Fentanyl underscores need for access to all opioid-reversal agents
During the COVID-19 pandemic, one of the most intractable public health challenges was overcoming distrust in government and public health agencies, including among Black and brown communities. Yet in Maryland, one innovative approach helped build trust and get shots in people’s arms — partnering with local barbershops and hairstylists, trusted cornerstones for many Black communities. As we fight the opioid overdose epidemic, another devastating crisis, the same hyperlocal innovative thinking should guide our response and ensure access and availability to all opioid reversal agents that have been approved by the U.S. Food and Drug Administration (FDA).
As a health policy and management professor and founding director of the Center for Health Equity at the University of Maryland, I have long focused on eliminating racial and ethnic health disparities. For seven years, I also served on the Maryland Health Commission under governors Martin O’Malley and Larry Hogan. My commitment to engaging local communities began more than a decade ago when I founded the barbershop initiative known as HAIR (Health Advocates In-Reach and Research).
Within the Black community, barbers and hairstylists have credibility. They are listened to and feel like family.
Our research shows that barbershops and beauty salons can be effective community-centered locations for health education and the promotion of disease prevention services. Training barbershop participants as health educators helped get shots in reluctant arms, we found.
Last year, the Centers for Disease Control released a report showing that in 2021, more Black Americans died from fentanyl overdoses than from any other drug. In fact, Black rates of overdose death were far higher than white or Hispanic rates, and fentanyl was far and away the leading cause of all overdose deaths.
In Maryland, this crisis affects both urban and rural communities. According to Maryland’s Office of Overdose Response, between October 2022 and September 2023, the state saw
2,513 fatal overdoses, and fentanyl was involved in about 80% of deaths. Accidental overdose is now the
leading cause of death in Maryland.
Lessons we learned through the HAIR initiative apply well here. We know that trusted neighborhood-based relationships can help make people more aware of the devastating role that synthetic opioids like fentanyl are having on Black and brown communities. This education is critical, as fentanyl is 50 times stronger than heroin and 100 times stronger than morphine. Just two milligrams, the equivalent of several grains of salt,
can kill. Synthetic opioids stay in the system longer, meaning multiple doses of the most widely available reversal agents may be required, if first responders even have them on hand. The fact that fentanyl is regularly added to counterfeit prescription pharmaceuticals like Adderall and Oxycontin, or recreational drugs like marijuana, only increases the lethality.
It is up to policymakers to ensure first responders, health care providers, and average citizens have access to all FDA-approved
opioid reversal agents critical to addressing sudden overdoses.
Every state is required to issue its own policy or standing order to ensure the availability of FDA-approved reversal agents for opioid overdoses. Here in Maryland, this has prompted leaders in our state legislature to introduce bills in the House and Senate that will prompt this change. I applaud these efforts and encourage our legislators to take up and pass these bills. In fact, just as I was testifying for the passage of these bills, I received a text from an old friend whose son had tragically passed away due to an overdose in front of her. I told the story to the legislature and urged them to increase our communities’ access to all overdose reversal agents.
Communities deserve access to the most effective and innovative tools to combat overdoses and the devastating impact of fentanyl. Programs like HAIR exemplify the resilience and ingenuity of Black communities, showcasing how they have pioneered approaches to address health disparities. It’s evident that when empowered with appropriate resources, communities can spearhead meaningful change. Yet, it’s disheartening to witness my state falling short in this regard. Maryland must take immediate action and draw upon the lessons of innovation learned from Black communities to inform better policy. It’s time to prioritize saving lives by ensuring access to all FDA-approved opioid-reversal agents.