Alarms sounding as opioid-overdose crisis worsens, especially with fentanyl

cdcoddeathsap21-300x122Even as the nation sees cause for optimism in its battle against the coronavirus, our struggles against substance abuse are falling far short of what’s needed. The opioid abuse and drug overdose crisis has worsened significantly during the pandemic and experts are warning that too many of us need to cut back from excess boozing.

The New York Times reported that recent federal figures on the opioid crisis have back worse that officials feared:

“More than 87,000 Americans died of drug overdoses over the 12-month period that ended in September, according to preliminary federal data, eclipsing the toll from any year since the opioid epidemic began in the 1990s. The surge represents an increasingly urgent public health crisis, one that has drawn less attention and fewer resources while the nation has battled the coronavirus pandemic. Deaths from overdoses started rising again in the months leading up to the coronavirus pandemic — after dropping slightly in 2018 for the first time in decades … The biggest jump in overdose deaths took place in April and May, when fear and stress were rampant, job losses were multiplying, and the strictest lockdown measures were in effect. Many treatment programs closed during that time, at least temporarily, and ‘drop-in centers’ that provide support, clean syringes and naloxone, the lifesaving medication that reverses overdoses, cut back services that in many cases have yet to be fully restored.

“The preliminary data released … by the Centers for Disease Control and Prevention show a 29% rise in overdose deaths from October 2019 through September 2020 — the most recent data available — compared with the previous 12-month period. Illicitly manufactured fentanyl and other synthetic opioids were the primary drivers, although many fatal overdoses have also involved stimulant drugs, particularly methamphetamine. And unlike in the early years of the opioid epidemic, when deaths were largely among white Americans in rural and suburban areas, the current crisis is affecting black Americans disproportionately.”

Fentanyl menaces new parts of U.S.

The Wall Street Journal reported that experts see fentanyl menacing new areas of the country, no longer just the East Coast and now notably in the West.

“In the Seattle area, overdose deaths involving fentanyl were up 57% in 2020 over the previous year, according to data from the county medical examiner. Preliminary data show deaths from synthetic opioids like fentanyl rose 162% in the Las Vegas area last year. In Los Angeles County, a recent report blamed fentanyl for a 26% jump in overdose deaths among the homeless population during the first seven months of 2020. The problem is particularly acute in San Francisco, where a record 708 people died of drug overdoses in 2020, a 61% increase from the previous year. By comparison, 254 people died of Covid-19 in the city last year. So far, this year has been worse: 135 died by overdose in January and February, on pace for more than 800 deaths by the end of the year …

“Fentanyl can be 50 times as potent as heroin, making it possible to overdose on tiny amounts. As a result, when fentanyl hits the streets in force, more people tend to die. That is what has happened in New England and the Rust Belt, where beginning nearly a decade ago it was often mixed into heroin. In some places in the Eastern U.S., it has all but replaced heroin as a popular street opioid. Fentanyl in the U.S. is often made by Mexican cartels using precursor chemicals from China, according to the Drug Enforcement Administration. It took off in the East faster, in part because of the region’s longstanding problem with opioids. The West has historically been a bigger methamphetamine market, but the cartels are now aggressively pushing fentanyl there, too, often in the form of fake pain pills, said Wade Shannon, special agent in charge of the DEA’s San Francisco office. Though fentanyl began to show up in San Francisco around 2015, only since 2018 has it become widely available, according to local officials, nonprofit workers, and drug users. Overdose deaths in San Francisco increased 173% between 2018 and 2020.”

While the latest CDC data on the opioid crisis was distressing, it was expected. The nonpartisan, independent Commonwealth Fund, working with federal figures, has estimated that the 2020 overdose deaths could have exceeded 90,000, compared with 70,630 in 2019, the Washington Post reported.

The administration, still new, is planning responses

The Biden Administration, through the “Office of National Drug Control Policy [has] released an outline … of its priorities for addressing the addiction and overdose epidemic,” the New York Times reported. “They include measures the Trump Administration also embraced, like expanding access to medication treatment for opioid addiction, but diverged from the Trump agenda by pledging to address ‘systemic inequities’ in prevention, treatment and recovery.” Biden officials have taken heat for reversing their predecessor’s hasty efforts, which they called legally unsound, to make it “easier for doctors to prescribe buprenorphine, a lifesaving anti-craving medication, for opioid addiction.”

Xavier Becerra, the head of the giant Health and Human Services agency, is under pressure to deal with that issue, as well as others needed to combat opioid abuse, including challenges to needle exchange programs. As the New York Times reported:

“Biden’s American Rescue Plan Act includes $1.5 billion for the prevention and treatment of substance use disorders, as well as $30 million in funding for local services that benefit people with addiction, including syringe exchange programs. The latter is significant because while federal funds still largely cannot be spent on syringes for people who use drugs, the restriction does not apply to money from the stimulus package, according to the Office of Drug Control Policy … the administration [also has] announced that federal funding could now be used to buy rapid fentanyl test strips, which can be used to check whether drugs have been mixed or cut with fentanyl. Fentanyl or its analogues have increasingly been detected in counterfeit pills being sold illegally as prescription opioids or benzodiazepines — sedatives like Xanax that are used as anti-anxiety medications — and particularly in meth.”

Not good. In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on them by dangerous drugs. Over the years, Big Pharma, doctors, hospitals, insurers, and others in health care — fueled by a relentless and excessive push for profits — created the opioid abuse crisis. Abuse of powerful painkillers, especially the synthetic varieties, also opened the door to nightmares with overdoses, notably of illegal drugs.

The nation’s progress in combatting the crisis has been compounded not only by the pandemic but also by chronic under investment in this country in public health and mental health programs.

The pandemic did not help our substance abuse challenges, shutting down treatment options and leaving people isolated, lonely, and despairing.

Alcohol abuse also can’t be ignored

This also fueled alcohol abuse and rising problems with it, the New York Times reported:

“Women and parents of young children seem to have been hit particularly hard. A nationwide survey commissioned by the American Psychological Association in February found that one in four adults reported drinking more this past year to manage their stress. That rate more than doubled among those who had children between the ages of 5 and 7. Another study published in JAMA Network Open in October found that Americans increased the frequency of their alcohol consumption by 14% compared to a year earlier. But the same study found a 41% increase in the number of days on which women drank heavily, defined as having four or more drinks in a couple of hours. ‘Women have disproportionately left the labor force entirely compared to men; they have disproportionately taken on the work around the house, the child care, and the child’s education,’ said Michael S. Pollard, the lead author of the JAMA study and a senior sociologist at the RAND Corporation. ‘So, it stands to reason that women would increase their alcohol use disproportionately as well.’”

If you have the slightest concern that tumultuous times have you drinking or using other substances to excess, talk to your loved ones and trusted professionals, including doctors and clergy. Your employer may offer confidential counseling programs. You may want to investigate online and in-person resources, for example those offered by Alcoholics Anonymous.

We’ve got a lot of work to do to increase awareness and to fight substance abuse, especially with opioids and overdoses addicting, debilitating, and killing unacceptable numbers of us.

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