PROVIDENCE — Two years ago, just before a new epidemic arrived in Rhode Island, an old one began to rise again. It has not slowed down: 2020 was the worst year on record for fatal drug overdoses in the state, and 2021′s toll is poised to be just as high, if not higher.
The increase began in late 2019, after declines every year since 2016.
“It’s not like what we’re doing isn’t working,” said Dr. James McDonald, the interim director of the state Department of Health. “It is working. But what we’re doing isn’t enough.”
The data reflects national trends.
In 2020, 384 Rhode Islanders died after accidentally overdosing on drugs, including opioids and non-opioids, the highest on record and a rise from 308 the year before — a 25 percent increase, according to state Department of Health data.
In 2021, at least 371 Rhode Islanders died after accidentally overdosing on drugs. The number for 2021 will continue to rise, because finding the cause and manner of someone’s death takes time. Data from August to December is still preliminary. So it’s possible, if not probable, that 2021 will surpass 2020′s total.
Why is this happening? One reason is an increasingly toxic drug supply, with fentanyl and its analogs finding their way into not just opioids but counterfeit pills and stimulants.
“We used to say fentanyl contaminated heroin. Now it’s more like heroin contaminates fentanyl,” said Linda Hurley, the president and CEO of CODAC Behavioral Healthcare, which treats people who have opioid use disorder. “It’s just everywhere.”
And while the rise began a few months before the arrival of COVID-19, experts say the pandemic-induced economic dislocations and disruptions to everyday routines — including in-person schooling and recovery meetings — have surely made things worse.
“I am seeing a level of frustration and just overwhelming sadness that I didn’t see earlier on,” said Dr. Laura Levine, the medical director of the Lifespan Recovery Center. “I see tremendous resiliency in the recovery community, but even with that, people are struggling at this point.”
What does help, Hurley and Levine said in separate interviews, is treatment.
CODAC, for instance, sees well over 5,000 patients a year, offering medication-assisted treatment and therapy. In the past 21 months, just one patient of theirs died of an overdose, Hurley said.
Hurley worries that people will see the number of overdoses rising and think that what they’re doing isn’t working. That’s not true, she said. Things would be even worse without it.
Later this year, though, Rhode Island will add something new: harm reduction centers. Authorized by the General Assembly and signed into law by Governor Dan McKee in 2021, these will be places where people can use drugs safely, without legal repercussions. Medical staff will be on hand to reverse overdoses. And treatment options will be offered to people who are ready. It’s a two-year pilot program and organizations around the state are preparing to get involved, although the locations of the facilities, which will be regulated by the Department of Health, are still unknown.
“It has the potential for a really big impact,” said McDonald, the Health Department director.
McDonald said they’ll probably open in the middle of this year, if not sooner. They will be placed in hot spots for overdoses — and areas where people can walk, rather than drive.
Harm reduction centers have their opponents; in Rhode Island, the legislation passed only after a lengthy debate. Supporters, though, point to one stark fact: Nobody has ever died of a drug overdose at a harm reduction center.
Bryan Wieczorek thinks they’ll work, although he has a different name for them: safe get-high places. Wieczorek, 45, was in Kennedy Plaza on a frigid recent Wednesday, picking up clean needles, Narcan, masks, and a few Cup Noodles from Project Weber/RENEW outreach workers.
“Out here, it’s chaos,” Wieczorek said.
He pointed to the lack of availability for treatment programs because of COVID-19 and the lack of resources for people getting out of prison.
“It’s scary out here,” Wieczorek said. “Fentanyl is killing people. It’s thinning the streets.”
Nearby, Matt Elliott, Braulio Ortiz, and Dennis Bailer were handing out supplies from the Project WEBER/Renew van. Like the safe get-high places, the idea here is harm reduction: Help people avoid the worst consequences of substance use disorders — clean needles to prevent HIV or hepatitis and Narcan to prevent fatal overdoses — and be there when they’re ready to get into recovery.
Sometimes help doesn’t come fast enough. Just last week Pawtucket saw a flare up of overdoses. Bailer knew of two people who had died. Project Weber/RENEW, an organization whose work includes recovery services, sent one of their vans, stocked with supplies, to the city.
“I take it personally,” Bailer said. “It’s a shock. It’s shocking.”
Bailer knows how the timeline works, and how it’s not always linear. He had spent 15 years in recovery from crack cocaine and occasional heroin use before he started using again for another seven years. One day Bailer was getting high on Manton Avenue, down to his last $125. He had burned his dealer for $1,000. He walked down to Kennedy Plaza and sat on a bench.
“I don’t want to go back,” he thought to himself, and then got on a bus to Butler Hospital for treatment.
Bailer is now the overdose prevention program director for Project WEBER/Renew.
“You never know when it’s going to happen for a person,” Bailer said on a recent Wednesday, standing not that far from where it happened for him.
For Tom, a patient at the Lifespan Recovery Center, it happened about four years ago. About eight or nine years ago, he got on pain medication for spinal stenosis and degenerative disc disease. He was not adequately informed, he said, of how addictive his opioid prescriptions would become.
He became addicted. And although he never went to the illicit market, he would always worry, even when he had to leave for a day trip, whether he had enough medication to get him through.
“You’re sort of chained to it,” said Tom, who asked that his last name not be used to protect his privacy. “It’s not a really good feeling.”
A few years ago he took a family member’s pain medication because he did not have any on him, he said. It wasn’t what he was prescribed, and that came up on a drug screening, which got him a referral to the Lifespan Recovery Center, he said.
There, he’s gotten on Suboxone to deal with withdrawal symptoms and attends therapy for support. It’s the sort of support and understanding that people who deal with addiction don’t always get. He can’t get pain medication now because his doctor had suspected him of abusing medication, he said.
So he still deals with severe pain. But it’s better than the alternative of being shackled to addiction.
“They need to stop treating addicts like they’re pariahs,” Tom said. “They need to treat them like they’re human beings. Most of these people — they’re like me. They were sold a bill of goods.”