Editor’s Note: In response to the news that the number of overdose deaths had fallen in 2023, ConvergenceRI asked Linda Hurley, CEO of CODAC, and Tommy Joyce, co-chair of the Governor’s Task Force, to talk about the meaning of the 2023 Rhode Island Overdose Fatality numbers. Here are their thoughts about what do these numbers really mean, and how can the reductions drive our next steps.

PROVIDENCE – Our first response to the reporting of the numbers that there had been a 7 percent reduction in the number of deaths from opioid overdoses in 2023 was one of relief: We were able to reduce the numbers and many lives were saved.

But, after our initial response, we wondered how we can improve our efforts.

Whether the reduction is 7 percent or 99 percent, we must continue to strive to do better. Our families deserve us to do better; our communities deserve us to do better, and the individuals still struggling deserves us to do better.

[“As I am working on writing this response,” Tommy Joyce wrote, “I just received a notification from the R.I. Department of Health that there was a spike in overdoses in Providence in the past seven days. [From 7/18/2024 through 7/24/2024, there were 22 non-fatal opioid overdoses]. This makes the case that we need to stay steadfast in our mission to provide access to services and provide a continuum of care to the community we serve.

Tommy has been working in the field for nearly 20 years and I, for some 35 years. At this moment, we have more access to treatment in Rhode Island than ever before. Based on the presentation given during the July Governor’s Overdose Prevention and Intervention Task Force, some 72 percent of the 2023 fatalities had no evidence of treatment[emphasis added] ; 17 percent were currently in treatment; and 11 percent had treatment in the past.

What this proves to us is that treatment works. Opioid treatment utilizing methadone – and now buprenorphine products as well – is the most researched and now most effective evidence-based modality to assist in the healing, recovery journey from opioid use disorder.

We also know that, here in Rhode Island, there are very few geographic barriers to access to care. The question is: Why aren’t individuals accessing treatment if it is so readily available?

The challenges ahead.  
We need to be better at educating the community workforce on treatment and recovery resources.

We have real time access to MAT with walk-in services at CODAC locations, as well as at other Opioid Treatment Programs and at Lifespan; we have same-day behavioral health access at East Bay Community Action Program, BH Link; and we have drop-in services at the six recovery community centers around the state.

In the Task Force Semi Annual Report to the Governor from September of 2023, there were more than 57,000 community contacts reported from the street outreach teams. Yet only 1 percent of those community contacts were referred to treatment [emphasis added]. Where is the disconnect?

Education helps address stigma and reduces personal bias on treatment and recovery. We need to address stigma within our workforce as well as in the general community. We need to be better on educating the community at large about the treatment and recovery resources available. This redundancy needs to be intentional. The messaging in these two sentences are remarkably important in our efforts to decrease overdose death.

What we know    
Many times, it is the friends and families of individuals that are struggling with substance use that are seeking information and support.

The Department of Health and BHDDH communications teams do an excellent job in getting the word out, and their PSA campaigns are well thought out and effective.

But we need everyone – harm reduction, prevention, treatment, and recovery specialists – to recognize and to understand that all paths to recovery are important, and that recovery is self-defined by those we serve.  

Within that context, we can then educate Rhode Island communities about all the valuable resources available. Many of these resources have real-time access to services with peers available to facilitate that real-time access.

Stimulant-related ODs.  
With the increase of stimulant-related overdoses, we are trying to create more effective treatment options for stimulant use.

There is also a rise in cocaine that is contaminated with fentanyl or other designer synthetic substances.

Yet there are very few programs that specialize in stimulant use. Ocean State Recovery has a great program that is specific to stimulant use. But we need more resources for stimulant use in Rhode Island.

BHDDH’s Linda Mahoney did a fantastic job in coordinating the state’s first stimulant-use disorder conference. The conference featured national experts that shared their programs and strategies to help Rhode Island create new initiatives to address stimulant use. There were more than 200 participants at the all-day conference.

More resources    
In the current environment, thanks to the Opioid Settlement Funds, we have more funding available to assist in the mission of reducing fatalities in Rhode Island, thanks to the legal advocacy of the Rhode Island Attorney General’s office

Yet the distribution of these funds has not been equitable or inclusive for all of the pillars that were established by the Opioid Settlement Advisory Committee [OSAC]. The lowest percentages of the initial distribution have been to programs in treatment and recovery.

At one point, more funding was allocated to pay staff for the oversight of the OSAC committee than was dedicated to recovery.

Treatment and recovery support services are evidence-based practices that have a strong history of being successful, based on the continuum of care that encourages the individual’s self-defined pathway to recovery.

We are at a point where we need to be less reactive and more proactive in our efforts.

 We need to utilize thoughtful, true, data-driven collaboration. We need to stop working in our silos and work towards the common goal of improving people’s lives.

The way that programs were funded over the years created a culture of working in silos and, at times, they felt competitive.

We have the funding, but we do not have the luxury of just looking after our own programs when Rhode Islander are still dying.

We need to work together to make an impact. Keeping people alive is not enough. We need to be better and work together wrapping around individuals at any point of contact.

Whether it is better collaborative aftercare planning, follow up and communication between service providers, or utilizing peer recovery support services when the individual is not ready for treatment, we must do better.

We need to be better at finding out why a person is so uncomfortable that they need something artificial to be comfortable.

Collaborative integrative services will encourage an environment that allows individuals struggling to work on the reason they are uncomfortable.

The environment on the streets of Rhode Island is one where the drug supply is contaminated. This includes counterfeit prescription medications. The supply of substances will always be there. It is like the law of supply and demand.

We can track the supply but will need to let law enforcement manage it. We need to better understand the demand, which is why human beings, for some reason based on their life experience, need something artificial to feel comfortable.

We are honored to have been able to work in this field for four decades as well as being fortunate enough to be involved with the Governor’s Task Force since its inception.

The individuals who have dedicated their lives to influencing positive change and serve tirelessly to help those who are struggling are truly heroes and rock stars.

The community we serve is highly creative. Rhode Island has a rich history of implementing creative initiatives to combat the opiate crisis.

Many of these initiatives have been first of their kind in the country such as the Anchor ED program, the CODAC MAT Program at the Dept. of Corrections and the CODAC Mobile Medical Units.

Other states often look to Rhode Island to help them engage their community stakeholders. The Governor’s Task Force meeting averages 170 attendees. That tells the true story of the Rhode Island community and its dedication to saving lives and providing support to those impacted by the opioid epidemic.