Bad News

I knew overdose deaths were increasing since COVID started last year. But data from the Centers for Disease Control and Prevention (CDC) is worse than I’d thought.

You can look at several interesting maps filled with facts here: https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

Overall, overdose deaths have increased 30.4 percent in the year from February 2020, the beginning of COVID, and February of 2021. At the end of February of this year, 95,133 people died from overdose over the preceding twelve months, compared to 73,344 who died over the twelve months prior to that. Opioids were involved in most of these deaths, though the total number includes deaths from all drugs.

That’s awful.

Some states are worse than others. Nearly all the Appalachian states had large percentage increases in overdose deaths. For example, Tennessee’s increase in overdose deaths was an astounding 51.1percent, while my home state of North Carolina went up by 40.5 percent. Kentucky’s deaths increased by 54.6 percent, and West Virginia increased by 55.2 percent.

Vermont saw the biggest percentage increase, at 74 percent.  New Hampshire, right next to Vermont, was one of the few states that had a reduction in overdose deaths.

Vermont has an innovative hub-and-spoke model, which other states try to emulate, to provide care for people with opioid use disorder. Yet New Hampshire has been lukewarm in its response to treatment of opioid use disorder, so initially this data puzzled me. But the data I’m talking about from the CDC reports the percentage change in overdose deaths. When I look at the actual total of deaths for the last reported 12-month period, they had 194. New Hampshire, however, had 381 over the same time.

But these raw numbers aren’t controlled for the population density. Vermont has, very roughly, about a third of the population that New Hampshire has.

Why have overdose death rates gone up? What’s driving this? The answer, in a word, is fentanyl.

This very potent opioid far surpassed heroin and prescription opioids a few years ago. When I started working at the OTP in my small town in the foothills of the Appalachian Mountains, all my patients were using prescription pain pills. Starting a year or so ago, heroin entered our area, but it wasn’t really heroin. It was the much cheaper and more potent fentanyl and its analogues.

Lately our patients tell us fentanyl is being added to stimulants like cocaine and methamphetamine. It’s also been pressed into pills that look like Xanax and other prescription medications. We had a few people tell us they bought Xanax or knew someone who bought Xanax that turned out to be fentanyl.

Stimulants are also killing people, but usually in combination with an opioid. According to NIHCM (National Institutes of Health Care Management), 63% of stimulant overdose deaths also involved an opioid in 2019, the last year that data is available. Cocaine overdose deaths haven’t increased as much as methamphetamine overdose deaths, which were climbing even before the pandemic. [2]

What are we to do?

First, we don’t give up. We can’t. This issue is too important, and the well-being of people affected by substance use disorders is too important. For workers in the field, it feels like we are trying to empty a swimming pool one teaspoon at a time. It feels overwhelming at times, yet even a teaspoon is something.

Second, use science to guide what we do. Use evidence-based methods to prevent new cases of substance use disorders. Implement the evidence-based methods of harm reduction to help people with substance use disorders. We need to demand funding for treatments that work and stop funding treatments that don’t work. For example, let’s stop cycling patients with opioid use disorder through short-term detox admissions that have little chance of producing real change. Or if patients are sent to detox units, let’s make sure they leave those places on one of the three medications that treat opioid use disorder. Inpatient detox is a great place to start depot naltrexone, for example.

Let’s demand more funding for research into all aspects of substance use disorders. And then, let’s use the data. Let’s refuse to be led by ideology with no evidence.

Third, let’s train new people to work in this field of substance use disorders, and let’s pay them an attractive wage. And let’s voice appreciation to the people working in the field now.

Today is National Addiction Professional Day, so celebrate by telling someone you know who works in the field how much you appreciate them!

  1. Ahmad FB, Rossen LM, Sutton P. Provisional drug overdose death counts. National Center for Health Statistics. 2021.
  2. https://nihcm.org/publications/stimulant-deaths-on-the-rise-compounded-by-rise-in-synthetic-opioids

7 responses to this post.

  1. Unfortunately starting people on Vivitrol often ends up with very bad outcomes when people are leaving jail or detox unless they have a great support system to get them to their next vivitrol injection . I’ve had many Of the providers patients who I work with do extremely well and have a until until their disease of addiction. a chronic relapsing disease. Unfortunately led to the death of these grear people because they missed a vivitrol injection and use the small amount of opioids which they then had become naïve to and so many of them died.
    the greatest statistics of these wonderful medication‘s of A fatal overdose because they missed their vivitrol appointments often a one day relapse and that one time using opioids was enough to kill them even after a substantial amount of recovery time for some of them and some of them 30 days but
    Without that monthly vivitrol injection
    I think injectable Buprenorphine or methadone are much better choices and much safer drugs then long acting naloxone (vivitrol ) and they have much better statistical outcomes as far as fatal overdose. I know alkermes doesn’t like tell this truth but read the data and work on a 12 man month vivitrol or at least warn people like they have never been warned before about the risks.

