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The race with death

As the number of overdose deaths in Rhode Island continues to climb, where is the public conversation occurring around the need to tweak the state’s current strategy?

By Richard Asinof
Posted 3/6/17
As the number of overdose deaths for 2016 has reached 329 and counting, the question must be asked: does the current strategy being pursued in Gov. Gina Raimondo’s action plan need to be changed. Who is willing to convene the public conversation to address such changes?
What are the statistics regarding the adoption of medication assisted treatment in Rhode Island? If we can’t arrest our way out of this problem, or “Narcan” our way out of this problem, what kinds of different strategies can be implemented? What are the statistics for Rhode Island, broken down by age demographics, for the rates of death for drugs, alcohol and suicide? What kinds of public health research based upon epidemiological standards could be employed to correlate economic distress and the rising number of deaths from drugs, alcohol and suicide in Rhode Island? Which companies in Rhode Island are willing to hire employees that are in recovery?
The recent finger pointing by the current New Hampshire governor, attempting to blame Lawrence, Mass., for the influx of fentanyl into New Hampshire, represents the worst kind of political scapegoating for a problem that has become endemic to New England. In turn, the efforts by former Congressmen Patrick Kennedy and Newt Gingrich to promote medication assisted treatment, funded by a drug company, Braeburn Pharmaceuticals, Inc., which makes implant devices to dispense the drug buprenorphine for such treatment, raises ethical questions about the power of drug companies to promote profitable solutions.

PROVIDENCE – The number of overdose deaths in Rhode Island in 2016 has hit 329 and counting, according to the latest statistics available on the R.I. Department of Health website tabulated on March 5.

The numbers come with a caveat: “Data for the most recent three months are not complete and do not reflect the total number of deaths for the month,” the website explains.

“Most overdose deaths are confirmed within three months,” the website continues. “However, sometimes toxicology test results take longer to confirm.”

The overarching message on the website still rings true: “Drug overdoses in Rhode Island are a public health crisis, and the number of deaths are increasing.”

The escalating trend line
On May 11, 2016, when Gov. Gina Raimondo unveiled the Governor’s Overdose and Prevention Intervention Task Force “action plan,” the total number of overdose deaths for 2015 in Rhode Island was given as 257.

The number-one goal of the action plan was to save lives, with the stated aim of reducing the number of overdose deaths by one-third by 2018, resulting in a projected reduction to 171 deaths from 257. [See link to ConvergenceRI story below.]

As part of the promotional effort in support of the release of the new action plan, a follow-up news release was issued by Raimondo’s communications team, entitled: “What They’re Saying: Gov. Raimondo’s Overdose Prevention Action Plan.”

It featured numerous quotes from prominent corporate Rhode Islanders, including: Helena Foulkes, executive vice president of CVS Health; Blue Cross & Blue Shield of Rhode Island’s outgoing president and CEO, Peter Andruszkiewicz; Neil Steinberg, president and CEO of the Rhode Island Foundation; Dennis Keefe, president and CEO of Care New England; Dr. Russell Settipane, president of the Rhode Island Medical Society; and Barbara Goldner and Brian Goldner, CEO of Hasbro, who recently lost a son to addiction.

The problem is that the numbers have kept moving in the wrong direction. The actual number of overdose deaths for 2015 was adjusted upward to 290, not 257, because of calculation errors, according to the R.I. Department of Health.

Much of that surge in deaths has been attributed to the increased presence of fentanyl in the illicit drug stream. [See link to ConvergenceRI story below.]

Doing the math
The number of overdose deaths in 2016 is currently 329 and counting.

If one does the math, that represents an increase of 25 percent in the number of deaths over the initial 257 deaths reported for 2015, when the action plan was first released. For the revised number of 290 deaths reported in 2015, it represents an increase of 13.4 percent.

To reach the original stated goal of one-third reduction in deaths to 171 by 2018, the target at the time when the action plan was announced, it would require a reduction of at least 159 deaths by next year, using the current 329 number of overdose deaths in 2016.

In terms of percentages, that requires a reduction of 48 percent.

More likely, the trend line for overdose deaths will continue to increase, reaching as high as 370 in 2018.

The questions are: Who will convene a public conversation around the need to change strategies moving forward? Who will get to participate in that conversation? How will the connection to economic distress and overdose deaths become part of that discussion?

