PROVIDENCE — While attention is riveted on the coronavirus pandemic, another public health crisis is unfolding here and in many other parts of the country: Accidental drug overdose deaths are on track to reach record levels in Rhode Island this year.
The 128 overdose deaths during the first four months of the year represent a 29 percent increase over the same period last year and a 38 percent jump from the same period in 2018, according to state Department of Health statistics.
Complete data is not yet available for fatal overdoses in May, June and July. But if that earlier rate continues, the state would see 384 deaths in 2020, surpassing the record of 336 accidental overdose deaths in 2016, according to records dating back to 2009.
“We are very concerned about this,” said Kathryn Power, director of the state Department of Behavioral Healthcare, Developmental Disabilities and Hospitals. “Given the high rate through the first four months, we think this could be a very difficult year and it could eclipse the peak level in 2016.”
Rhode Island is not alone.
According to the American Medical Association, more than 35 states have reported increases in opioid-related deaths. “The AMA is greatly concerned by an increasing number of reports from national, state and local media suggesting increases in opioid-related mortality — particularly from illicitly manufactured fentanyl and fentanyl analogs,” the association said.
So what is driving the increase in overdose deaths?
Power attributed the rise in part to the social isolation, anxiety, and depression caused by the pandemic.
Those factors can push people who are in recovery to return to drug use, she said. And amid the pandemic’s physical and social isolation, that can mean using drugs alone, with no one around to seek help or provide naloxone to counter the effects of an opioid overdose, she said.
“I’ll say this about the pandemic: It’s the great disrupter and it’s the great disconnector,” said Dr. James McDonald, medical director for the state Department of Health.
When the pandemic first hit, he asked the medical examiner’s office to let him know if it saw a rise in overdose deaths. “Sure enough, a couple weeks later we saw an increase in overdose deaths,” he said.
McDonald said he was worried overdose deaths would rise because he could see “a population across the planet getting more anxious, more depressed, more upset.”
Most people have never seen an outbreak like the COVID-19 pandemic in their lifetimes, he noted.
“It’s ripe for people just saying: How do I change my reality?” McDonald said. “When you think about the beginning of the pandemic, it was just fear, fear, fear. Fear drives catastrophic thinking, and catastrophic thinking never drives positive outcomes.”
Plus, the pandemic isolated people, cutting them off from support networks, he said.
“It really disconnected people so fast,” McDonald said. “If you didn’t have a bubble to retreat to that was supportive, you were at much higher risk.”
While the number of fatal drug overdoses is rising, the number of nonfatal drug overdoses is falling, he said.
That might seem surprising, but McDonald suspects people who had not been using drugs began using again at a time when there are “more potent products in the illicit drug world in Rhode Island.”
Also, he said, while the pandemic produced a shortage of many products, it did not cut off the drug supply.
“The illicit drug market was not disrupted,” McDonald said, citing reports from law enforcement officials. “And that is kind of hard to understand, because we couldn’t get toilet paper and people could get their fentanyl.”
Power agreed that the rise in accidental overdose deaths is linked to an increase in the toxicity and concentration of drugs, such as fentanyl and carfentanil, on the global and local drug markets.
She said drugs are coming in from foreign markets and moving across the country while getting redistributed and “recut” with unknown levels of contaminants. And, she said, “The level of lethal contaminants in some of the drugs is having the unintended consequence of people dying.”
McDonald said 2 milligrams of fentanyl is enough to kill a person, while 1 ounce is enough to kill 15,000 people.
And carfentanil is even more potent.
“Carfentanil is an elephant tranquilizer,” McDonald said. “It was popularized in one of the Jurassic Park movies. You see this guy with a tranquilizer dart shooting at an oncoming Tyrannosaurus rex. That is movie hyperbole, but it is used for elephants.”
Department of Health Director Dr. Nicole Alexander-Scott said it has always been dangerous to use illicit drugs. “But right now they are more deadly than ever,” she said. “If you do use drugs, do not use alone, and make sure that your friends and family have naloxone available.”
Alexander-Scott and Power are co-chairs of Governor Gina M. Raimondo’s Overdose Prevention and Intervention Task Force, which has issued a strategic plan and continues to meet on the second Wednesday of each month. Zoom meetings are open to the public.
So what needs to be done now that the number of overdose deaths is rising?
Power said health officials and providers agree on the need to increase the number of “street outreach workers” who can go to the communities with high levels of overdose deaths, build relationships, and get people the help they need before they overdose.
“We can’t wait for people to overdose and then have a friend call or do naloxone,” she said. “We have to get out in the street, like we would with people who are homeless, and reach out to them and connect to them.”
While the pandemic complicates outreach efforts, she said substance abuse agencies have counselors who can contact people and provide information while maintaining social distance, and she said officials are looking to increase use of vans that go into communities with high overdose rates.
The American Medical Association is recommending that states use telemedicine to increase the flexibility of evaluation and prescription requirements.
Power said Rhode Island is doing just that.
She said the state is expanding use of medication-assisted treatment to combat opioid addiction, and in May, the state launched the Buprenorphine Hotline — at 401-606-5456 — allowing people to talk with doctors who can get them started on medication-assisted treatment without in-person visits.
“It has been very successful,” she said.
Also, she said people can call a 24/7 behavioral health hotline — at 401-414-LINK — to talk to professionals who can provide confidential counseling, referrals, and support services.
Those telehealth services will prove crucial if people cannot return to their jobs because of the pandemic, Power said.
“We are worried that the economy won’t rebound at the level we expected it to,” she said. “That could trigger additional anxiety and depression and drug use.”
McDonald said that during a Zoom conference call last week, health officials and providers talked about what needs to be done in communities hit hard by overdose deaths, such as Providence, Pawtucket, Central Falls, and Woonsocket.
Among other ideas, they talked about overdose prevention sites where people could bring illicit drugs and use them in a supervised setting where naloxone would be available, along with health screenings and referrals for medication-assisted treatment, he said.
The United States does not allow overdose prevention sites, but they represent a “harm reduction strategy” that has proved successful in places such as Vancouver and Montreal, McDonald said. They used to be called supervised injection sites, but fewer people are injecting and more people are using oral drugs these days, he said.
“The reality of it is we need to stop people from dying because you can’t get anyone into recovery once they are dead,” McDonald said. “Not everyone is ready for recovery today, but that doesn’t mean they won’t be ready for recovery tomorrow.”