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."
KELLY MCEVERS, HOST:
The declaration of an opioid emergency by President Trump has put the focus on the need for treatment. And now some communities are asking who will pay. NPR's Allison Aubrey reports on the rising costs of treating the epidemic.
ALLISON AUBREY, BYLINE: Like a lot of communities around the country, Baltimore has seen an uptick in deaths from opioids.
LEANA WEN: Here in Baltimore City I see the impact of the opioid epidemic every single day. We have two people in our city dying from overdose every day.
AUBREY: That's the city's health commissioner, Leana Wen. Part of her strategy to tackle the problem is to make the lifesaving drug naloxone, known by the prescription name Narcan, available to all residents.
WEN: If somebody is having an opioid overdose, they have stopped breathing. And Narcan can be given as a nasal spray. And within 30 seconds or so of getting Narcan, that person can be walking and talking again.
AUBREY: Wen says they've prevented a lot of deaths by getting this drug into the hands of more people. But now, she says, her city has a problem.
WEN: We're out of money for purchasing Narcan. We're having to ration this medication. And every day I have community members, community leaders, faith leaders contacting us because they want to have Narcan available in order to save people's lives.
AUBREY: People can purchase the drug at pharmacies, but at a cost of about $125 many people can't afford it. So Wen says she'd like a commitment from the Trump administration to help pay. And she'd like the administration to negotiate with manufacturers to decrease the price of the opioid antidote.
WEN: We know that treatment works, but we don't have the money for treatment.
AUBREY: How to pay for drugs is not the only issue. A recent study of urban hospital systems finds a significant spike in the cost of treating people who end up in intensive care after an overdose. Here's the study author, Jennifer Stevens.
JENNIFER STEVENS: These are patients who have already survived to admission and have significant complications from an overdose itself.
AUBREY: Stevens is a critical care doctor at Beth Israel Deaconess Medical Center in Boston. She says when opioid users have been unconscious for an extended period, they can come in in really bad shape.
STEVENS: You can have kidney injury or failure. And you can have aspirated and given yourself a big pneumonia that requires a ventilator to help you through that.
AUBREY: Stevens says the number of overdose patients needing treatment in the ICU has increased about 34 percent between 2009 and 2015. And the average cost of care has shot up from about $58,000 to $92,000 per person.
STEVENS: So that's an increase of nearly 60 percent.
AUBREY: Stevens says it's not just the costs that are rising. The mortality rate of overdose patients admitted to the ICU is up, too. Her study found that opioid deaths in the ICU nearly doubled during the study period.
STEVENS: In spite of everything we can do we're still seeing a rise in mortality. And I should say that's certainly - it's a call to arms that everything that we're doing isn't enough.
AUBREY: These new numbers reinforce what's now clear - the epidemic has achieved a new sense of urgency. Allison Aubrey, NPR News.
(SOUNDBITE OF THE XX SONG, "A VIOLENT NOISE") Transcript provided by NPR, Copyright NPR.