Recently, the U.S. Centers for Disease Control and Prevention released headline-grabbing statistics showing that, for the first time in four years, life expectancy in the United States rose slightly. The increase was due in no small part to a decline in drug overdose deaths — a cause for cautious celebration among those on the frontlines of treating people whose lives have been turned upside down by the opioid epidemic that has roiled our nation and claimed nearly 500,000 lives since the late 1990s.

Here in Baltimore, our own Michael Fingerhood and his team at the Comprehensive Care Practice at Bayview Medical Center have been toiling on those front lines of addiction medicine for 25 years. I first met Dr. Fingerhood in person last fall, to plan a booklet celebrating the CCP’s silver anniversary — and was moved beyond measure by his vision and by the compassion and commitment shown by him and his colleagues. While the numbers quantifying the CCP’s reach are impressive (more than 6,000 Baltimoreans rely on the practice for medical care), it is in the stories of individuals — unflinching, candid accounts — that the true measure of the practice can really be felt. We share some of those stories in “Compassion, Not Judgment.” 

If you’re like me, those stories will leave you feeling a bit more hopeful that with people like Michael Fingerhood in the world, the stigma that too often surrounds addiction can indeed be surmounted, paving the way for effective health care that saves lives and preserves families.

Letters 

I read your Fall 2019 issue with interest but was stopped short by an assertion in “Relief from Despair.” In the third paragraph of Judith Minkove’s article on the use of esketamine [to treat intractable depression] is the following statement: “… how the drug esketamine — a more potent form of ketamine — might relieve symptoms…” 

I would be grateful if the author could cite a source of data that demonstrates that esketamine is in fact more potent — or different in any way pharmacologically — than racemic ketamine. If there isn’t any, then she may have inadvertently provided yet another example of the situation addressed in the cover story of this issue [“Busted Pipeline”]. 

Andrew J. Alpert, Ph.D. 

Columbia, Maryland 

Editor: We reached out to featured Johns Hopkins scientist Adam Kaplin with this question. He referred us to an article, “Antidepressant Efficacy and Tolerability of Ketamine and Esketamine: A Critical Review,” which appeared in CNS Drugs (2018) 32:411–420. It noted, “Esketamine has a higher affinity for the NMDA receptors than ketamine, resulting in the S-enantiomer being about two to four times as potent as the R-enantiomer.”