BOSTON — It may be a great way to contain a pandemic, but social distancing can apparently be deadly for those with opioid use disorder.
A new CDC report found a dramatic rise in drug overdose deaths during the pandemic -- after nearly two years of stable numbers. The preliminary findings cover the one-year period from September 2019 to September 2020. During that period, overall U.S. overdose deaths rose nearly 27 percent.
In Massachusetts, overdose deaths were up about 7 percent.
Some in the addiction medicine field were not surprised.
“What we saw particularly in the early days of COVID, but really to this day, is that the pandemic has really separated people from addiction treatment services, from harm reduction services and from the communities and networks that they use to stay safe and avoid overdose,” said Dr. Jessica Taylor, an addiction medicine specialist at Boston Medical Center’s Grayken Center for Addiction and an assistant professor of Medicine at Boston University School of Medicine.
Taylor said the pandemic has also separated those with opioid use disorder from each other.
“Using alone is a major risk factor,” she said. “And during the pandemic we’ve been saying, socially distance, don’t be in a crowd, don’t be around people. That’s actually the opposite of our typical overdose prevention counseling, which is use in a group, use with someone who is looking at you, who has naloxone, which is the medicine to reverse an opioid overdose.”
Ideally, the person with the naloxone will also have a cell phone to call 911 in case of an overdose.
“We really need people to be using with that kind of close supervision,” she said. “Historically, with just regular old heroin, an overdose might progress over minutes to hours. But with the fentanyl that’s on the street, it’s incredibly potent. And an overdose can happen over seconds to minutes.”
Adding to the problem, Taylor said, is that fentanyl is now found as an adulterant in many different types of drugs.
“What we’re seeing in Massachusetts, but actually across the country, is very significant contamination of the drug supply with illicitly manufactured fentanyl,” Taylor said. “So for many years in Boston we’ve had fentanyl contamination of heroin. But we are now seeing fentanyl contamination of almost any type of drug, which could include cocaine, amphetamines or benzodiazepines.”
In fact, the CDC report shows that in Massachusetts, cocaine is third on the list of drugs most responsible for overdose deaths in September 2020 -- and at a rate nearly 25 percent higher than in September 2019.
“And the reason that’s scary is, if someone purchases cocaine, they’re not expecting to be at risk of an opioid overdose,” Taylor said. “And may not have measures in place to protect themselves.”
Cocaine all on its own can, of course, also be deadly.
“Cocaine kills by a very different mechanism,” said Robert Powers, PhD, a forensic toxicologist at the University of New Haven in Connecticut. “The opioids are what we call central nervous system depressants. They slow down brain activity and they slow down breathing. Cocaine is a stimulant. And death associated with cocaine is normally a function of a spike in blood pressure -- very high transient blood pressure -- which precipitates a cardiac event.”
How can this trend be reversed?
A lot of it comes down to access, Taylor said -- to telemedicine services, as long as they’re needed -- and to pharmaceuticals used to treat addiction disorders.
“We have excellent medications for opioid use disorder,” Taylor said. “We just need to get them to the people who need them.”
Those medications include buprenorphine, which goes by the brand name Suboxone -- as well as methadone.
“Something new and different (during the pandemic) is that we were able to start buprenorphine based on a telemedicine visit without seeing someone face to face in-person first,” Taylor said. “We think it’s incredibly important that we keep that access.”
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