Efforts to corral the epidemic of opioid abuse and addiction in Connecticut are swinging into higher gear, led by Gov. Dannel Malloy and the state’s U.S. senators and marked by continued expansion of local counseling, rehab and recovery efforts at area hospitals and other health care organizations.
Opioid addiction is “a time bomb that’s been going on continuously for several years,” said state Consumer Protection Commissioner Jonathan Harris.
The data back him up. Nationally, more than half a million people died from drug overdoses from 2000 to 2015, according to the Centers for Disease Control and Prevention, which also maintains that 91 Americans die every day from an opioid overdose. Since 1999, the amount of prescription opioids sold in the U.S. nearly quadrupled, while deaths from prescription opioids like oxycodone, hydrocodone, and methadone have more than quadrupled during that same time period.
The American Society of Addiction Medicine maintains that drug overdose is the leading cause of accidental death in the U.S., with 55,403 lethal drug overdoses in 2015. Opioid addiction was responsible for 20,101 overdose deaths related to prescription pain relievers, with 12,990 overdose deaths related to heroin.
James Gill, the state’s chief medical examiner, reported in September that for the first six months of this year, 444 people died of accidental drug intoxication in Connecticut; as a result, he projected 888 for the entirety of 2016, compared with 729 fatal drug overdoses in 2015 and 568 in 2014.
That steady increase played a part in the medical examiner’s office being informed in an Oct. 13 letter from the National Association of Medical Examiners that it could lose full accreditation and be demoted to a one-year probationary term early next year. At issue are the one-two punch of budget cuts and the rise in drug overdoses: unable to hire additional staff to deal with drug-related autopsies and other processes – the office has a fiscal 2016 expenditure line of $6.5 million but an estimated 2017 expenditure line of just $5.8 million – the M.E. office would appear to be working at a distinct disadvantage. Gill’s office did not return calls for comment.
In addition to the human toll, the issue is also having an increasingly alarming effect on business. According to a recent report by health information firm Castlight Health, opioid abuse costs U.S. employers about $10 billion a year in absenteeism and medical expenses alone, and costs the U.S. economy as a whole nearly $56 billion.
In his most visible reaction to the epidemic to date, Gov. Malloy on Oct. 6 announced the Connecticut Opioid REsponse (CORE) Initiative, a strategic plan to address use, addiction and overdose that essentially codifies many of the methods already in use by hospitals and other health care organizations.
Connecticut spends “over $65 million a year on treatment for opioid dependency,” Malloy said. “This plan will help ensure that those dollars are spent on the best and most effective ways possible.”
“It (CORE) legitimizes what we’ve been saying and doing,” said Jeremy Barowsky, medical director of Greenwich Hospital’s Addiction Recovery Center. “It gives us some shared language that we can use with other hospitals, physicians and medical specialists, and underscores that this is not a fringe issue – this is something that kills more people than gun violence, HIV/AIDS or auto accidents.”
As did other interviewees, Barowsky said that much of the blame for the epidemic could be blamed upon physicians “over-prescribing” opioids, with the result that patients faced a higher risk of becoming addicted to painkillers. Once their prescriptions run out, and/or the cost becomes too high, “a lot of people turn to street drugs like heroin,” he said.
“Heroin is much more available – and cheaper – than it used to be,” Barowsky explained. “But it’s often laced with something even more powerful,” such as Carfentanil, a synthetic opioid used to sedate elephants.
On top of that, people don’t know how to dose themselves, given that a few grains of something like Carfentanil can prove fatal to humans. “They end up taking different does and killing themselves,” he said, “or they mix it with benzodiapines like Xanax and Valium, or alcohol – often to the same awful effect.”
Such was the case with Commissioner Harris’s brother-in-law, who after suffering a 40-foot fall at his job went from prescribed opioids to heroin to methadone before eventually overdosing. “I tell that story to illustrate how common this problem has become,” Harris said.
Barowsky, Charles Herrick, chair of psychiatry at Western Connecticut Health Network (WCHN) and at Danbury Hospital, and Dr. Katherine Michael, a psychiatrist at Norwalk Hospital, all reported an increase in opioid-related addictions or overdoses.
