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As deaths from opioid overdoses rise around the country, the city of Baltimore feels the weight of the epidemic.
"I see the impact every single day," says Leana Wen, the city health commissioner. "We have two people in our city dying from overdose every day."
As part of Baltimore's strategy to tackle the problem, Wen issued a blanket prescription for the opioid overdose drug naloxone, which often comes in a nasal spray, to all city residents in 2015.
She says many deaths have been prevented by getting the drug into the hands of more people. But now, there's a problem:
"We're out of money for purchasing Narcan [a brand of naloxone]. We're having to ration this medication," Wen says.
People can purchase Narcan at pharmacies on their own. As we've reported, it's now sold at all Walgreens. But at a cost of about $125 a pop, many people can't afford it.
Thursday, the Trump administration declared the opioid crisis a public health emergency, but many critics say it doesn't go far enough when it comes to funding.
Wen says she would like a commitment from the administration to help pay for this drug. She says the administration could also negotiate directly with manufacturers to lower the price of naloxone. "We know treatment works, but we don't have [the] money," Wen says.
Paying for rapid reversal drugs is certainly not the only challenge health officials face in tackling the opioid epidemic.
A recent nationwide study published in the Annals of the American Thoracic Society points to a significant increase in the cost of treating overdose patients who are admitted to hospital intensive care units.
"These are patients who have survived admission [to the hospital] and have significant complications from an overdose," says study author Jennifer Stevens, a critical care doctor at Beth Israel Deaconess Medical Center. She says complications can include kidney failure and infection. Some patients require a ventilator during hospitalization to support breathing.
Researchers analyzed billing data from more than 150 hospitals in 44 states, and they evaluated all the opioid-associated overdose admissions to ICUs between 2009 and 2015.
The study found a 34 percent increase in overdose-related ICU admissions during that period. And costs rose by almost 60 percent. In 2009, the average cost of care per admission was about $58,000. By 2015, the cost had risen to about $92,000.
In addition, the study points to almost a doubling of deaths among opioid overdose patients in hospital ICUs during the study period.
"It's a call to arms that everything we're doing is not enough," Stevens says.
Stevens says she thinks a lot about the services patients may need once they're released from the hospital. "They need long-term support," she says.
Many experts say this must include expanded access to addiction treatment.
"The key to unlocking the opioid crisis is the availability of quality treatment beds," Gil Kerlikowske, a former drug policy adviser to President Obama, tells us in an email. "We know treatment works and is far less expensive than jail or hospitalization."