Curbing Baltimore’s Opioid Epidemic: Advocates and Hospitals Take Novel Approaches

Ava is a fun-loving five-year-old who’s obsessed with Barbie, pink glitter, and her sparkly Stanley cup. She’s also a fierce competitor on the soccer field, a chronic sufferer of “summer knees,” and someone who never hesitates to let insults fly.

Rebecca Armstrong adores her daughter’s sugar and spice.

“Ava is extremely funny, outgoing, and smart, and has a huge imagination,” she says. “She’s a loving, empathetic savage.”

She’s also the embodiment of Armstrong’s own complexities. When Armstrong thinks about her daughter, she can’t help but reflect on her own journey. Her darkness. Her battles with heroin addiction. Her arrests and homelessness. Her complicated relationship with Ava’s dad, who died of a drug overdose shortly after Ava was 16 months old. Her inner strength. The active recovery. The successful career. The willingness to share her story

“When I look at Ava, I see someone who helped save my life and doesn’t know it,” says Armstrong. “I feel guilt and shame for not stopping heroin the very second I found out that I was pregnant. I see her father in her and worry about how she’ll feel about him when she fully understands our past.”

Armstrong, now 42, didn’t abuse drugs to numb the pain of childhood trauma. She grew up in Carroll County with two doting parents. It was a happy life filled with big family gatherings and lots of love. The partying began in high school. Drinking. Smoking weed. The normal stuff.

It was the summer music festival scene that introduced Armstrong to ecstasy and acid. During her senior year, she learned about the powerful high of pharmaceuticals and began dabbling in OxyContin. It was the first intoxicating slip down the slipperiest of slopes that eventually led her to heroin, the opioid synthesized from morphine.

Armstrong managed to graduate from college with strong grades, even though she’d often skip classes and drive to the open-air drug markets of Baltimore when the cravings hit.

Her first successful attempt at getting clean came after she was arrested for drug possession and paraphernalia. Life was good for a while. She moved in with the father of her two older children and settled into a routine of relative bliss. But the happy couple eventually broke up and Armstrong moved on with another man. Ava’s eventual dad. An addict. She began using heroin again. Lots of it.

“I knew immediately that I couldn’t stop,” she said.

Armstrong spiraled into the throes of addiction and was eventually arrested again, this time for theft. She served a 30-day sentence before being released on her 36th birthday.

Birthdays are typically a time for festivities and self-reflection. Armstrong was celebrating the end of a jail term and knew her life was spiraling out of control.

“That,” she says, “was a moment.”

She had nowhere to go and spent six months in an abandoned Baltimore rowhome. The drug use continued. She was injecting herself with heroin, which she’s certain now was laced with fentanyl, the synthetic opioid and powerful sedative that has changed the illicit drug scene across the country.

Armstrong knew that what she was doing was wrong but was powerless to stop her drug-fueled alter ego. She pushes back on the stigma attached to addiction, knowing full well it’s a chronic disease, not a moral failing.

“Drugs change your brain’s chemistry, almost like a form of possession in the way that they take over,” she explains. “Your body needs them like it needs food and water. Addiction doesn’t discriminate. It can happen to anyone.”

The national opioid epidemic is in its third destructive wave, marked by a significant spike in overdose deaths associated with fentanyl, which drug dealers often add to heroin, cocaine, methamphetamines, and pills because of its extreme potency. Streetsmart dealers understand market forces and thrive on repeat customers, who are in search of drugs that are cheap, powerful, and highly addictive.

Fentanyl-laced products are also much more dangerous—and potentially more lethal—than the illicit drugs that riddled Baltimore’s streets just a decade ago. Fentanyl is a strong sedative, creating sudden drowsiness instead of the initial euphoric rush that addicts crave. It’s approximately 100 times more potent than morphine and 50 times stronger than heroin, according to the Federal Drug Enforcement Administration (DEA).

In April 2022, the DEA warned that fentanyl is driving the nationwide overdose epidemic. Provisional data from the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics indicate approximately 107,500 drug overdose deaths occurred in the U.S. in 2023, an estimated 2,499 in Maryland (38 fewer than in 2022).

The Maryland Overdose Data Dashboard reported a similar number of fatal overdoses in the state in 2023 and said 81 percent involved fentanyl. Statistics provide valuable data points and the latest available information from the CDC suggests slight progress has been made in curbing drug- and opioid-related deaths throughout Maryland.

