On an average day nationwide: more than 650,000 opioid prescriptions are dispensed, 3,900 people initiate nonmedical use of prescription opioids, 2,580 people initiate heroin use and 278 people die from an opioid-related overdose, according to the U.S. Department of Health and Human Services.
The crisis has garnered responses from federal and local governments alike.
Mayor Muriel Bowser highlighted D.C.’s efforts to combat its opioid epidemic, which largely affects middle-aged African-American males, during a July 14 press conference at the Southeast Family and Medical Counseling Services clinic.
“We must work together to curb this growing epidemic and treat it like the public health issue that it is,” Bowser said. “It’s a serious issue and we have a serious plan to combat it.”
In 2015, then-HHS Secretary Sylvia M. Burwell announced the agency’s plan which targeted three priority areas: improving prescribing practices, expanding access to medication-assisted treatment and expanding the use of naloxone. Many states, D.C. included, followed suit and developed their own plans to tackle to opioid epidemic.
Bowser said the city’s government, public health and law enforcement agencies have developed a similar broad and coordinated response to address its opioid epidemic which include expanding access to substance abuse services and the opioid counteragent naloxone, as well as increased public education.
“In Washington, D.C., we will continue to lead the way by conducting cutting-edge research, developing proven treatments, and working with our regional and federal partners to coordinate efforts,” Bowser said.
In late 2015, heroin surpassed cocaine as the second most used substance in the city, with alcohol as the most used substance.
The city’s opioid-related deaths jumped from 83 in 2014 to 231 in 2016. So far, this year, the epidemic has claimed 106 lives.
“Washington, D.C., is unfortunately not immune to the [opioid] epidemic,” Roger Mitchell Jr., the District’s chief medical examiner, said of the national opioid crisis. “However, the epidemic looks a little bit different in our city.”
The District’s opioid epidemic is unique in that it primarily affects African-American males who have been active heroin users for more than 10 years. Nearly 90 percent of the city’s users are aged 40 and older.
Roger said the city’s opioid overdose deaths primarily occur among black men, aged 40-60 and in Wards 5, 6, 7 and 8. He said Ward 7 is affected the most.
According to Rogers, many of the city’s opioid epidemic victims are long-term heroin users and suffer from the chronic disease of addiction, and die due to the presence of more potent synthetic opiates included in or replacing the heroin supply, most notably fentanyl.
Fentanyl suppresses pain, but also affects a user’s ability to breathe.
“The drugs that are being found at death are now 50 to 100 times more potent than the drugs we have seen in the past,” Mitchell said. “Because the designer drugs that are flooding our community are changing day-to-day and week-to-week, we must match our level of forensic testing to the severity of these substances.”
Part of the District’s coordinated response involves an innovative partnership between the Office of the Chief Medical Examiner and the Department of Forensic Sciences in which the department tests the contents of needles found at the sites of potential opioid overdose deaths and compares them with compounds in the victim’s body to help OCME identify emerging synthetic drugs being marketed as heroin in the city.
Bowser also announced that the city would distribute 2,500 naloxone kits.
Naloxone is an FDA-approved emergency treatment for known or suspected opioid overdose, with no reported side effects in people who are or are not taking opioids.
In May 2016, the District purchased nasal spray naloxone kits and has since distributed 1,000. Officials say last year’s kits aided in over 300 overdose reversals.
The city’s Department of Health distributes the kits through two community partners, Family and Medical Counseling Service Inc. and the Northeast organization Helping Individual Prostitutes Survive (HIPS).
DOH will also launch a project to expand medication-assisted treatment in the city, which combines counseling with medications that block cravings for opioids and other drugs. It will train 100 primary care providers to prescribe suboxone, a combination medicine that reduced withdrawal symptoms and cravings, to expand patient’s access to the drug by eliminating the need to visit overwhelmed stand-alone clinics.
The District’s Department of Behavioral Health has been awarded a $2 million federal grant over the next two years to combat its opioid crisis and expand its recovery and prevention services that support DOH’s medication-assisted treatment effort.
The grant will aid the city in the implementation of a public awareness campaign in the fall targeting long-term heroin users with “innovative” messages to encourage them to seek treatment and make use of the city’s naloxone kits. The campaign will also address the leading route to opioid abuse nationwide, misuse of prescription opioids.
Though DBH officials say prescription abuse in the District is not “a huge problem,” they “are starting to see some peaks” and want to implement early intervention strategies with the public awareness campaign.
The grant will also help the city add additional care coordinators to their system to link patients with other needed services.
“For people who are struggling with recovery from substances, the message that we have is that there is help available and there is hope you can recover,” said DBH Director Tanya Royster. “There is one simple phone number: 1-888-7WE-HELP.”
DBH partners with more than 30 service-providers to link patients with individualized recovery services including detox and residential and outpatient care.