Old Problem, New Challenges

Baltimore City Health Commissioner Dr. Leana Wen speaks about the city’s heroin epidemic, as panelists (from left) Heather Ralston, Karen James,  Dr. Beth McGinty and Baltimore City Police Lt. Timothy Devine look on. (Daniel Schere)
Baltimore City Health Commissioner Dr. Leana Wen speaks about the city’s heroin epidemic, as panelists (from left) Heather Ralston, Karen James,
Dr. Beth McGinty and Baltimore City Police Lt. Timothy Devine look on. (Daniel Schere)

Baltimore’s heroin epidemic has persisted for several decades, but City leaders and health professionals are looking to solve the current crisis by taking away the stigma and approaching it as a public health issue.

On Sept. 30, the Baltimore Jewish Council, in conjunction with the Metropolitan Issues Commission and the Governor’s Office of Community Initiatives, hosted a panel discussion on the heroin epidemic at the headquarters of The Associated: Jewish Community Federation of Baltimore.

The participants discussed the history of heroin in Baltimore dating back to the 1980s as well as the stigma that has become attached to those who have used the drug. Among those featured was Baltimore City Health Commissioner Dr. Leana Wen, who said heroin addiction should not be discriminated from other diseases.

“We would never say to somebody, ‘Why is it that your blood sugar is so high, it’s your fault that your blood sugar is so high’,” she said. “We have to understand addiction also affects the brain in that same way and therefore is something we have to treat with a combination of medications [and] psychosocial support, and also that it’s not just one thing that is effective; that multiple things have to be used.”

Wen and others discussed the changing demographic of heroin users throughout the country from a more urban, working-class group 30 years ago to one that consists mainly of white, middle-class suburbanites.

“The face of someone who has addiction isn’t what you might expect,” she said.

Dr. Beth McGinty, a professor at the Johns Hopkins Bloomberg School of Public Health, echoed these sentiments and said the age of initiation for heroin users has gone from around 16 in the 1960s to more middle-aged now. She added that 90 percent of users within the past decade were white.

“Heroin users today look very different now than in the past,” she said.

McGinty said overdose from opioid drugs is now the leading cause of injury-related death in the United States, and that the problem of addiction needs to be reframed as a public health issue and not only a law enforcement one.

Some say the changing demographics in heroin use can be attributed to the increase in doctors who are prescribing painkillers that contain opioids, which are considered a pathway to heroin. Wen has issued a standing order that will make the opioid antidote naloxone available without the need for a prescription to those who complete overdose response programs. The order comes as a result of a new state law that took effect Oct. 1 allowing doctors affiliated with local health departments to issue naloxone to these designated individuals.

“You don’t have to go to your doctor and justify why you as a family member or friend need to get this medication for a loved one,” she said.

Wen cited Baltimore’s 19,000 heroin users and the expected 25,000 deaths this year nationwide from opioid overdose as a major cause for concern and a way to see that addiction is a widespread epidemic.

“We hear the NIMBY [not in my backyard] arguments all the time, but we know that people who have addictions are all around us,” she said.

Having a heroin user in the family can be financially and emotionally taxing, as it was for Lt. Marjorie German of the Baltimore Police Department. German’s siblings are both recovering heroin addicts. German said her sister became addicted through a boyfriend while she had a 6-month-old baby. She said being part of the narcotics unit became stressful when she saw her sister on the job and had to reprimand her for using. German was also at odds with her parents, who, she said, enabled her siblings.

“What I didn’t understand at the time that understand now, because I’m a parent of two boys, is that I’m telling my parents to let the children go, and it was a big struggle and an uphill battle,” she said.

German’s sister has been clean for 15 years but said she still thinks about her past every day. She hopes her story illustrates the impact heroin addiction can have on family life.

“Our department has tried to arrest themselves out of the situation, but it doesn’t work,” she said. “It’s still here. It touches everybody. If you think it doesn’t touch your family or it can’t touch your family, you are wrong.”

Karen James, a licensed clinical social worker with Jewish Community Services, points out that heroin use has been romanticized by celebrities such as rock stars, leading to a good deal of recreational use, but that no one knows when “that switch will come,” meaning a fundamental change in a person’s brain.

“Heroin’s grip is so strong that it actually changes people’s brains, and that’s what families will often say,” she said. “‘He’s just not the same person, she was never like this before, she’s stealing cars, she’s taking her grandmother’s engagement ring.’”

James emphasized that during recovery, detoxification is not the “end all” since the body has not learned any new skills and is still crying out for pain relief.

“If someone relapses while they’re beginning recovery or later, there is such an experience of despair and guilt that can set off a stronger relapse. So the stigma hurts people who are trying to get well,” she said.

Heroin has become a million-dollar-a-year profit industry due to its inexpensiveness and easy access. Baltimore City District 5 Councilwoman Rochelle “Rikki” Spector, who was present at the meeting, said in an interview with the JT that this is her chief concern with the heroin epidemic.

“If we give the best education starting very early that you don’t have to be in this trade to get the things that you want in your life, the alternative to gets you the car and the clothes and the fancy lifestyle. That’s what we need to do,” she said.

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