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.