VERMONT OPIOID TRENDS HERALDED AS IMPROVEMENT FOLLOW LETHAL PATTERN: NARCAN SAVES HIDE A WORSENING EPIDEMIC
As in other locales consistently, increases in naloxone reversal of opioid overdose lethality hides increasing high-risk opioid use – the measure of a worsening crisis
by Clark Miller
Published August 16, 2024
The apparent decrease by 13 fewer lethal opioid overdoses in 2023 than in 2022 seems to point to gains on the opioid crisis in Vermont, topping other states in per capita involvement in medication-assisted treatment (MAT) with methadone and buprenorphine.
Seems to point to gains until, as in other locations consistently, the evidence and outcomes are examined and critically evaluated.
From the Vermont Department of Health (DOH) report –
Here’s one of those important details, from the same report:
“Of note, there are still 15 pending death certificates in 2023, so it is possible that the number of deaths will increase to a level closer to that seen in 2022.”
That is of note, isn’t it, because it tells us that as far as we know, the numbers of lethal ODs for those years are not different, that there is no real change.
Whether that is true or not is irrelevant, because what we find, as consistently is found for other locales, is that increases from year to year in incidence of high-risk opioid misuse leading to potentially lethal overdose that are prevented, reversed, by increasingly distributed and used naloxone (Narcan) are many times greater than the (apparent) small decrease in OD deaths. That is, the increase in 2023 of OD death reversals by Narcan far more than accounts for any leveling or decrease in OD deaths. That is, from all indications, there is no reduced mortality left after naloxone reversals to which to attribute gold standard medical treatments for opioid dependence.
From the WCAX3 news report:
“The state has put a lot of tax dollars into harm reduction programs, including fentanyl and Xylazine testing, needle exchanges, and the overdose-reversing drug Narcan.”
Needle exchanges are not expected to prevent OD deaths, and no evidence is available to suggest that the “fentanyl and Xylazine testing” had effects.
Naloxone is different; essentially each use can be assumed to have prevented a potential death.
In Vermont, those reversals in 2023 would have been expected to climb from prior years, with home delivery of free Narcan beginning and per this report:
“Kinney Drugs, with 18 locations in Vermont, became one of the first pharmacies in the country to offer Narcan over-the-counter as of Aug. 31.”
The at best very small reduction in opioid overdose deaths while many times more potential OD deaths are prevented only because incidences of high-risk use and overdose are being reversed by increasing use of emergency measures – not by treatments that address the compulsive, high-risk opioid use – can only mean one thing: a worsening opioid crisis in Vermont, as elsewhere.
That worsening comes with Vermont expanding over those years access to and dispensing of methadone and buprenorphine by allowing relaxed prescribing and safely standards.
That’s for another post.
Meanwhile predictably, increasingly and inexorably new synthetic, more potent and dangerous drugs and opioid drug combinations come into abuse, portending ultimately the eventual limits of desperate emergency measures like Narcan campaigns to stem a tidal wave of high-risk compulsive drug use and leave fully revealed the established failure and lethality of expert gold standard treatments.
