Drug Overdose Cases Rise in the Wake of Stay-at-Home Orders

“It’s 10 PM: Do You Know Where Your Narcan Is?”

By Randall Dwenger, MD

“It’s 10 PM; do you know where your children are?”  This was the Public Service Announcement that seemingly ran for years during my childhood.  My sisters and brothers and I would be watching the final credits roll after Medical Center or Love American Style or the ABC Movie-of-the-Week, and this nightly announcement would come on.  My mother – seemingly asleep on the couch ­– would open one eye and answer the television: “Not in bed, like they’re supposed to be.”  But then she’d fall back to sleep for a little longer.  The warning back in the 60’s was in response to social unrest and rioting, and in the 70’s was used to increase parents’ awareness about potential child kidnappers or predators. 

But there is another threat lurking in our communities that still needs our attention.  And I am not talking about COVID-19 – which, of course, is a very real threat that’s rightly dominating the news cycles.  The opioid crisis has not disappeared during the current coronavirus pandemic.  In fact, it is as prevalent as ever – if not worse.  According to the Overdose Detection Mapping Application Program (ODMAP), a project designed to monitor overdose data nationally, there was a 17.59 percent increase in suspected drug overdose cases post-COVID stay-at-home orders compared to the preceding pre-COVID time period.  More than 61 percent of all participating counties reported a rise in overdose cases during the post-COVID time period.  The number of “spike alerts” has increased by 30 percent since COVID.  Additionally, overdose clusters appear to have shifted away from centralized urban locations to surrounding suburban and rural areas.

Many of us predicted how difficult social distancing and self-quarantine would be for those who are suffering from addiction.  Isolation is the opposite of what we recommend for our clients in recovery.  We encourage our clients to go out to Alcoholics Anonymous or Narcotics Anonymous meetings, to meet with their sponsors, to engage with other sober people or supportive loved ones in the community.  And during times of stress, those with a history of addiction are more likely to turn to substances to cope with anxiety, depression, and loneliness.  Apparently, the pandemic has not disrupted drug markets or available supplies of heroin and other opioid drugs on the streets.  In assessing potential clients for admission to Detox, a common response when asked about recent contacts has been: “Well, I saw my drug dealer… but he wore a mask and gloves.”

August 31st is International Overdose Awareness Day.  Although current worldwide statistics are hard to come by, in 2017 there were more than 585,000 drug-use related deaths – according to the World Drug Report.  In the Unites States, approximately 115 people die every day from opioid overdose.  Opioids are respiratory depressants, and during an overdose the person stops breathing.  Naloxone (sold under the brand names Narcan® and Evzio®) is a medication designed to rapidly reverse opioid overdose.  It is an opioid antagonist and will, essentially, “kick-off” the opiate drug (such as heroin, oxycodone, fentanyl, morphine) from the receptors and – if administered in time – will restore breathing and consciousness. 

For years, naloxone was limited to first responders and emergency room personnel.  But this life-saving emergency medication is now available as an easy-to-use nasal spray – and it is available to YOU.  The laws vary state-by-state (some states require a prescription, and some states permit pharmacists to dispense without a prescription), and there are many programs aimed at getting naloxone kits into the hands of citizens at no cost.  Many insurance companies will cover the cost of naloxone. 

Recognizing the signs of opioid overdose is essential to saving lives.  These include:

·       Abnormal breathing that is very slow or has stopped

·       Person does not wake up or respond to touch or voice

·       Pin-point sized pupils

·       Bluish color around lips and nose

Naloxone is not “treatment” and not a cure by any means.  The effects of naloxone may wear off after 30 to 90 minutes, so it is critical that the person obtain medical intervention after being successfully revived by naloxone. 

The great news is: there is treatment out there.  For those people suffering from opioid use disorder, there are inpatient detoxes and rehabs, there are outpatient treatment programs, there are NA meetings and AA meetings and other support groups.  And there are excellent Medication-Assisted Treatments including methadone, buprenorphine (Suboxone® or Sublocade®) and naltrexone (Vivitrol®).  But the client has to be alive in order to benefit from these treatments.  And YOU can play a role in changing the trajectory of someone’s life – from one more bleak statistic to one more success story

My mother, (the one on the couch), knew to be prepared for emergencies.  She saved two-inch candle nubs in a box in the dining room for when the power went out; there was a fire extinguisher in  the alcove between the kitchen and the family room although we never had to use it; she even kept a box of powdered milk in the cabinet in case the gallon jug in the fridge went bad.  Given the pervasiveness of the opioid crisis, naloxone should now be a part of every family’s emergency preparedness.  It should be in every household, every office, every purse and every briefcase.  And so I ask: Do you know where your Narcan is?

 Dr. Randall Dwenger is the Chief Medical Officer at Mountainside alcohol and drug addiction treatment center, where he has provided guidance and leadership over the detoxification program since 2008. 


References

Alter, A. and Yeager, C. (2020). COVID-19 Impact on US National Overdose Crisis. Overdose Detection          Mapping Application Program.

World Drug Report 2019 (United Nations publication, Sales No. E.19.XI.8).