MICHIGAN – SURGE OF 6,600 EMERGENCY COMMUNITY NARCAN REVERSALS TO PREVENT FATAL OPIOID ODs IS AN UNDERESTIMATE OF WORSENING CRISIS
In Michigan 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 November 15, 2024
From Michigan, the most valuable data and trends – e.g., all drug overdoses versus opioids, fatal versus nonfatal ODs – are not so helpfully presented or easily located, with some very valuable and important exceptions.
Available reports on the recent, as in other locales, apparent decrease in fatal opioid overdose deaths that include the observations of those closest to state and local efforts leading to and over the period of decrease give us credible, direct reports of what can be reasonably concluded and attributed related to the drops in deaths.
Importantly, there are quantitative records of reported community use of fatal opioid OD reversing naloxone for reversals, along with observations of front-line workers on why those typically unreported reversals – each in addition to a life saved, an incidence and measure of high-risk opioid use as a nonfatal overdose – are confidently understood to be generally seriously underreported.
From a May 2024 report in the Detroit Free Press –
The number of people who died as a result of drug overdoses declined by 3% across the nation last year, according to provisional data released Wednesday by the U.S. Centers for Disease Control and Prevention. It was the first year-over-year decline in overdose deaths since 2018.
In Michigan, overdose deaths were also down 3% in 2023, marking the second straight year the state’s overdose deaths dropped. . . .
In Michigan, the CDC estimated that 2,931 people died from drug overdoses in 2023, down from an estimated 3,027 in 2022.
Experts across the state have credited the increased availability of Narcan, which can reverse opioid overdoses if given correctly and in time. “Michigan is one of the … states in the country that is not seeing an overall overdose rate increase and it’s largely because of that naloxone availability,” said Pam Lynch, director of Harm Reduction Michigan, which is based in Traverse City and Petoskey, but does work throughout the state. . .
While the majority of overdose deaths nationally as well as in Michigan still involved opioids, specifically fentanyl, the ultra-potent synthetic opioid that has infiltrated the street drug supply, those fentanyl-related deaths declined 2% nationally and 3.6% in Michigan.
Some points to note. For this Detroit Free Press news article and as we’ll see soon in others for Michigan outcomes and trends and saw for Kentucky, news staff are not avoidant of using headline and feature image combinations to illustrate what is obvious to adult minds considering the available evidence: that the declines are attributable to statewide and local campaigns to distribute, provide training on, and support the effective use of naloxone to reverse what would otherwise become fatal opioid overdoses.
Nor were the cited harm reduction organization director or other “Experts across the state” inhibited from reporting the obvious connections they are observing – those campaigns resulting in actual use of Narcan to save lives, frequently.
What about the numbers?
The decreased opioid overdose deaths for 2023 were modest and for our purposes estimates based on:
1. All drug fatal overdoses decreasing from 3,027 in 2022 to 2,931 in 2023, a decrease of 3 percent, and of 96 deaths.
2. The “majority” of those overdose deaths were attributable to fentanyl, and decreased by 3.6 percent in 2023.
3. That’s a smaller drop in deaths than for all drugs or for all opioids, reasonably estimated to be in the range of 60 to 90 deaths.
60 to 90 fewer opioid overdose deaths in 2023
From data provided by the state of Michigan, the decrease started in 2022.
That fits, because Michigan’s intensive naloxone campaign began in 2020 with, per this report in early 2024, persistent expansion of the role of naloxone inn Michigan communities.
The Naloxone Direct Portal was launched in 2020 to provide the overdose reversal drug to community groups across the state for free. It has distributed more than 730,000 Naloxone kits and recorded more than 6,600 reversals since.
That is to say, Michigan flooded its high-risk opioid community settings with Narcan.
Per this report, 2,600 potential OD deaths were reversed in fiscal year 2023 (October 1 2022 to end of September 2023), pointing to increasing distribution, use, and saves over those years.
Sharp increases in the years just prior to and during recorded drops in opioid OD deaths are supported by data on portal orders for Narcan.
The distributions were at least to some significant extent targeted and provided with trainings.
From the same source –
As part of the effort to get naloxone into the hands of communities of color, The Youth Connection in Detroit has provided in-person and virtual trainings on naloxone administration for 6,727 individuals and distributed 7,600 naloxone kits. Training has been provided to numerous community organizations, including law enforcement, block clubs, churches, schools and senior facilities.
“Making sure a variety of community members know how to use and have access to naloxone is key to being able to address overdoses, which can happen in any setting,” said Dr. Grenae Dudley, president and CEO of The Youth Connection. “Naloxone saves lives and we have received reports of 100 overdose reversals by participants of our trainings.”
Three-quarters of a million naloxone kits and 6,600 reversals
That’s a lot. We need to talk about that.
6,600 reversals over a 3.5-year period, 2,600 in late 2022 to 2033. That is, as we will see shortly, almost certainly an underestimate.
But let’s be constrained and consider it an overestimate. Let’s use a figure of an increase of 2000 saves in Michigan for 2023.
[Rhetorical question alert]
Can those 2,000 reversals of potentially fatal opioid overdoses account for the decrease in 2023 from 2022 of an estimated 60 to 90 opioid-related deaths?
Ha.
Right.
