New Overdose Data Suggest Epidemic Outpacing Response

By Dr. Jeff Duchin, Health Officer, Public Health – Seattle & King County

We just published new data from 2017 that shows overdose deaths due to opioids, methamphetamine and other drugs continue to increase in King County. In 2017, drug use caused the deaths of 379 people in our community, 31 more lives lost than the year prior, representing an increase of almost 10 percent.

In the US, more people now die each year from drug overdoses than died at the peak of the AIDS epidemic, more than died during the entire Vietnam War. Drug overdose is now the leading cause of death for Americans under 50 years of age, and the epidemic cost the US an estimated $117 billion in 2017 alone.  Here are some key findings from our report and my perspective on actions we need to take in order to see this epidemic come under control.

Heroin use continues to increase, resulting in a growing number of fatalities.
Heroin and other opioids continue to be the most common drugs associated with overdose deaths in King County (approximately 70%). In recent years, overdoses from prescription opioids have decreased while overdoses from heroin and synthetic opioids like fentanyl have increased.

Providing easy access to medication-assisted treatment is the key to helping those at risk for a fatal opioid overdose. We know from our local Public Health Needle Exchange data, that 78% of clients report interest in reducing or stopping opioid use, signaling the need to expand low-barrier access to treatment. Several community partners have expanded low barrier programs so that people can access treatment when they need it, where they need it. We need to continue to increase the number and capacity of these programs.

Community-based healthcare providers need to think in a new way about how best to help patients with substance use disorder, such as providing medication-assisted treatment in a patient’s primary medical home and learning about and providing trauma-informed care.  Hospitals should develop inpatient treatment programs for people with substance use disorder who are admitted to the hospital for infections and other problems.

We also know that naloxone can reverse an overdose if administered quickly, and several partners are working to provide naloxone to people who live or work with individuals at risk for overdose. For example, naloxone kits have been distributed to service providers reaching homeless populations such as DESC and Evergreen REACH team.

Illicit fentanyl is increasing
Fentanyl is a synthetic opioid that is much more potent than heroin. Illicitly manufactured fentanyl is the main driver of the nationwide increase in opioid overdose deaths. We continue to be concerned about the growing impact of illicit fentanyl-associated deaths locally. Fentanyl was involved in 33 deaths last year, up from 23 in 2016. In the first three months of 2018, there have been 17 confirmed fentanyl-related deaths. If fentanyl becomes more common, we could see a dramatic increase in overdose deaths, similar to what has been seen in several other areas of the country.

Public Health along with the Medical Examiner’s Office are tracking patterns in fentanyl-involved overdoses closely so that we can know as much as possible as soon as possible about how fentanyl is impacting our community.

Methamphetamine has increased sharply over the last decade.

While the public may often hear about the impact of opioids, the number of methamphetamine-involved deaths in King County has increased dramatically over the past decade, from 17 in 2008 to 134 in 2017.

We don’t have as many tools to address risks of overdose from methamphetamine. For example, unlike naloxone, which can reverse opioid overdoses, there isn’t a similar medication to combat overdose from methamphetamine. However, because many fatal overdoses involve methamphetamine and opioids, treatment for opioid addiction should help reduce methamphetamine-associated deaths as well.

What else can be done?
The current report shows that the opioid epidemic is currently outpacing our response and highlights the magnitude of the challenge that lies ahead. We need to build upon the important progress made to-date on the recommendations put forth by the King County Heroin and Prescription Opiate Addiction Taskforce, including the priority of dramatically increasing availability of low-barrier medication-assisted treatment.

We also need to continue to focus on prevention efforts like safe storage and disposal of prescription pain medications, improving healthcare provider prescribing practices for pain, use of the prescription drug monitoring program, and  screening to identify youth and others at risk for substance abuse (such as programs supported through Best Starts for Kids).

But it is essential to recognize that these actions alone, even if wholly successful, are not sufficient to end this crisis. To bend the curve on this epidemic we have no choice but to address the underlying social, economic, and psychological stressors driving substance use disorders and addiction (as well as other major causes of illness and death in our communities), including economic hardship and poverty; housing instability and homelessness; behavioral health disorders including depression and anxiety; discrimination and racism; and adverse child experiences and trauma.

As Dr. Nora Volkow, Director of the National Institute on Drug Abuse describes, “. . . some individuals are more susceptible to drug use and addiction than others, not only because of genetic factors but also because of stress and a host of other environmental and social factors in their lives that have made them more vulnerable.”

For these reasons, to address the “upstream” root causes of this epidemic of despair, we must work to provide economic and educational opportunities for all, build individual and community resilience, dismantle entrenched structural racism and discrimination, ensure access to behavioral and physical health care, and invest in creating a healthy childhood as a foundation for lifelong health.

Finally, we all should be advocates against the stigma that is associated with substance use disorders—and recognize that addiction is a disease of brain chemistry, not a moral failure or lifestyle choice.

And, we can share the Washington Recovery Help Line information with friends and family. Staff are available 24 hours a day to provide emotional and offer local treatment resources. Washington Recovery Hotline. 866.789.1511.

Originally published on May 9, 2018.