But Baltimore remains at the epicenter of the epidemic. The city led the nation with the highest overdose death rate in the country—184.8 per 100,000 people—from September 2022 to August 2023, according to a national tracker maintained by the San Francisco Chronicle and based on mortality data from the CDC.

The efforts of advocates for safe spaces and accessible treatment for those with substance use disorder and local hospitals that employ proactive treatment protocols are needed now more than ever.

“DRUGS CHANGE YOUR BRAIN’S CHEMISTRY…”

Baltimore’s Toni Torsch is at the forefront of local efforts to help stem the tide of opioid-related deaths in the city and surrounding suburbs. Her 24-year-old son Daniel died of an accidental opioid overdose on Dec. 3, 2010. The intense pain of an unspeakable loss fueled her activism. She went to Washington, D.C., and Annapolis to lobby lawmakers to pass anti-drug legislation but grew frustrated with the bureaucratic red tape.

Torsch and her son John established The Daniel Carl Torsch Foundation to do what they could—something, anything—on the Baltimore streets and throughout Maryland communities to avert another preventable death. The foundation is a community-based nonprofit that supports individuals and their families who are struggling with substance use and addiction. It provides harm reduction services and overdose prevention and response programs. When individuals reach out for help, the organization has resources available to place them in treatment within hours before another day is lost to addiction.

During the afternoon every Monday through Thursday, the foundation’s seven-person team conducts outreach in areas of Baltimore that have been hardest hit by the opioid epidemic: Dundalk’s eastside, Middle River, Essex, and Parkville. They load up a minivan with doses of Narcan, the medication that’s administered to reverse an opioid overdose in emergency situations. They also pack safe-use kits—syringes, sterile water, cookers that are used to mix and heat heroin, tourniquets, alcohol prep pads, and cotton balls—and supplies to treat wounds caused by repeated injections of xylazine, a powerful sedative and emerging threat throughout Baltimore communities.

“We’re trying to keep people alive until, hopefully, they’re ready to make different lifestyle decisions,” says Torsch.

She is aware that some people think harm-reduction is simply a way to encourage people to be safer drug addicts, but she pushes back.

“I feel strongly about the impact harm reduction efforts are having throughout the city and believe that’s why we’re seeing fewer fatal and non-fatal overdoses,” she says, noting that requests for opioid addiction treatments in Baltimore have increased by more than 23 percent since her team began handing out safe-use kits two years ago.

Torsch is known as “Momma T” among the active and recovering addicts who rely on her compassion and resources for help. She shies away from the spotlight and shuns the accolades she’s received for all the good she’s done, but doesn’t hesitate to share that her foundation’s outreach impacts hundreds of individuals each month.

“It’s overwhelming to know that another person gets to live,” says Torsch before becoming quiet, overtaken by the unspeakable pain no parent should feel and no amount of time can heal. “Sometimes I question why there wasn’t a Momma T around to help my son.”

It’s a fleeting moment. Torsch looks up, her eyes brighten, the passion returns. “We’ve helped a lot of people—including a couple working for us now—who are thriving. They’ve got their families back. They’ve got their children back. That’s an amazing feeling.”

Addiction isn’t always obvious. That’s why emergency department personnel at Greater Baltimore Medical Center (GBMC) are instructed to run through a series of questions with every patient who walks through the doors to evaluate them for substance use disorder. The Screening, Brief Intervention, and Referral to Treatment (SBIRT) Program is a quick way to assess an individual’s level of substance use and determine the best intervention to employ.

Ariel Leone, an emergency department nurse who heads SBIRT at GBMC, has worked hard to ensure that 97 percent of patients are screened.

Still, the process is an imperfect system. “The screening tool allows our staff to have initial conversations about potential substance abuse issues, but patients aren’t always honest about their level of use,” she says. “They also need to be ready to ask for help. That’s why the touchpoint is so important. You never know who’s going to agree to get the assistance they need.”

Patients who are flagged for addiction services meet with one of GBMC’s peer recovery coaches, who are established members of the recovery community. They share their lived experience with a level of empathy only a former addict can provide.

