Local doctors say they are seeing the increase in drug overdoses reported by the federal Centers for Disease Control and Prevention and while they believe they understand some of the causes, they are working to reduce the problem among local substance abusers.
A report from the CDC released this week found that more than 100,000 people had died from drug overdoses from April 2020 to April 2021, an increase of 28.5% nationally from about 78,000 during the same period from April 2019 to 2020. Among U.S. states, Vermont saw the biggest percentage increase, 70%, going from 123 deaths to 209 in the period covered by the CDC report.
Dr. Ben Smith, medical director of the emergency department at Central Vermont Medical Center, said staff members at his hospital have seen an increase from the beginning of the pandemic.
Smith said it was especially disappointing because Vermont had been making progress in decreasing the number of deaths from overdoses through 2019 but now the trend has “dramatically reversed.”
“Isolation is like the antithesis of recovery for a lot of these folks. It’s really been a punch to the gut for people struggling with substance use disorder,” he said.
People struggling with substance use disorder often have other health needs. So many patients needing those services come through the emergency department, Smith said.
Smith noted that among the challenges for patients and the health care providers is that many “street drugs,” from what are generally accepted to be in that category like heroin to fake prescription medications, designed to look like Xanax or oxycodone, are now laced with fentanyl.
The presence of fentanyl, a synthetic opioid used for treating severe pain, which the CDC says is “50 to 100 times more potent than morphine,” is not only dangerous because of the greater risk of death, but also because many of the users may not be aware they’re taking fentanyl.
The CDC reports almost 73% of overdose deaths involve synthetic opioids.
Dr. Saeed Ahmed, medical director of West Ridge Center at Rutland Regional Medical Center, said he’s aware of fentanyl being present at times even in a drug like marijuana that generally presents little risk.
This can also present a threat when a person buys a counterfeit medication.
“Someone who is naïve to fentanyl, and they go and try to get Xanax or Klonopin or Ativan, they end up getting fentanyl. They have no tolerance to opioids, they have no tolerance to fentanyl. They end up dying,” Ahmed said.
Like Smith, Ahmed said he believed the spread of the COVID virus and the use of opioids was becoming a “dual pandemic.”
“COVID caused economic instability in our patients and individuals in general, caused homelessness, people lost their homes, lost their jobs. People became socially isolated which is a big, big factor in opioids and people had limited access to the treatment centers,” he said.
According to Ahmed, patients can be very supportive of others who are abusing substances. They can provide something like naloxone, also known as Narcan, without even being asked. But that kind of peer support won’t happen in isolation.
Ahmed said there were no group meetings for patients, no Alcoholic Anonymous meetings and no Narcotics Anonymous meetings during the pandemic.
“This becomes a terrible situation when patients have no access to treatment. People were reluctant to come to the clinics because they were fearful of being exposed to the virus. Similarly, the health care system became fearful because there were numerous deaths among health care staff. We lost a lot of services,” he said.
Ahmed pointed out the problem went beyond Vermont.
Smith said the health care providers at Central Vermont have been trying to help by providing materials to patients including clean needles, naloxone, which can reverse the effects of drug overdose and fentanyl testing strips that can allow someone to see whether the substance they’re about to use is laced.
Ahmed said some of the efforts being taken at West Ridge include the increased use of telehealth. He said that can be helpful for patients who are still trying to avoid being among groups of people but can also reduce the stigma of getting treatment.
This barrier to treatment can be especially prevalent at places like West Ridge that offer medication-assisted therapy (MAT) treatment, like methadone. Ahmed said community members are aware that many of West Ridge’s patients have a substance abuse issue and, as a result, those patients may not want to be seen coming or going from the facility.
Ahmed is also emphasizing the “harm reduction” model to reduce the likelihood of drug overdoses. The model includes the distribution of naloxone and fentanyl testing strips.
Smith pointed out the ongoing danger faced by those who are abusing substances.
“We know that when they do come to the ER, if they’ve been resuscitated or we resuscitate them, if someone comes to the (emergency department) after an overdose, that person has a one in 10 chance of dying in the subsequent calendar year so those patients are extraordinarily high risk,” he said.
Smith and Ahmed said they wanted members of the community to know that if they or a loved one is abusing a substance and needs treatment, they should not hesitate to seek treatment.
Smith added community members should also be aware of a “severe increase in alcohol use,” sometimes by people who are also abusing opioids.
“The number of young people, in their 30s, 40s, 50s, with terrible, end-stage liver failure from which it’s very hard to recover, in the last year and a half from the beginning of the pandemic has been really fairly staggering,” he said.
CVMC is rolling out a program to treat alcohol withdrawal in the emergency department, according to Smith.
“In addition to reminding ourselves about the dangers of opioid use and isolation, I think it’s important to remember that alcohol is also an increasing killer among us right now,” he said.