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Epidemic getting worse
Increased Narcan use saving lives, hiding larger iceberg

04/12/18



 For the first time since the addiction epidemic began an ever-escalating death toll, officials are projecting a decrease in overdose deaths in 2017. But experts say this is not about the success of treatment and recovery services so much as it is about the increased use and availability of the lifesaving drug naloxone, known also by the brand name Narcan. That’s because other statistics such as overall overdoses and opioid-related emergency room visits are on the rise.

The numbers
David Mara, the governor’s advisor on addiction and behavioral health and the former police chief in Manchester, said it’s always a good thing to be saving more lives, but it doesn’t serve the underlying problem to focus on that number.
“Overdose deaths, because of Narcan, I don’t think is accurate at measuring the problem,” Mara said. “It’s great that for the first time since 2012 the overdose [death] rate has gone down, but we have a big problem out there and the problem is going up.”
There is projected to be 35.78 drug-related deaths per 100,000 population in 2017, according to data provided to the state Drug Monitoring Initiative by the Medical Examiner’s Office, and published in the DMI’s March report. The 2016 death toll was the highest ever at 36.46 per 100,000. That’s 485 individuals who died.
But deaths are just the tip of the iceberg. Underlying that statistic are thousands of overdoses each year and thousands of doses of Narcan administered by first responders.
“To me, the stats that really tell what is going on out there are the number of overdoses themselves, the number of emergency room visits for opioid-related things. Those are the true things that, to me, measure it,” Mara said.
Opioid-related hospital visits increased by 9.8 percent between 2016 and 2017, with a total of 6,684 in 2017. Incidents involving Narcan being administered by EMS personnel numbered 2,774 in 2017. That was just a 4-percent decrease to 2016’s 2,895 incidents. 
Nick Mercuri, the chief of fire and EMS strategy and planning at the state Department of Safety, said Narcan use is on the rise.
“Certainly, pre-hospital Narcan has [increased] and the state has distributed I think just over 14,000 public doses of Narcan,” Mercuri said.
While the state doesn’t track lay person use of Narcan, American Medical Response, the main EMS provider in Manchester and Nashua, does. According to AMR statistics, lay person use of Narcan skyrocketed in the last year.
In the month of March alone, both Manchester and Nashua reached new record doses of Narcan administered by friends and family members before first responders arrived. That’s 56 milligrams of Narcan in Manchester and 30 milligrams in Nashua. And while fatalities went down in the cities, together they also saw increases in overdose events in 2017. Between 2016 and 2017, combined city overdoses went from 1,140 to 1,171.
Why the increase?
Mara said the short answer to why we are continuing to see a rise in overdoses and opioid-related ER visits is simply the continued gaps in our treatment and recovery services infrastructure. Too many people are still waiting, sometimes days or weeks, to get into a program after seeking help. 
That’s a very vulnerable time for addicts, Mara said, because they’ve hit rock bottom at that point.
Another factor at play is that by staving off death, some individuals are overdosing again and again.
“There is a certain amount of people who are repeat customers, so to speak,” Mercuri said. “The longer it takes somebody to get off of and get a handle on their addiction, certainly that can be part of the challenge. The longer it takes, the more chances they will have to relapse.”
What’s next?
For Mara, the immediate solution to addressing the treatment gaps is to continue expanding access to Medication Assisted Treatment, with drugs like methadone, suboxone or vivitrol. The state has made some strides in that direction over the past year by getting more doctors licensed to prescribe suboxone, but Mara said more work needs to be done.
Perhaps a more pressing need is for transitional housing for people who need to detox and become medically stable. Without facilities like that, those who have to wait for treatment are being told to go home and wait, but Mara said they are likely to return to an environment that is not conducive to sobriety.
“We need to get people out of the environment that they’re in,” Mara said.
The catch is that there isn’t much federal funding out there for building or renovating facilities, he said. They are keeping an eye on any possible grant funding for project like that, but he thinks the safest bet is working with area hospitals to set up private-public partnerships aimed at providing the public with beds for stabilization, and partnering with area nursing programs to help staff those facilities.
“Narcan is not going to solve their problem. It’s basically going to keep them alive so we can get them into treatment,” Mercuri said. “Narcan is only that stop-gap measure.” 





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