“The intimate conversations patients have with peer recovery coaches create a connection that might give them the final push they need to enter a treatment program,” says Leone. “Patients realize what recovery is like and the benefits of accepting treatment. They see, perhaps for the first time in their lives, what a different path forward looks like.”

Patients who are willing to enter a treatment program are fast-tracked to a recovery facility. GBMC handles the processing and transportation. In most cases, accepting facilities discourage letting patients go home to gather their personal belongings.

“That cuts down on the chance they’ll change their mind,” says Leone. “We link them directly to the care they need and get them there as quickly as possible.”

The stakes are that high.

“Treatment can create a positive change that affects so many aspects of an addict’s life and the lives of their loved ones,” says Leone. “That’s what pushes us to keep going, evenwhen the problem seems too big to solve.”

GBMC’s emergency room staff are empowered to dispense two doses of Narcan to patients who are treated for a suspected overdose event or are on medications that could lead to an accidental overdose. No questions are asked. No judgments are made. “We reassure them that they won’t be reported to the authorities,” says Leone. “We just want them to be safe.”

The Kahlert Institute for Addiction Medicine at the University of Maryland School of Medicine opened in May 2023 to foster collaboration among diverse disciplines that address addiction holistically through evidence-based treatments, comprehensive education mod ules, and the development of novel therapeutics for treating individuals with substance use disorder.

“THERE’S A GROWING RECOGNITION THAT ADDICTION IS A CHRONIC ILLNESS…”

For many years, addiction treatments remained marginalized within the medical field, with a lack of understanding and training among healthcare providers about how to address it, according to Dr. Eric Weintraub, professor of psychiatry, director of the division of the Addiction Research and Treatment, and associate director of the Kahlert Institute of Addiction Medicine at the University of Maryland School of Medicine.

“There’s a growing recognition that addiction is a chronic illness requiring concerted treatment efforts from various medical professionals,” says Weintraub. “This includes substance abuse specialists, but also primary care physicians, emergency room doctors, and physicians who work in correctional facilities.”

It’s crucial to implement widespread screening programs to identify individuals suffering from substance use disorders to facilitate early intervention and access to treatment, notes Weintraub. “We’re actively engaged with local communities with the Maryland Addiction Consultation Service (MACS), a state-funded program that supports healthcare providers in improving the care of individuals with substance use disorder,” he says.

The multidisciplinary research team at the Kahlert Institute is exploring several new ways to treat addiction, including neuromodulation, which involves using low- and high-intensity ultrasound to disrupt nerve connections in the brain that spark cravings. They are engaged in a multi-site study to investigate the effectiveness of weightloss drugs in reducing desires for drugs and alcohol. Another potential area of research interest involves exploring the therapeutic potential of psychedelic substances. The Kahlert Institute is also intensifying efforts to connect with Baltimore-area communities through formal outreach programs.

“One of our primary objectives is to combat the stigma and discrimination associated with addiction by emphasizing that it’s a chronic illness with complex multifactorial causes, including genetic factors,” says Weintraub.

And since drugs alter the brain’s chemistry, it’s challenging for addicts to stop using without pharmaceutical help. The synthetic opioids methadone and buprenorphine are two effective options.

“Dispelling misconceptions about these medications is crucial,” says Weintraub. “Recovering addicts do very well on them. Stability and functionality in daily life are indicators of successful treatment. We’re not replacing one addiction with another.”

Armstrong wants to see improvements made to the step-down recovery process. She says addicts who are fresh out of rehab often have nowhere to turn and lack the continued support they need to stay clean. She’s also frustrated that some recovery centers don’t allow patients to undergo medication-assisted treatment (MAT) or take methadone or buprenorphine.

She personally knows many addicts in recovery who have had success with MAT and continue to rely on it. Armstrong no longer craves heroin but is self-aware enough to know that she hasn’t beaten her addiction.

“The wrong thing at the wrong moment could bring it back alive,” she says.

It hasn’t yet. Ava keeps her more than busy. So does her job as the regional operations manager at Merry Maids of Towson. She oversees 25 employees and loves the responsibility and routine of her first-ever nine-to-five gig. Armstrong continues to string together days into weeks, weeks into months, and months into six years of recovery. She takes 4 mg of buprenorphine each morning and again at night to manage her disease.

“I’m honest with myself about my past and believe it’s up to me to show continuous growth,” she says. “I feel like I need to make up for lost time.”