IN WEST VIRGINIA – AS ELSEWHERE, RECENT SURGING NALOXONE OPIOID OVERDOSE REVERSALS EXPLAIN DROP IN DEATHS, AFFIRM A WORSENING CRISIS
In West Virginia as consistently elsewhere, data 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 18, 2024
The numbers 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 this WVNews news piece –
While numbers are still elevated over pre-pandemic levels, preliminary data from the Centers for Disease Control and Prevention suggest there’s been a 12.2% decrease in overdose deaths nationally and a 10.8% decrease in deaths in West Virginia in comparison to this time last year.
“This most recent decrease is due to the tireless efforts of our providers — from the smallest mom and pop shops, to the large organizations, and everyone in between. Evidence-based work is showing success,” said Executive Director of the West Virginia First Foundation Jonathan Board.
Over the last decade, but especially in the past year, more resources have been allocated to provide quality services to those with substance use disorder.
Additionally, the recent proliferation of the opioid overdose reversal medication naloxone, also known as Narcan, has been very effective at saving lives in an instant.
So far so good, as we’ll see, the intensive Narcan campaigns in West Virginia correlated directly with the drop in fatal ODs, as in other locales consistently, prevented more than enough fatal opioid ODs to fully account for the changes.
But then Mr. Board slips, says something he is not allowed to say, comes close to the truth about the meaning of the reduced fatal ODs.
But overdose death prevention should not be the main focus when tackling the opioid epidemic, Board said.
“We don’t just want to save lives in the instant. We want to restore those lives back to their families and communities and ensure that real healing is occurring and that those individuals can live the lives they so desperately want to live,” he said.
He might have added, “healing, so they are able to avoid the compulsive use of opioids or other drugs to numb the emotional pain and inner distress that drives problem substance use”.
He is absolutely right and intentionally or unintentionally points to what is obvious and disallowed – that emergency Narcan reversals are not a form of treatment and do nothing to address the psychological, social, material, and other stressors that drive problem substance use. Taking the obvious one unavoidable step farther – that those fatal opioid overdose reductions in West Virginia and elsewhere in the U.S. attributable entirely and only to Narcan saves point to the desperate need for intensive Narcan campaigns to reduce fatalities, that is, to continuing failure of America’s expert treatments.
But back to West Virginia and another anomalous case of reporting and headline writing actually accurately reflecting the reality of what evidence reveals about recent drops in opioid overdose deaths.
“a record 97,780 naloxone kits in 2023”
The piece describes intensified state efforts “through increased naloxone distribution” in which state agencies “distributed a record 97,780 naloxone kits in 2023, and is on track to surpass that amount by the end of this year.” That’s record distribution of naloxone kits directly antecedent to and over the period of CDC reporting decreased opioid overdose deaths in the state.
The writer and headline writer needed no special expertise to conclude accurately that that level of community provision of the easy to use overdose fatality reversal agent would more than account for the sudden decrease in OD deaths after years of increase. They would not have had to be aware that the expert treatments associated with steadily mounting OD deaths for decades have never been supported by evidence as effective, neither gold standard medical treatments nor traditional “addiction treatment“, like rehab, instead consistently found to predict harm and worsening epidemics, as reinforced by this recent $350 million NIH study. They, like anyone, would have noticed by now or could easily discover, that opioid and other substance use epidemics have become more grave and lethal over decades, decades over which America’s expert “evidence based” treatments have expanded and increasingly been provided to the medical model diseased brains.
“14,719 kits containing 29,438 doses of naloxone”
The magnitude of those Narcan kits distributed in West Virginia antecedent to the predictable drops in OD deaths – a couple hundred thousand, it seems – is one part of the story of recently intensified distribution efforts.
In September 2023, during the 1-year period of recorded decrease in OD deaths, community based organizations distributed to individuals within West Virginia communities nearly 30,000 naloxone doses on one day. As reported here,
“In West Virginia, teams in all 55 counties distributed 14,719 kits containing 29,438 doses of naloxone on Save a Life Day. Nearly 2,100 kits with 4,200 doses were distributed in Kanawha County.”
Described here for one of the 55 counties, the organized distribution efforts were highly targeted to get the kits to individuals and areas where they are needed most, and included personal contact and training.
Standing In the hallway of a Charleston church, Lindsay Acree patiently talks a man through the signs of an opioid overdose, and tells him how to administer a nasal spray version of naloxone, a drug that reverses them.
Not far from them are nearly a dozen people who have come to a drop-in program at the church — Bream Memorial Presbyterian Church — to have showers and do their laundry, among other services the program offers. . . .
She finishes the training, and hands the man a box of naloxone. It was one of more than 113 kits of the opioid antagonist that Acree, an assistant professor at the University of Charleston School of Pharmacy and a team representing Cabin Creek Health System gave out during Thursday’s annual naloxone distribution Save A Life Day. . . .
At the church’s drop-in center, naloxone is “probably the number two asked question,” outreach coordinator Derek Hudson said. There’s never been an overdose at the church, he said, but its night outreach teams see them frequently when visiting homeless encampments and “trap houses,” Hudson said.
Partner organizations frequently distribute naloxone at the program, Hudson said, but “you can never have enough.”
Acree and the team next head to a North Charleston housing public housing development, where they find longtime resident Virginia Nesmith on a front porch.
Nesmith — who manages a food distribution program and is known to some as the “mayor of Orchard Manor,” and simply “Miss Virginia” to others, is planning a community emergency preparedness event, she tells Van Horn.
“You [at] one time told me you wanted naloxone, do you remember that?” he asks. “I’ve got naloxone, do you want it now?”
But Nesmith has a better idea: could someone come back during food distribution and lead naloxone training for the people there?
By the time the team leaves minutes later, Acree has firm plans to come back the following day to lead a training, and distribute the opioid reversal drugs. . . .
According to distribution counts from Solomon, 2,075 naloxone kits were distributed in Kanawha County Thursday — more than double the 1,005 recorded during last year’s event. Totals from the entire Appalachian region were not yet available Friday.
Solomon said the increasing amounts of naloxone distributed this year points to the need for an accessible countywide syringe service program.
Kanawha County’s one syringe service program is operated by West Virginia Health Right.
Local and state leaders in recent years imposed restrictions on the programs that health officials said create barriers, such as a requirement to operate with a goal of getting back every syringe it distributes.
“[Syringe service programs] are our best opportunity at distributing mass naloxone to people who are at risk of overdose year round,” he said. “Everything else we can do without [syringe services programs] is still vital — and even moreso without them — though we’re still missing the bedrock response to this crisis in Charleston and Kanawha County.”
Coordinator Iris Sidikman attributed “substantially” more naloxone being distributed to volunteers who were energized and excited by the success teams had last year.
[emphasis added]
For 2023,
more than double the 1,005 recorded during last year’s event
the increasing amounts of naloxone distributed this year
“substantially” more naloxone being distributed
That paints a clear picture of a surge in community naloxone distribution, use, and fatal OD prevention.
In West Virginia and elsewhere, consistently and unavoidably –
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.
It’s the Narcan, serving as harm reduction against American Medicine and its gold standard treatments.
