Over 20 drug overdose deaths have already been reported to the R.I. Department of Health in 2014, prompting widespread reflection on the public health and law enforcement mechanisms in place to handle opiate and other drug addictions.
“Opiate dependence addiction has been a problem in Rhode Island for a long time — it’s not a recent trend,” said Rebecca Boss, administrator of behavioral health care at the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities and Hospitals.
But deaths due to drug overdose nearly doubled in the state from 2009 to 2012, according to the most recent statistics from the Department of Health. Almost 100 deaths were reported as drug-related overdoses by the state coroner’s office in 2012.
“Drug overdose death is the most common cause of accidental injury death in Rhode Island,” said Michael Fine, director of the Department of Health. “We see more deaths from drug overdoses than we do from motor vehicle accidents, suicides and homicides combined.”
Boss said the phenomenon can be traced back to an overall increase in pain medication prescriptions.
“There are more narcotics being prescribed now than ever before,” Boss said, which “can lead to increased tolerance and dependence and, with some folks, addiction.”
But the pharmaceutical industry is simultaneously moving toward greater restrictions, said Traci Green, assistant professor of medicine and epidemiology, adding that the medical community is struggling to balance regulation with providing sufficient care for patients experiencing chronic pain.
Rhode Island’s Prescription Monitoring Program, run by the Department of Health, attempts to “help detect overprescribing, and diversion or fraud related to prescription of controlled substances,” according to the department’s website. The program was created last year and stems from legislation introduced in the General Assembly last February.
The prescription-monitoring program has made it harder for patients to access their prescribed pain medication, making them more likely to “seek street drugs,” Boss said.
Given that the composition and effects of heroin are similar to those of many prescription opioids prescribed for chronic pain, people are more prone to resort to the illegal drug as a substitution, Boss said.
“When you buy drugs on the street you’re never quite sure what you’re getting,” Boss said. The recent spike in overdoses may be due to greater rates of heroin tainted with fentanyl, which is potentially very deadly, she said.
“Heroin is coming in at cheaper and more potent and combined ways,” which in turn results in higher overdose rates, Green said.
“The deaths we’ve been seeing are all over the state,” Green said. But despite these setbacks, “Rhode Island is unusually well positioned to deal with the trends we’ve been seeing in the past month, probably more than any other state in the union.” The Department of Behavioral Healthcare already has programs established for educating medical professionals about overdose prevention, she said.
The department is focusing on education programs specifically teaching the administration of Naloxone, a drug identified as a safe and effective antidote to opiate overdose, Boss said.
Walgreens, in collaboration with the University of Rhode Island School of Pharmacy, has established an agreement to provide prescriptions of Naloxone directly to patients, providers and caregivers, Green said. “Anyone could walk into a Walgreens in the state and say, ‘I’d like some Naloxone,’” she said.
Fine said the Department of Health is “currently in the process of getting Naloxone into the hands of police officers.”
The Rhode Island Good Samaritan Law also provides a mechanism for drug overdose prevention by protecting people who report an overdose from arrest if there are drugs in their possession, Boss said.
Though the current trends are concerning, the state’s programs and law enforcement procedures have been critical in addressing opiate addiction problems so far, Green said.
“The key is to try and slow death down. In a basic sense we’re actually trying to vaccinate communities,” Green said, adding that she is “hopeful” Rhode Island is heading in the right direction.
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