15 Nov We Are Losing the War on Overdose Deaths
Despite the great successes of addiction treatment these days, particularly in regards to medication assisted treatment, we still seem to be losing the war on overdose deaths. Why is this?
Once someone enters addiction treatment, we see a huge improvement in their health and quality of life. Treatment leads to an incredible reduction in significant medical and social risks that go along with substance use. It reduces HIV rates, Hepatitis C infections, wound infections, endocarditis, osteomyelitis, pancreatitis, trauma, and accidents. We also see a reduction in overdoses, suicides, depression, anxiety, spousal abuse, violence, homelessness, unemployment, poverty, incarceration, and crime.
Yet despite these incredible benefits that we see treatment bringing to our patients, the overdose death rate from the use of illicit drugs continues to climb. The reason is fentanyl.
In the old days (before 2018), the people most at risk for dying of a drug overdose were long-term illicit drug users who were using large amounts of heroin. Most of these patients had a long history of very heavy illicit drug use, and when they overdosed it was on fairly large doses of heroin used intravenously (IV). Today however, fentanyl (and its even more potent analogues sufentanil and carfentanil), has contaminated nearly every sample taken of the street supply of illicit drugs. Recent surveys in San Francisco have found fentanyl was present in 73% of the methamphetamine overdoses, and in 76% of the cocaine overdoses. Before the fentanyl surge, using methamphetamine or cocaine (while not a recommended activity) was not usually associated with large numbers of overdose deaths. Fentanyl has also been found in a large percentage of pressed pills that have flooded the streets looking like Percocet or Xanax.
The result of this fentanyl invasion into every corner of the illicit drug market has been that more and more people are exposed to potentially lethal doses of fentanyl, long before they ever have a chance to develop a severe opiate use disorder and progress to IV heroin use. The overdoses that we are seeing today are in younger and younger people, who are unintentionally exposed to fentanyl very early in their drug history, or even on their first use of any illicit drug at all. Younger people who are not intending to use fentanyl are getting it unintentionally in a lookalike pressed pill that they get from a friend, or a single hit of cocaine at a party. Especially in someone with no opiate tolerance, often that is all it takes to cause overdose and death.
As the overdose rate skyrockets in the 15–19-year-old population, before they have even had the chance to develop or be diagnosed with an addictive disorder and seek the benefits of treatment, we will need to invest in earlier prevention strategies. Treatment after the fact is not enough; we need to work on preventing that first exposure to these lethal products. Enter the Social Determinants of Health.
Dr. Lee Tannenbaum M.D., FASAM