BOSTON – AS ELSEWHERE, RECENT SURGING NALOXONE OPIOID OVERDOSE REVERSALS EXPLAIN DROP IN DEATHS, AFFIRM A WORSENING CRISIS
Data from Boston as consistently elsewhere affirm the longstanding obvious meaning of recent drops in opioid overdose deaths and reported nonfatal overdoses – desperate intensive Narcan campaigns to moderate deaths due to continuously mounting high risk use and treatment failure represent a worsening crisis
by Clark Miller
Published October 4, 2024
The data – direct accounting of distributed units of Narcan, eyewitness accounts of increasing nonfatal opioid overdoses reversed by Narcan in communities and not recorded in medical records or emergency responder logs – don’t lie, nor do the front line healthcare, community, and support workers who are witnessing first-hand the intensively expanding distribution, training, effective use, and outcomes of campaigns to make the potentially lethal opioid overdose reversal agent naloxone more accessible in communities.
Consider, from the material provided by Boston Public Health Commission –
New data analyzed by the Boston Public Health Commission (BPHC) show a decline in overdose deaths in Boston at the beginning of this year compared to the same four-month time period last year. Compared to January through April 2023, the same time period in 2024 shows that opioid-related overdose deaths among Boston residents are down 33% overall with notable decreases among Black and Latinx residents.
Boston’s mayor attributed the provisional reduction in fatal (versus nonfatal) opioid overdoses to the “lifesaving work our street outreach workers and BPHC staff do every day”.
Public health officials seem to be taking their cues from outreach workers on the streets and in neighborhoods, continuing to focus on what has accounted for the decrease, including street-level outreach to most vulnerable individuals and “increasing access to naloxone”, along with housing support for homeless high-risk opioid users, per Dr. Bisola Ojikutu, Commissioner of Public Health for the City of Boston.
The 15 individuals placed in stable housing “over the past year” cannot come close to explaining the significant decrease – up to a provisional estimate of 33 percent – in lethal ODs, and there is no direct evidence for a causal link that would allow attributing the 15 housed individuals to 15 or any fewer deaths.
But there are larger numbers, much larger, that do point to direct reductions in opioid deaths, well established over years of reporting and and direct accounting of the direct lethality reduction effects of increased distribution and use of the fatal OD reversing agent naloxone (Narcan) in communities.
And those numbers in Boston have been dramatically increasing recently.
Boston Public Health (BPHC) Commission has been using $millions in funds to expand access to naloxone and other resources.
BPHC is at the forefront of the City’s response to the substance use crisis. BPHC’s Recovery Services Bureau operates a continuum of care, spanning outreach, harm reduction, treatment, and community-based programs. The Bureau’s outreach workers regularly reverse up to five overdoses per day and host free trainings on how to respond to overdoses and administer naloxone. In 2023 the Bureau distributed over 23,000 doses of naloxone to residents and community partners and made 2,389 referrals for substance use treatment.
[emphasis added]
Those 23,000 doses of naloxone distributed to family and community members including in high-risk areas and with training on use for many recipients more than accounts for all of the decrease in fatal ODs.
That picture painted by data reflecting overdose responses in real communities and with direct, life-saving outcomes is congruent with and reinforced by statewide intensive recent campaigns to flood communities with Narcan, described in this recent post.
From that post –
Massachusetts recorded a significant drop in opioid-related overdose deaths in 2023, forging a potential turning point after the state’s fatality count hit a record high the previous year.
State officials say there were 2,125 confirmed and estimated opioid-related overdose deaths last year, or 30.2 per 100,000 residents. That marks a 10% decline compared to 2022, when the epidemic claimed the lives of 2,357 Bay Staters, at a rate of 33.5 per 100,000. . . .
Goldstein attributed the declining fatality rate in 2023 to the state’s distribution of naloxone, a medication that reverses overdoses, as well as syringe service programs, an overdose prevention hotline, and a drug-checking program that allows officials to understand the lethality of the drug supply here.
“We have one of the best naloxone distribution programs in the country, and we have naloxone everywhere in every community, so that people can use it,” Goldstein said. “We have really pioneered the use of syringe service programs in this state, and to use a harm reduction lens in everything that is being done.”
DPH said it has distributed more than 196,500 naloxone kits, with each kit containing two doses, since 2023. The effort has led to at least 10,206 overdose reversals, officials said.
Let’s keep those dramatic numbers and claims in mind –
Goldstein attributed the declining fatality rate in 2023 to the state’s distribution of naloxone, a medication that reverses overdoses, . . .
“We have one of the best naloxone distribution programs in the country, and we have naloxone everywhere in every community, so that people can use it,” Goldstein said. . . .
DPH said it has distributed more than 196,500 naloxone kits, with each kit containing two doses, since 2023. The effort has led to at least 10,206 overdose reversals, officials said.
This sounds familiar – like the intensive, successful naloxone campaigns in Utah, in Florida and Connecticut we’ve discussed in prior posts.
Back to our current post –
Narcan reversals save individual lives, the most important consideration for individuals trapped by America’s medical/media/public health institutions in the lethal crisis.
There are additional, pressing concerns on public health and epidemiological levels that drive the continuing crisis.
Each and every Narcan reversal – increasingly occurring in community settings and not reported or publicly recorded – is a case of high-risk opioid use reflecting failure of treatment and prevention approaches.
Each and every Narcan reversal is an emergency measure to prevent a death from an underlying condition or high-risk behavior – as are instances of use of an AED for sudden heart failure – and in no sense constitutes gain against that underlying condition.
That is, each and every Narcan save and associated data point in fatal or nonfatal opioid overdose trends represents a life saved, or death forestalled, and as well represents a worsening public health crisis.
Heightening those uncomfortable and inescapable facts, nearly each day brings new reports on the predictable complication of emergence of new, more potent opioids and other drugs of abuse in opioid combinations, in lethal illicit economies including increasingly substances challenging the biochemical capacity of naloxone to continue to reverse overdoses.
Narcan is a blessing and a curse, giving life and ultimately taking it away,
in the fatal deception fueled by media/medical lies that the misrepresented numbers and trends are progress provided by treatments against high-risk, life-threatening substance use. They are not, any more than a surge in prevention of fatal cardiac events by use of increasingly more accessible AEDs would represent treatment, prevention, or public health gains against heart diseases.
A curse, because what media have spun as progress against an epidemic has always been, instead, a clear case of emergency naloxone saves consistently more than explaining any apparent moderations of incidence of fatal opioid overdoses. Spun to hide from public view the established lethal failure of American expert gold standard medical cures.
A curse, because its dramatically increasing, life-saving use in homes and community settings due to intense, recent Narcan campaigns now obscures data provided and available to understand trends in fatal and nonfatal opioid overdoses, making it easier for America’s medical/media collusion to distort findings, to lie to you.
Numbers of nonfatal opioid overdoses, if accurately measured, have been a more valid measure of high-risk opioid use than lethal overdoses, lethal ODs always confounded by differential (across time or study conditions) prevalence of emergency naloxone availability and saves, precluding valid attribution of results to treatment effects. Now, nonfatal overdoses as well cannot be relied on as a valid measure of high-risk opioid use or severity of the epidemic, because so many are occurring in community settings and go unreported and thus not accounted for in studies that rely, for example, on hospital and emergency responder data. That distortion provides room for results to be spun and manipulated in ways to lie about opioid treatment outcomes, as in this recent report in America’s top medical journal, featured in the upcoming post
“TO COVER OPIOID CRISIS MEDICAL CURE FAILURE, MORE LIES IN AMERICA’S TOP MEDICAL JOURNAL”
