PROVIDENCE — He welcomed the pair of new warm socks, explaining that his old socks were soaked and frozen and he’d just spent the night sleeping in an ATM vestibule.
And he gladly accepted a two-pack of naloxone nasal spray, saying he’d recently used the medication to save a man from an overdose at Merino Park.
“I’ve seen five people overdose this year,” Cesar Gomez said Thursday as Rhode Island Communities for Addiction Recovery Efforts (RICARES) program manager Diego Arene-Morley distributed naloxone, also known by the brand name Narcan, and basic supplies outside McAuley House. He said one of those five men was later found dead outside soon after an overdose.
Gomez, 22, of Providence, said he is on methadone and not using drugs. “But I know a lot of people who are using,” he said. “So I have Narcan with me — just in case.”
In 2020, accidental overdose deaths reached record levels in Rhode Island. While it’s still awaiting toxicology reports and final tallies for October, November, and December, the state Department of Health had already recorded 359 accidental overdose deaths through September of last year — surpassing the previous record of 336 set in 2016.
Jennifer Koziol, the Health Department’s drug overdose prevention program administrator, said health officials don’t know for certain why accidental overdoses have increased, but said it may be in part from the increasing toxicity of the drug supply. She said a wider variety of drugs are now laced with fentanyl, an extremely potent narcotic that can prove fatal in smaller doses than other opiates.
The ongoing COVID-19 pandemic and associated widespread loss of jobs is likely also a factor, Koziol said.
“It is definitely exacerbating substance use disorders,” she said. “A lot of people who have been in long-term recovery, feeling solid in their recovery, are relapsing because of everything that is happening.”
Koziol said that between COVID-19 and the overdose crisis, Rhode Island finds itself in a “syndemic,” which she defined as “two or more crises impacting a population simultaneously.”
“You can’t address one without acknowledging the other,” she said.
As part of its response, Rhode Island is using federal Coronavirus Aid, Relief, and Economic Security (CARES) Act funding to distribute 10,000 kits of naloxone, the overdose reversal medicine, through community organizations such as RICARES. Each kit contains two doses.
Governor Gina M. Raimondo’s Overdose Prevention and Intervention Task Force launched Rhode Island’s 10,000 Chances Project earlier this month.
“We are trying to saturate the community with naloxone,” Koziol said. “We are hoping we will see a reduction in overdose fatalities.”
The state is also working with community nonprofits to increase street outreach work with certified peer recovery workers, she said.
Community groups are targeting the state’s hardest hit areas, including Providence, Pawtucket, and Woonsocket, Koziol said. And they’re trying to get naloxone to vulnerable populations, such as people experiencing homelessness, and to the family members and friends of people with substance abuse disorders, she said.
Any Rhode Island resident can get free naloxone delivered to them by going to the preventoverdoseri.org website. Naloxone is safe to use and only works if a person has opioids in their body. If you give naloxone to someone who is overdosing, you are protected by the state’s Good Samaritan Law and cannot be arrested, the website says.
On Thursday, Arene-Morley parked a 2006 Subaru Outback next to McAuley House, the Elmwood Avenue meal site and community center sponsored by the Sisters of Mercy, and he began distributing supplies from the rear hatch.
After picking up food at McAuley House, people formed a line behind the Subaru to receive draw-string bags filled with a pair of socks, a granola bar, and a face mask, along with naloxone kits and fentanyl test strips.
Arene-Morley said he has seen the toll taken by accidental overdose deaths up close.
“Almost everyone that I talk to, almost everyone in Rhode Island — whether they are a Brown University grad student or whether they are part of this (McAuley House) ministry — they know someone who has been lost,” he said. “And at RICARES we have plenty of close friends who we don’t have anymore.”
The majority of the RICARES staff and board members are in long-term recovery from substance use disorder, he said.
“We know that addiction is not really just an issue of the drug, it’s an issue of childhood trauma, an issue of the undiagnosed mental illness, an issue of systemic oppression in the criminal justice system that keeps people from getting to that next step,” he said. “So as people with lived experience, we help people go from step to step.”
That help could be as simple as providing someone with a bus pass or as crucial as connecting people with a recovery program or primary-care doctor, he said.
Arene-Morley said overdose deaths had been rising even before the pandemic, but COVID-19 is making matters worse. People are losing their jobs, getting behind on the rent, and growing more anxious, he said. “All of those are factors that are not helping,” he said.
Also, he said fentanyl is being found not only in opioids but in cocaine, methamphetamines, and counterfeit benzodiazepines like Xanax. “It is in almost every drug that people can buy on the street,” he said. “So that person may not have ‘a problem,’ but they may still be in danger.”
That’s why RICARES is distributing fentanyl test kits and naloxone.
“No one thinks, ‘I’m going to need the naloxone tonight,’ ” Arene-Morley said. “But people think ‘Well, I’ll test it, and give me the naloxone, why not?’ So it’s not a silver bullet, but it gets a foot in the door.”
He said that about half of the people that he gave naloxone kits to on Thursday told him they’d used the medication before to save someone from an overdose.
Arene-Morley called for Rhode Island to adopt a more long-term solution by opening “overdose prevention sites” where people could use drugs under the supervision of health professionals.
Senate Health and Human Services Committee chairman Joshua Miller, a Cranston Democrat, has introduced a bill that would create an advisory committee and pilot program to establish such “harm reduction centers.” And Representative John G. Edwards, a Tiverton Democrat, has introduced a similar bill.
Arene-Morley said similar programs have proven successful in Canada and Europe. “This is not a fringe thing,” he said. “We know that this is the way to reduce overdose deaths.”
He also called for passing legislation to expand the Good Samaritan Law.
Meanwhile, the focus is on keeping people alive amid the twin threats of the pandemic and the overdose crisis.
On Thursday, McAuley House case manager Shannon Rivers made sure that Gomez walked away with some food, a new pair of boots, and a tent.
And Arene-Morley made sure Gomez left with a naloxone kit. He said RICARES hands out naloxone and basic supplies at McAuley House at lunchtime on Mondays, Wednesdays, and Thursdays, and at the Mathewson Street Methodist Church in Providence on Sunday mornings.
With the overdose death toll rising in Rhode Island, it is crucial to get naloxone into as many hands as possible, Arene-Morley said.
“It’s like a face mask now,” he said. “We all need to have it.”