Health Care
9:30 am
Thu March 6, 2014

Parsing Out Rhode Island's Overdose Epidemic

In the first 9 weeks of this year, 55 Rhode Islanders have died from apparent drug overdoses. Overdose has been the number one cause of accidental death in Rhode Island since 2008, but the problem has been drawing more attention in recent days because of the surprising number of deaths this year alone. Rhode Island Public Radio health care reporter Kristin Gourlay has been at work on a documentary about drug overdose and addiction since well before the flood of recent headlines.

Opioids like oxycodone have contributed to the record numbers of overdose deaths in Rhode Island.
Credit Kristin Gourlay / RIPR

ELIS: Let’s start with the grim statistics. The death toll for 2014 has already reached 55. What's happening?

KRIS: It is grim. A few things are happening. Number one, these all appear to be accidents – meaning the person who died either took too much of a drug, took a dangerous combination, or happened to take a drug he or she wasn’t expecting. The state’s medical examiner is still analyzing the data from toxicology reports, examinations, and so forth, but of the 51 she’s screened so far this year, 34 people tested positive for a drug called fentanyl. That’s a really powerful prescription painkiller – 50 times or more as powerful as heroin. Dealers have been adding it to heroin, some say to boost the high. But the thing is, even if a user knows it’s in there, even if they’re a habitual user, that fentanyl is killing them. And it probably killed them quickly. 27 of the dead so far this year were found near some kind of drug paraphernalia – a needle still in the arm or a bag of heroin nearby for example.

ELIS: What do we know about the people who have died? Where are they from, what are the ages?

KRIS: Here’s what we know so far this year: the dead range in age from 20 to 62. 40 were men, 15 were women. Most were white, 5 were black. They came from 17 different towns and cities. And while the majority had only illicit drugs like heroin in their systems, several had a combination of pharmaceuticals like OxyContin in their systems as well.

ELIS: But I bet that’s just part of the story, right? Kristin, you've been working on a documentary on deadly overdoses, and we're also having a forum on the topic at the Providence Athenaeum on March 11th. What was it about this story that grabbed your attention when you first started the project?

KRIS: Well, when I came to Rhode Island, I learned pretty quickly that drug overdoses were the state’s number one killer. And as a health care reporter I figured I’d better be reporting on that. It’s grim stuff to cover, but it’s also a fascinating story because you’re right, it’s about more than overdose deaths. That’s the tragic end of someone’s story. Before that there’s probably a history of addiction, which is better understood by scientists and doctors but there’s still so much about it we don’t understand. This story is also at the nexus of so many other issues: law enforcement, the pharmaceutical business, politics. I focus on a few of those in my documentary. For instance, I’ve done a couple of ride alongs with police- one in Quincy, Massachusetts where they’ve been carrying this overdose antidote called Narcan and saving a lot of lives.

ELIS: Let's talk more about Narcan for a moment. That’s a word most of us were unfamiliar with before this outbreak started such a public conversation  … what is narcan and how is it being used in Rhode Island?

KRIS: Narcan is the common name for a drug called naloxone. It’s an opioid antagonist. That means that it blocks the opioids – drugs like heroin, or painkillers like OxyContin, Vicodin, Percocet – from working. It pries them off the brain’s opioid receptors. And it works really quickly. Seconds in most cases. Opioids depress your breathing and too big a dose can cause you to eventually just stop breathing. Quincy police carry nasal naloxone – it’s basically a nasal spray – they just squirt up a person’s nostrils. And they’re usually breathing again, even sitting up, in seconds. Because seconds count in an overdose, some have been saying it’s important for more first responders to carry narcan – paramedics have been using it for years. But the Rhode Island State Police just announced they’ll be carrying it. and other Rhode island police departments are considering it.

ELIS: This discussion about whether all police should carry Narcan is a big part of your documentary, what did you find?

KRIS: Well, I found that in Quincy, Massachusetts, which like a lot of new England towns has a big opioid addiction and overdose problem, it works. Police have been carrying it for about a year and a half. And in that time they’ve reversed more than 200 overdoses with Narcan. But I also found that not everyone is convinced it’s a good idea. You’ll hear from a researcher in my documentary about her investigation of police attitudes about this. And some think addicts shouldn’t have this kind of get out of jail free card.

ELIS: There was an op-ed in the providence journal recently from another first responder who thinks having narcan more widely available might encourage addicts to push it, to try to get even higher and risk overdose because there’s an out.

KRIS: Yes, I saw that. But most people I spoke to for this documentary – including police and recovering addicts – think more Narcan is a good idea. If you can save one life, they said, and give an addict the opportunity to get clean, that’s worth it.

ELIS: But if someone’s using illicit drugs, aren’t they going to be worried about getting arrested if they call 911 for a friend who’s overdosing?

KRIS: Good point. That is an issue. But there’s this relatively new law on the books called the Good Samaritan law that gives callers some immunity from being charged if they call for help. I spoke with many recovering addicts as well as rhode island police who weren’t too aware of the law. So it’ll be interesting to see whether awareness grows. I’ve been hearing anecdotally about people who have actually gotten arrested for calling 911 to report an overdose because there were drugs around.

                                 

ELIS: Kristin, as you were putting your documentary together, you talked with law enforcement, recovering addicts, researchers, doctors and those who help people kick their addiction. What did you hear or learn that surprised you the most?

KRIS: A couple of things. One is who this is affecting. When you think of drug overdoses, you might think – oh, junkie in an alley in some blighted city somewhere. But that’s usually not the case with opioid overdoses. it’s really two groups: it’s younger people who started using painkillers recreationally maybe and then sometimes get hooked on heroin – which is the same high but cheaper. But it’s also middle aged, suburban, small town, and increasing numbers of women, I might add, who started using opioids medically. For an injury, recovery from surgery, whatever the reason. And they stay on these really high doses for a long time and get hooked. Opioids are incredibly addictive. They help a lot of people. But after a certain point, they may be doing more harm than good.

I also learned that there are some really smart, really compassionate people working hard in Rhode Island to try to turn the tide on this epidemic. It’s an epidemic of opioid addiction – which can lead to overdose. And although addiction has been with us for a long time, there are more opioids floating around than ever. And treatment advocates and policy makers and the medical and law enforcement community – lots of folks in Rhode Island want to take advantage of the fact that this is really making headlines right now to try to get some funding, get some changes in the law, and push opportunities for treatment and prevention.

ELIS: Rhode Island Public Radio health care reporter Kristin Gourlay’ documentary "Killer Drugs: Tackling Opioid Addiction and Overdose" airs this Sunday at 6pm, and we'll be hosting a public discussion at the Providence Athenaeum that will also be aired on this station the following Sunday at 6pm.