over the last eight months, mostly in the Penn North community.

She and the others in her group report the number of opioid reversals they’ve helped with to the city health department.

Jose Rodriguez, the department’s director of opioid overdose intervention, says those self-reported reversals have helped the department learn about the scope of the opioid epidemic. But he worries that self-reported data doesn’t reflect all the opioid reversals in the city, leaving the department with incomplete data.

“We need the data to not only look at what’s working, but also look at different areas of intervention,” says Rodriguez.

And the lack of data isn’t just a problem for Baltimore City. Dr. Bruce Anderson, of the Maryland Poison Control Center, says it’s hard to know where to provide more narcan kits across the state without accurate data.

“Unfortunately, we don’t have a system in place, or at least we don’t have any consistency in place to be able to try and make sure that folks report when they are using naloxone,’ says Anderson.

The poison control center partnered with the state Health Department at the start of the opioid crisis nationwide to look at a way to collect data.

“To try and help deal with these overdose cases we said we can collect this information if people call us at the regular old poison center number,” says Anderson. “We can document these cases and we can report on them.”

But that plan came with some drawbacks.

“Unfortunately there is no way to guarantee that people will call,” says Anderson. “And the reality is many people don’t call.”

Anderson says he doesn’t blame people for not calling…

“The last thing on your mind would be, ‘oh my gosh, I need to now, after I call 911 after I do all this stuff, now I need to call someone else to report this,” says Anderson. “It’s just not top of mind, it’s not something you’re concerned about.”

Not top of mind for some and others who feel there will be consequences, like arrest, if they call.

Back at the War Memorial, Doctor Wen calms city employees’ fears of reporting an opioid overdose to 911.

“The good Samaritan law says that if you do your best, in your goal as a good Samaritan that you’re not going to be prosecuted for it,” says Wen. “You are not arrested or prosecuted if you call for help.”

So, there is no easy solution for local and state public health experts to get the data they need. Based on data WYPR acquired from the health, EMS/Fire, and police departments the number looks closer to opioid reversal in 2017 and  so far for 2018.

But for now, it’s trainings like these and good Samaritans that will help public health experts get closer to the actual numbers.

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