Having peer recovery coaches and providing access to an overdose-reversal drug were key components in the Baltimore City Health Department’s January decision to grant its highest certification to opioid treatment efforts at both The Johns Hopkins Hospital and Johns Hopkins Bayview Medical Center.
On Jan. 17, city health commissioner Letitia Dzirasa sent congratulatory letters to Johns Hopkins Hospital President Redonda Miller and Bayview Medical Center President Richard Bennett on their institutions’ increased efforts to prevent overdose deaths.
“The opioid epidemic continues to disproportionately affect Baltimore City,” wrote Dzirasa. According to the Maryland Department of Health, 1,028 people died in Baltimore from accidental overdoses in 2020, the last full year for which data is complete. “We appreciate Johns Hopkins’ hard work in addressing the epidemic through the Levels of Care initiative.”
Dzirasa cited the two hospitals’ improvements in providing access to naloxone, a nasal spray that, when administered properly, can reverse the effects of an overdose of opioids such as fentanyl, oxycodone or heroin.
Introduced in 2018, the city health department’s Levels of Care program grades each of Baltimore’s 11 hospitals based on their ability to care for patients with opioid use disorders (OUD). The lowest certification, Level 3, indicates that a hospital performs the basic functions of care, such as screening for OUD, referring patients to community-based services and prescribing naloxone. A Level 2 designation adds enhanced emergency department services for patients with OUD, as well as monitoring of provider adherence to responsible opioid prescribing guidelines.
Care teams at both The Johns Hopkins Hospital and Bayview Medical Center now have protocols in place to dispense free, take-home naloxone kits to patients discharged from the emergency departments who are at risk of opioid overdose. Last year, the two hospitals provided emergency department patients and their caregivers more than 350 overdose-prevention kits total.
Michael Fingerhood, director of addiction medicine at Bayview Medical Center, says that in recent years, both hospitals have removed barriers to dispensing naloxone, which he says is critical to preventing overdose deaths.
“It’s not enough to just prescribe it. Giving someone a prescription for naloxone doesn’t mean they’re going to fill it,” says Fingerhood. “There are a lot of reasons for that. Copays, for instance, can be a deal breaker.”
Fingerhood cites research that says a significant percentage of people seeking naloxone look for it at night, when pharmacies are typically closed. For example, of the 236 take-home naloxone kits dispensed from The Johns Hopkins Hospital’s emergency department in 2021, nearly 40% were dispensed between 11 p.m. and 7 a.m., he says
“The percentage was only a little lower at Bayview, but the principle is the same,” says Fingerhood. “The data is glaring: we’d have missed a whole lot of patients because they’re unlikely to go to a pharmacy in the middle of the night. And that’s assuming they can even find one that’s open.”
In addition to the take-home naloxone kits, the health department commended both hospitals for their use of peer recovery coaches, nurses and pharmacists to train patients, their caregivers and their families to administer the drug properly.
A Nationwide Crisis
Across the country, overdose deaths have risen steadily for more than two decades. According to the National Center for Drug Abuse Statistics, the number of opioid overdose deaths per 100,000 Americans was 2.9 in 1999. By 2019, that number increased 435% to 15.5. The U.S. Centers for Disease Control and Prevention estimate that more than 100,000 Americans died of overdose during the first 12 months of the COVID-19 pandemic.
“It’s easy to forget that — even if we don’t hear about it as much as we did before COVID-19 — the opioid crisis is still very much an issue,” says Melissa Richardson, vice president of care coordination and clinical resource management at The Johns Hopkins Hospital. She called the health department certification “important recognition of the work we’ve done to provide the best care possible for our patients with opioid use disorders.”
Richardson says the effort to bring The Johns Hopkins Hospital and Bayview Medical Center up to Level 1 certification involved physicians, nurses and hospital administrators, as well as staff from pharmacy, information technology and Epic.
“A lot of people at both our city hospitals worked very hard to make this happen,” says Richardson.
According to Baltimore City Health Department officials, the certification process is annual; when the 2022 process begins in the summer, hospitals with Level 1 certification must show that they’ve maintained the high standard that earned them the distinction.
The other Baltimore hospitals to attain the health department’s 2021 Level 1 certification are the University of Maryland Medical Center and its affiliated Midtown Campus hospital.
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