We are compelled, obligated to attribute all of those reduced deaths, those saved lives, to nothing other than Michigan’s naloxone campaign and its use in communities.
At the very least to apply the same reasoning and obligation to the evidence that we did considering similar data and trends for Minnesota and Kentucky.
The evidence makes clear
that as in other locations consistently, an intensive Narcan campaign and its use in communities was responsible for the decrease in opioid overdose deaths in Michigan.
To rule out or dismiss that conclusion requires an explanation that takes into account the described increases in Narcan provision, training, and community outreach, also reports from community-based workers in the area, and requires making a cogent argument that the 500,000 to 700,000 or so units placed in community settings in the years prior to and during 2023, leading to the recording of 2,600 reversals in 2023 and representing sharp increases over those years, did not result in thousands or hundreds of otherwise fatal opioid ODs being reversed in 2023.
Thousands or hundreds are numbers multiple times higher than 60 to 90.
There is no question or uncertainty
regarding how to understand the sudden, recent fatal opioid OD decrease in Michigan correlated with Narcan campaigns. The question is how to understand that the drop was only by 60 to 90 deaths, when over the same period provision of expert, gold standard treatments in Michigan were being provided,
with dispensing of gold standard substitute opioids expanding, from 489 buprenorphine units per 1000 residents in early 2020 to 579 per 1000 in early 2023.
In Michigan as elsewhere,
in 2023, opioid overdose deaths were reduced by a small number, 3.6 percent, as a result of desperate, effective, targeted, successful efforts to dramatically increase use of naloxone in community settings for emergency revivals of incidences of high-risk opioid use, the small reduction pointing to a worsening crisis of high-risk opioid use demanding such Narcan campaigns as a form of harm reduction.
A worsening crisis requiring dramatic harm reduction efforts while American experts’ gold standard treatments were increasing in availability and use.
That’s no mystery. We know why that is.
Those answers have been established for years.
A more fundamental and widespread issue threatening public health
demands our attention here – the profound incapacity of America’s expert class and Medical/Media collusion for the critical thought and veracity required to make sense of research results and avoid the cowardly spinning of those results to protect the status quo, the power and institutional structures to which they cling for a positive sense of self.
Let’s focus on nonfatal opioid overdoses. An opioid overdose, by nature, definition, and circumstance essentially always constitutes high-risk use of an opioid drug. In distinct contrast to the emergency use of naloxone to reverse such instances after occurrence, the expert, gold standard medical “treatment” consisting of medical dispensing of substitute opioids buprenorphine (Suboxone) and methadone can only provide benefit by preventing such high-risk use from occurring.
Accordingly, each and every opioid overdose, including nonfatal, constitutes an incidence of treatment failure, nonfatal opioid overdoses measured over time or in comparison groups are, if valid and accurate, a legitimate measure of the severity of high-risk opioid use in a population or group, of the severity and trends in severity of the epidemic, “crisis”.
In addition to the critically important, and inevitably doomed, role and value of saving lives provided by community-targeted successful naloxone campaigns we’ve seen in Michigan and other locales, another profoundly important effect has come from those campaigns – intensely mounting frequency of potentially lethal opioid overdoses going unreported because family, peers and others in communities are enacting the revivals, instead of ED staff or first responder professionals. That allows concrete thinking and mendacious members of America’s expert class and media to pretend the ongoing thousands of incidences of opioid high-risk use don’t exist and to spin recent opioid trend results to fabricate them as gains against the crisis, to celebrate evidence of a lethal, continually worsening crisis as validation of the “treatments” driving it.
How do we know that high-risk opioid misuse (= gold standard treatment failure) is persistently increasing?
The cumulative, consistent evidence of very large numbers of naloxone units being distributed in communities and its use there, without triggering professionals or reporting, is sufficient.
But, more importantly, we have the consistent reports of community-level professionals, of community organization volunteers and directors, and of laypersons in communities telling us that.
From this Michigan news report –
As for the 6,600 overdose reversals, that’s likely an undercount, said Dr. Natasha Bagdasarian, Michigan’s chief medical executive.
“Most overdose reversals happen at 2 in the morning, when no one is calling the police, and no one is calling for help,” agreed Andrew Coleman, a site supervisor at the Sterling Heights office of the Arab Community Center for Economic and Social Services, or ACCESS, which also distributes naloxone.
Regular drug users have learned to take care of each other in an overdose, he said
“They see their friends falling out; they are turning blue, and they are Narcaning their friends,” he said. “But you’re not calling police if you’re with a group of people around who are involved with felony-level drug activity.” So those reversals never get recorded by the state.
Buried deep in the reporting on Michigan’s opioid crisis is an example of the type anomalous, disallowed truth telling that can at times slip into a news piece, too potentially damaging to not remain buried. This one comes from public health official Guy Miller in Berrien County, Michigan, as included in this news piece.
Guy Miller is the health officer for Berrien County. He said these emergency or “tertiary” measures are successful, but do little to address the root cause of addiction.
“The tertiary prevention is doing a great job at suppressing the number of deaths, but it’s not actually providing the solution to the opioid crisis, which is, how do we stop people from entering into a substance use disorder or a drug or opioid dependency?”
Miller said investing in preventative measures like education and counseling, as well as recovery support for users is cost-effective and necessary to turn the tide on the opioid crisis.
Or investing earlier, where and when it actually starts.