    Reply

  2. Posted by shelbypolis on September 21, 2021 at 1:48 am

    The worse part about trying to drum up support concerning my own experience is knowing that if only the people who are able to advocate for me were willing to do it before another person does.

    Legislative change is what will save people like my dear friend, Tasha. She overdosed on September 6, 2021. Since her tolerance for opioids was relatively low her body never knew what hit her. But knowing that she probably wouldn’t have even injected herself if not for the people she had been trying to impress, the ones that became opioid dependant or manufactured in the same way I was.

    “Tasha I’m trying as hard as can! And I really miss you!”

    Reply

    • Shelby I am really sorry for your loss and pain you are in please reach out to the methadone support group on Facebook. Just let them know you heard about group here. In my payers you are.
      Best

      PB

      Reply

  3. Posted by Sparky on September 21, 2021 at 1:34 pm

    You can thank idiot Dea,idiot cops,idiot medical boards, and idiot politicians for shutting down caring Drs that were helping people with their pain,we have 10times more overdoses now since they have got involved in making medical decisions regarding opiates and sending Drs to prison for no reason at all,heck if you got a bone sticking out of your skin they will say oh
    Tylenol is all you need,thanks for nothing dea and cops

    Reply

  4. Posted by William Taylor MD on September 22, 2021 at 2:51 am

    Every day I talk to buprenorphine patients whose pharmacies are out of stock, citing shortages, which appear to be related to government restrictions on supply and distribution. How is this helping with the overdose crisis?

    The latest data also confirm what every pain patient knows: the draconian cutbacks on prescribing for legitimate pain sufferers have had NO impact on preventing overdose deaths, but have just compounded human misery.

    Reply

    • Why is access to this lifesaving drug being limited?
      This means that buprenorphine both stimulates and blocks the opioid receptor. However, when patients with opioid addiction are prescribed buprenorphine they are often able to stop other opioids and avoid overdose and other negative effects of opioid misuse. So why are patients having problems getting legitimate buprenorphine prescriptions filled?

      First, government policies designed to curb opioid diversion pressure pharmacists not to dispense buprenorphine. The Drug Enforcement Administration (DEA) requires drug wholesalers to report suspicious prescriptions, but drug wholesalers who fear DEA investigation and prosecution have consequently established thresholds for opioid orders which include buprenorphine. Since the wholesalers lump buprenorphine with opioids prescribed for pain, they fail to distinguish between a medication used to treat opioid use disorder (OUD) – buprenorphine, and other opiate drugs which contribute to the development of OUD. Pharmacists whose orders exceed certain thresholds may be subject to DEA investigation. But no one knows what these thresholds are or whether there even are any specific thresholds.

      A study of 15 Kentucky pharmacies showed that pharmacists interpreted the opiate thresholds imposed by wholesalers as a “DEA cap”. (Int J Drug Policy 2020 March 26(Epub ahead of print) Since the pharmacists had no idea about precisely where the thresholds had been set, they worried that every buprenorphine prescription filled brought them closer to exceeding the unknown cap and possible DEA investigation. A Tennessee study reached similar conclusions. (Subst Use Misuse 2020;55:349-357.) DEA policies that inhibit the legitimate prescription of buprenorphine are obviously misguided. Even diverted buprenorphine (buprenorphine is taken without a prescription) is often used by patients with OUD to manage withdrawal from opioids or to support cessation. Such use is a kind of self-management due at least in part to the stigma and inaccessibility of addiction treatment programs.
      Paul Bowman Massachusetts NAMA recovery

      Reply

  5. Posted by sparky on October 5, 2021 at 10:04 pm

    this is the end result when idiot cops and dea shut all the caring drs down and punish any dr that prescribes pain medicine,now instead of getting a legitimate prescription that could be verified the addicts are getting fake pills full of pure fentanyl,if the idiots would have just left things alone and left drs alone things would not be this bad,i promise you this,the more the idiots try to stop prescrbing of pain meds the worse the overdose deaths get,they are so dang clueless it is pitiful.i really really hope the the dea and cops that all did this to the drs will need pain meds one day and cant get them then they can lay and suffer and get pills full of pure fentanyl

    Reply

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