D.C. lawmakers, public health experts, doctors and addiction treatment providers forcefully criticized the city’s efforts to address an explosion in fatal opioid overdoses, saying at a D.C. Council hearing Monday that city officials failed to heed best practices and haven’t adequately fixed their strategy.
The joint hearing by the council’s health and judiciary committees served as a cathartic moment for advocates and medical professionals who bemoaned what they described as years of missed opportunities to save lives. Early in the hearing, council member and judiciary committee chairman Charles Allen (D-Ward 6) encouraged people to air their complaints.
“There’s over 700 people who are dead, over the last four years, because of opioid overdoses,” Allen said. “I think we are being way too polite in our conversation today.”
It was not immediately clear what new initiatives or legislation could emerge from the hearing, which ran uninterrupted for more than nine hours and touched on topics including the need for more street outreach to heroin users and the possibility of government-supervised sites where drug users can inject heroin.
LaQuandra Nesbitt, director of the D.C. Department of Health and interim director of the Department of Behavioral Health, defended the city’s actions and plans, saying she was “optimistic” that initiatives announced by Mayor Muriel E. Bowser (D) over the past month would “prevent opioid use, reduce misuse and save lives.”
Allen and health committee chairman Vincent C. Gray (D-Ward 7) called the hearing after the publication of a Washington Post series last month that disclosed widespread shortcomings in the District’s response to one of the nation’s most severe increases in fatal opioid overdoses.
Unlike the white drug users in rural and suburban areas who have been the focus of attention in the opioid epidemic, the District’s victims are predominantly African American — many of them chronic users who have been addicted to heroin for decades. Those victims began dying in large numbers several years ago, when heroin contaminated with the deadly synthetic opioid fentanyl became widespread.
Of at least 860 people known to have died of opioid overdoses since 2014, 4 in 5 were black, according to the D.C. chief medical examiner. In 2017 — the most recent year of data from the Centers for Disease Control and Prevention — the rate of fatal drug overdoses among African Americans in the District was higher than that of whites in West Virginia, Ohio or New Hampshire.
The Post found that city officials did not take basic steps to check the rise in opioid deaths, making the overdose antidote naloxone far less available than in cities with comparable drug problems and mismanaging millions of federal grant dollars that were intended for opioid programs. After the series was published, officials with the U.S. Substance Abuse and Mental Health Services Administration launched an audit of the city’s behavioral health agency, which oversees the grants.
“I think that we have taken some comfort in neglecting heroin users and thinking that this is a long-standing problem in the District of Columbia and because things are different here that somehow this didn’t need any additional attention,” said Mark LeVota, executive director of the D.C. Behavioral Health Association. That complacency, LeVota said, left city officials ill prepared for the devastation caused by fentanyl.
Unlike many rural parts of the United States, the District no longer suffers from a shortage of medical providers trained in prescribing medications that diminish the cravings of those addicted to opioids. The use of such medications — which include buprenorphine, methadone and naltrexone — is considered the most effective way to treat opioid addiction, in contrast to traditional programs that emphasize abstinence.
The expansion of buprenorphine providers has been driven in part by $1.7 million that the D.C. Department of Health has distributed to clinics to fund treatment programs — a rare bright spot in the city’s response to the opioid crisis over the past several years.
But Richard S. Schottenfeld, chairman of the department of psychiatry and behavioral sciences at Howard University College of Medicine, said the city still has a long way to go in connecting opioid-addicted users with treatment.
“We’ve increased capacity in the District to provide effective opioid-use disorder treatment with medications. That’s an accomplishment we should take seriously. But we know that even as we’ve increased capacity, we know that we’re underutilized,” Schottenfeld said. “Many — probably most — people who need treatment aren’t getting it.”
Over the past month, Bowser has announced initiatives to reduce fatal overdoses. In late December, she released a 22-page anti-opioid strategy, and about two weeks ago, she announced a dramatic expansion in the city’s efforts to distribute naloxone. She has pledged to cut opioid deaths in half by 2020.
In an introductory letter, Bowser said the plan was a “blueprint for how best to continue moving forward with urgency and thoughtfulness as we work towards reversing fatal opioid overdoses.” However, some speakers at Tuesday’s hearing complained that they were not consulted as the plan was prepared, and they described it as too thin. Many initiatives described in the document echo programs previously planned by city officials, including some the District is already doing or has promised but failed to implement.
Gray said the plan was “really an outline” that needs to be fleshed out. He said he would be asking the Bowser administration to provide a timeline for achieving each of the dozens of strategies laid out in the plan and to identify the staff responsible for them.
Nesbitt, in her testimony Monday, announced three hospitals where new efforts to prescribe buprenorphine and perform outreach to overdose patients would be established in the coming months: MedStar Washington Hospital Center, Howard University Hospital and United Medical Center.