Hundreds in Rhode Island Expected to Die from Overdose in 2014

Tuesday, February 18, 2014

Kate Nagle, GoLocal Contributor

Drug overdoses in Rhode Island have been labeled an "epidemic" by HEALTH, and academics.

Literally, Rhode Islanders are dying by the hundreds.

If the pace continues in Rhode Island this year, the number of overdose fatalities tied to heroin and other opiates will exceed 320 deaths, nearly double the 180 deaths reported 2012, the last year the Rhode Island Department of Health (HEALTH) has reported data.

"This is an epidemic. It's been an epidemic before it spiked, it's outrageous," said Dr. Jody Rich, an infectious disease specialist at Miriam Hospital. "[HEALTH Director] Dr. Fine's done a great job of understanding the issue, and pushing on it. We need a greater understanding. This is people dying. Colonel O'Donnell a few months back said, if we had this many shooting fatalities, this would be an outrage."

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The Rhode Island Department of Health (HEALTH) reported last week that for the first six weeks of the year, there have been 38 overdose deaths in the state so far this year.

Dr. Traci Green, Professor of Epidemiology at Brown University, said, "Why hasn't there been more outrage? I think this is the stigma of addiction rearing its ugly head -- we have a really clear call for help who aren't able to call for help."

Green continued, "I think at this point, we don't have a precedent -- and no one else does either. The sad thing is we're ahead of the game in Rhode Island because we're seeing it first. The acetylfentanyl outbreak we saw last spring, Dr. [Christina] Stanley, RI's Chief Medical Examiner, was able to see those numbers quickly, and we have a coordinated approach. I worry that other states will now be catching up."

"This certainly qualifies as an epidemic," said Dr. Brandon Marshall, Assistant Professor in Epidemiology at Brown. "This is now the leading cause of accidental death in Rhode Island, outpacing car deaths." Marshall echoed Green when he said, "We're starting to see this now across the country."

Rapid Rise in Rhode Island

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For 2013, HEALTH reported 118 overdose deaths in the first six months -- it has not reported on the second half of the year -- which was on pace for nearly 240 deaths. The number rose steadily from from 137 in 2009, to 152 in 2010, to 176 in 2011, and 182 in 2012, before it made a more significant leap, in the past two years.

"We saw something similar in 2005, we saw an outbreak in fentanyl based heroin, which killed thousands in Chicago, [Philadelphia]...they were able to trace it back to an underground lab," said Green. "Subsequently, a number of people came people came together nationally, from multiple state agencies, to talk twice a month on what they were seeing. It had been relatively quiet since then, but now we've had a lot to report back."

Green continued, "We're not seeing acetylfentanyl-- but something still synthetic, and it's being created somewhere. Access and availability are a key component. What we're seeing with patterns of deaths, is not only that the numbers are increasing, the composition of people dying are changing. It used to be that two-thirds of opiate overdoses were prescription related, and we're see more illicit substances now, people are taking more chances of combining prescription opiates with illicit drugs."

"Each of those things is incredibly dangerous. It doesn't take too much shifting of the purity to alter the fatality rates. We have a high prevalence of opioid abuse as a starting point to begin with. If you're an enterprising dealer, and you want to try something out, what's a better place to try it out," said Green. "The fact that it happened here, and now this is happening, there's something about where we are, and we need to keep closer tabs."

Responses Addressed

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"The most effective response we've seen are comprehensive, multi-pronged approach, there's a role for a lot of different groups -- law enforcement, healthcare, leadership," said Marshall.

At Friday's HEALTH press conference, Craig Stenning with the Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals highlighted three tools in place to help cut down on opioid related deaths throughout the state, including the Good Samaritan Law, access to expanded treatment, and the use of Naxolone (used to counter the effects of an opiate overdose).

"The Rhode Island police will be now be carrying Naxolone in all of their cruisers, and now Walgreen's signed a collaborative practice agreement to sell Naxolone at their stores," said Marshall. "It is a safe medication, and incredibly effective in reducing the effects of an overdose."

Marshall explained, "An overdose is a surprisingly long process -- it's a slower rate of breathing, it's a lack of oxygen. The opioid slows down a person's breath. There's a significant amount of time to intervene -- and Naxolone is able to address it right away

Brown's Greene addressed the Good Samaritan Law, which was approved in Rhode Island to allow someone who call for help for someone overdosing won’t face charges for drugs found at the scene.

"They did move the "Good Samaritan Law". One thing I'm worried about is there's a sunset clause, and it's incomplete. It will expire at the end 2015. I hope it will be reinstated. The Attorney office is updating the number of cases that have been dismissed because for law."

Green mentioned an aspect of the law she hoped to see changed. "Folks who are out of prison might not call police in the event of as suspected overdose...the law does provide that under probation or parole, you're not protected. We've had at least two people call and end up getting picked up, or people who didn't call and overdose. "

Community Perceptions, Solutions

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A community forum Wednesday will attempt to get the pulse -- and a remedy -- for the overdose epidemic in Rhode Island.

"There's a disconnect between the body bags piling bags and the response," said Rich. "There is a tremendous stigma around this. This addiction is worse than other addictions. The physiology behind opiates...users develop a tolerance, and they keep having to use a higher and higher dose. The withdrawal to stop is horrendous. To see someone in that situation, you see someone curled up in the fetal position."

"People should know about the diabolical nature of opiate addiction -- there's strong predisposition. The more people are exposed, the more they'll be hooked. On some levels, it is a choice -- on some levels, it's not. When someone's using, there's no one answer. Strong community, family, and individual support is a start.

"A lot of people say, they get what they deserve -- the answer is "no," said Rich. "No one knows what they're getting into. I hear from patients who say they don't want to get high anymore, they just want to feel normal. And for them that's not possible."

On Wednesday, A Community Listening Forum on Overdose Prevention will be held from 7 to 9 p.m. in Miriam Hospital, with state, health, community, and law enforcement leaders coming together to address the overdose epidemic.

Rebecca McGoldrick with Protect Families First, who will be at the forum, addressed what saw as their main goal -- saving lives.

"This is a complex battle that we need to combat on several fronts. One, we need to prevent people who aren't already addicted from becoming addicted, which means raising awareness among doctors and patients about the risk of dependence and overdose. It also means decreasing the possibility of non-prescribed users from trying prescription opioids, so people should store and dispose of their medications properly. And for those already addicted, we need more access to affordable, evidence-based treatment programs. Currently, only one in ten people who needs treatment gets it," said McGoldrick."

"Unfortunately, it's taken too many deaths for people to sound the alarms and mobilize, but there is a lot of great work going on across the state to address this crisis. State troopers are going to start carrying naloxone. BHDDH is going to provide naloxone to patients with a history of opioid use. Hopefully we can get the ACI to do the same for inmates upon discharge. Right now I think most people are in damage-control mode, and saving lives is our priority."