Posts Tagged ‘opioid overdose death’

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:

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.

Naloxone in Action

At the recent American Society of Addiction Medicine (ASAM) conference, I read a poster describing a study entitled “Lives Saved with Take-home Naloxone for Patients in Medication Assisted Treatment.” The article, by Katzman et al., from the University of New Mexico School of Medicine, described the outcomes from providing naloxone overdose reversal kits to patients enrolling in medication-assisted treatment of opioid use disorders

The study subjects were admitted to medication-assisted treatment over three months in 2016. The poster didn’t say whether they started buprenorphine, naltrexone, or methadone, but I’m guessing the patients were admitted to methadone maintenance.

In the end, 244 subjects enrolled and had education about opioid overdose and how to use a naloxone auto injector kit.

Twenty-nine subjects were lost to follow up, leaving 215 subjects available for inclusion in the study. Of these 215 subjects, 184 didn’t witness or experience overdose.

That means 31 subjects either experienced or witnessed at least one opioid overdose episode.

The scientists conducting the study interviewed these 31 subjects, and discovered that 39 opioid overdoses had been reversed and all of those lives were saved. Thirty-eight people were saved with the naloxone kits distributed by the opioid treatment program, and one study subject was revived by EMS personnel.

When study authors looked at who was saved by these study subjects, they discovered 11% of people saved were acquaintances of the study subjects, 16% were family members, 58% were friends, 6% were the significant others of study subjects, and 13% were strangers.

The study authors concluded that “a significant number of lives can be saved by using take-home naloxone for patients treated in MAT [medication assisted treatment] programs.” The authors also felt the study showed that naloxone isn’t usually on the patient who entered treatment, but more frequently on friends, relatives, and acquaintances that the MAT patient encounters.

I was intrigued by this study because it mirrors what I’ve heard in the opioid treatment program where I work. We are fortunate to get naloxone kits from Project Lazarus to give to our patients. It’s rare that one of our patients enrolled in treatment needs naloxone for an overdose, but much more frequently, I hear our patients say they used their kit to save another person’s life.

If anyone doubted the abilities of people with opioid use disorders, and felt they couldn’t learn to give naloxone effectively, this study should put that idea to rest. If anyone mistaken thought people with opioid use disorders wouldn’t care enough about other people to put forth an effort to save another person, this study should put that idea to rest, too.

In fact, I’ve seen a real enthusiasm among our patients to make sure they have a kit, in case they get the opportunity to save a life. They are eager to help other people, and I find that to be an admirable attitude that’s nearly universal among the people we treat.

Sometimes I get into discussions with patients about what they think about the naloxone kits, and where they think the kits can do the most good. I’ve heard some good ideas. One patient said every fast food restaurant should have a naloxone kit, since she knew many people with opioid use disorder inject in the bathrooms of these facilities. Actually, I just an online article discussing something similar:  

This article expresses the problems that injection drug use has become for public restrooms, and makes a case for safe injection centers. This is presently illegal in the U.S.

Even Massachusetts General Hospital armed its security guards with naloxone kits, so they could give this life-saving medication to people they found who had overdosed in the hospital’s public bathrooms.

Another patient suggested giving naloxone kits to people living in trailer parks.

I know that feeds into a kind of stereotype of those who live in trailer parks, but apparently there is some basis for saying such residential areas have high density of people with opioid use disorders. It’s worth looking at.

Several patients said that all people receiving opioid prescriptions for chronic pain should also be prescribed naloxone kits, and I think that’s been recommended by many health organizations too.

Most communities have at least talked about arming law enforcement and first responders with naloxone kits, and hopefully that’s a trend that will continue to spread.

Naloxone isn’t a permanent solution for opioid use disorder, but it can keep the people alive until they can enter opioid use disorder treatment. Because dead addicts don’t recover.