Herrick said that WCHN’s emergency department staff is constantly receiving instruction and training to gain a better understanding of overdose protocols, and works with nonprofits like the Midwestern Connecticut Council of Alcoholism and Connecticut Counseling Centers to provide education and support to not only opioid users but also their family, friends and other caregivers.
The CCCs serve in part as methadone clinics, Herrick noted. “Just as with heroin, methadone doesn’t have the same image that it did 30 years ago. Historically both were perceived to be negative and criminal,” he said, but young people today are more open to going to methadone clinics to help wean themselves off of heroin.
They had better be: “The typical heroin user today is a middle-class, suburban, white male,” with an average age of 23, Barowsky said.
WCHN has had great success with its telemedicine program when it comes to diagnosis and treatment, said Michael. Patients at the network’s New Milford Hospital are seen via iChat by crisis clinicians at Danbury Hospital, with the result that “they don’t necessarily have to be shipped to Danbury for evaluation and then ride back,” she explained.
Indeed, of the initiative’s first 100 patients, 66 were evaluated remotely via telemedicine staff and 33 by an outpatient clinic; only six required being transferred to Danbury. Before the program began, Michael said, about 50 percent were making the trek.
Staffing remains something of a problem at Greenwich Hospital’s Addiction Recovery Center, Barowsky said. With a headcount of eight, he said he’s looking to add two or three people in the new year. “It’s good because it’s creating jobs, but it’s not so good because of why the need exists in the first place,” Barowsky said.
Meanwhile, last week the CDC released new tools and materials to give health care providers additional resources to reduce opioid abuse and overdose, including a new app and videos.
And last year the state passed legislation allowing prescribers to prescribe, dispense or administer naloxone (narcan) directly to customers requesting it. Narcan works as an antidote to an opioid overdose; “It’s sort of the EpiPen for OD’s,” said Barkowsky. According to the CDC, as of June 2014 the use of narcan had reversed over 26,000 overdoses.
This month the Hartford police department announced its members would begin carrying narcan and act to get more addicts to treatment centers; the city’s fire department already carries narcan, and said it had saved 221 lives to date.
Harris said that 363 pharmacies around the state currently carry narcan, with the Walgreens chain “coming online soon.” His department’s website features a map showing where such pharmacies are located, which can be viewed here.
In addition, Harris’s department recently approved Hartford’s Saint Francis Hospital and Medical Center’s medical marijuana research program, which is designed to compare the effectiveness of medical marijuana versus oxycodone in patients with post-traumatic acute, subacute and chronic pain from multiple rib fractures. The idea is to provide another alternative to opioid prescriptions, he said, and to underscore how the state is “leading the nation in this kind of research.”
Another potential factor in opioid addiction is mental health. As Department of Mental Health and Addiction Services Commissioner Miriam Delphin-Rittmon explained, “People with mental health issues tend to be more prone to becoming addicted, and vice-versa.
“In a lot of cases, if mental health conditions such as depression are not properly diagnosed or treated, people turn to what’s popularly called ‘self-medication’,” she added. “Ultimately that leads to a situation where they can crash and burn.”
In addition to praising CORE, Delphin-Rittmon noted that her agency has recently received two Substance Abuse and Mental Health Services Administration (SAMHSA) grants: One for $371,000 to address prevention, and another for $1 million over three years to expand access to buprenorphine, a semisynthetic drug used to treat opioid addiction.
She is particularly excited about the recent passage of the 21st Century Cures Act by the U.S. Congress. That legislation includes $1 billion in new opioid funding over two years.
Although Connecticut’s drug problem pales next to other states’ – it ranked 26th in number of overdose deaths in 2015 – Sen. Richard Blumenthal (D) has sent Attorney General Loretta Lynch and Health and Human Services Secretary Sylvia Burwell a letter urging them to funnel some of the money to the Nutmeg State. Sen. Chris Murphy (D), whose mental health reform bill was included in the 21st Century Cures Act, said he had phoned Burwell to make a similar plea.
Although no monies have yet been granted, Delphin-Rittmon said that at a meeting last week to celebrate the passage of 21st Century Cares, she understood that the state is eligible for $5.5 million. Her department is working on an application for a 21 Century grant, the deadline for which is Feb. 17.
“We want to apply for every last cent we can,” she said.