The connection to economic distress
Increasingly, there are new studies connecting the epidemic in overdoses deaths to economic distress.

As reported recently by ConvergenceRI: “A new study published by Shannon M. Monnat in the Winter 2017 edition of Carsey Research begins with the provocative first sentences: “Americans are killing themselves at an alarming rate. Nationwide, the mortality rate from drug poisoning, alcohol poisoning, and suicide increased by 52 percent between 2000 and 2014.” [See link to ConvergenceRI study below.]

Most of this increase, Monnat continued, “was driven by a surge in prescription opioid and heroin overdoses, but overdoses from other drugs, suicides by means other than drugs, and alcohol-induced deaths also increased over this period.”

Especially striking, Monnat found, is that “mortality from drugs, alcohol and suicide increased during a period of declining mortality for other major causes of death, including diabetes, heart disease, most cancers and motor vehicle accidents.”

Further, between 2000 and 2014, Monnat reported: “White males have the highest combined mortality rate for the three causes, but the combined rate for white females increased the most [by 123 percent].”

With particular relevance to Rhode Island, Monnat’s study found that drugs, alcohol and suicide were the cause of over half the deaths of young white adults, ages 25-34, in 12 states, from 2010-2014, with Rhode Island having the highest rate, at 59.8 percent.

In a March 3 “Wonkblog” published by The Washington Post, entitled, “The deadly connection between prescription painkillers and the economy,” reporter Jeff Guo offered a review of similar kinds of studies connecting the economy to overdose deaths. [See link to story below.]

The story begins: “About 15 years ago, death rates among middle-aged white Americans stopped falling and started to climb. It was an unprecedented reversal for a modern industrialized country, and we still don’t fully understand why it happened.”

Regionalization and prevention
In an effort to better coordinate a regional approach to substance use prevention and behavioral health promotion services, the R.I Department of Behavioral Healthcare, Developmental Disabilities and Hospitals announced on Feb. 22 that it had awarded $1.4 million in federal block grants to five regional entities. They included:

• Woonsocket Prevention Coalition Corporation, $304,225.06, serving Burrillville, Woonsocket, Cumberland, Lincoln, Pawtucket, North Smithfield and Central Falls;

• Providence Healthy Communities Office, City of Providence, $252,819.64, serving the City of Providence;

• BAY Team, Town of Barrington, $137, 615.04, serving East Providence, Barrington, Warren and Bristol;

• Newport County Prevention Coalition, Town of Tiverton, $117, 789, serving Portsmouth, Tiverton, Little Compton, Jamestown, Middletown and Newport; and

• Coastline EAP, $171,186.68, serving South County, including the communities of North Kingstown, Narragansett, South Kingstown, Hopkinton, Richmond, Charlestown, Westerly and New Shoreham.

How do these regional groupings tie into the ongoing efforts around substance use, such as the efforts in Central Falls to establish the first citywide strategic plan in Rhode Island? Are such groups the place where the conversations around the need to tweak prevention strategies can happen? Or, are these entities set in their ways and their programs? How open are they to working with peer counselors as a strategy?

On the agenda
The next meeting of the Governor’s Task Force on Overdose Prevention and Intervention will take place on Wednesday, March 8, at 11 a.m. in Conference Room 2A in the Department of Administration building.

On the agenda is a discussion led by Traci Green on “Levels of Care for Rhode Island Emergency Departments and Hospitals for Treating Overdose and Opioid Use Disorder.

Brandon Marshall will give an update on the drug overdose dashboard.

Tara Boggs and Dr. Michael Coburn will give a presentation on AdCare Rhode Island Medication Assisted Treatment, a 46-bed inpatient alcohol and drug treatment center located in North Kingstown, which AdCare acquired in 2015. The facility provides detoxification, crisis stabilization, residential treatment and comprehensive outpatient services, according to company’s website.

As the last item on the agenda, 15 minutes are reserved for public comment. Is there anyone attending the meeting who will ask what Studs Terkel called “the impertinent question”: Does the state strategy to prevent overdose and promote intervention need a substantial tweak?

More than numbers
Beyond the focus on the number of deaths, it is important to frame the discussion that these are people’s lives, damaging families, neighborhoods and communities. As poet Emily Dickinson wrote: Because I could not stop for Death/He kindly stopped for me.


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