October 21, 2014
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Overdoses continue to be a top killer
Dr. Fine issues appeal for community to recognize, address problem

Every weekend, Kent Hospital admits three to four patients with severe accidental illicit drug overdoses, a number that is up from eight months ago and on par with what the hospital was seeing about 18 months ago.

“We’re back up to where it was before,” Kent’s chief medical officer, Dr. Michael Dacey, said in an interview Tuesday.

Dacey said the hospital is seeing an increase in drugs administered by injection, which he believes is a result of the fact that it has become increasingly difficult to illicitly get prescription drugs.

What Kent is seeing is consistent with a report issued last week by the Rhode Island Department of Health (HEALTH). The department reported that accidental deaths caused by illicit drug overdoses nearly doubled in Rhode Islanders between 2009 and 2012, and that in 2013 there was a reduction of accidental deaths involving illicitly obtained prescription medications, such as Vicodin and Oxycodone.

According to preliminary data from the State Medical Examiners Office, illicit drug overdose deaths statewide involving street drugs like heroin and cocaine increased from 53 in 2009 to 97 in 2012.

HEALTH Director Dr. Michael Fine said the number of deaths attributable to overdoses is equivalent to the numbers of Rhode Islanders who die annually from colon cancer.

“Both are preventable. That’s what drives me crazy,” Fine said. He said colon cancer fatalities could be eliminated if people of 50 years old and older had a colonoscopy every 10 years. As fatalities from overdoses tend to be younger people than those dying of colon cancer, the years of life lost to overdoses are far greater, he noted.

Fine called the increase in IV drug usage “very dangerous.”

He said it is of concern because IV drugs pose other health risks, such as HIV and Hepatitis C.

Dacey said most overdose cases at Kent don’t result in death. Generally, he said, patients spend four days at the hospital, the first two of which are in intensive care where they are kept on ventilators. Most of the Kent patients, he said, are males and middle-aged.

While there tend to be more cases from the Oakland Beach section of Warwick and West Warwick, Dacey said accidental overdoses are not limited to lower income areas and that many are from affluent neighborhoods.

It was a spike in overdose deaths (five deaths in eight weeks) in early 2012 that prompted the hospital to examine trends and start tracking them. The hospital also took steps to educate the public on the dangers of misusing prescription drugs and how they might be reaching those without prescriptions. At an April 16, 2012 press conference, Fine reported three to five people were dying monthly from overdoses statewide.

At that time, Fine announced plans for its Prescription Monitoring Program that enables doctors and pharmacists to monitor drugs being prescribed so as to avoid dangerous drug combinations and quantities. Also, the system is designed to prevent prescription drugs from reaching those who don’t have a prescription.

“Dr. Fine deserves a lot of credit for it,” Dacey said of the program. “He’s been a big force in getting the word out.”

Fine would like to think the program is responsible for the reduction of illicit prescription drug overdoses, although he doesn’t have statistics. He attributes what successes the program has had to the partnerships and the consolidated efforts within the community.

As to what can be done, Dacey said, “At some point it is more of a social problem than a health care problem. The whole community has to do more.”

He identified alcohol as a major contributor.

“It is the drug of choice in Rhode Island,” he said.

While he grew up in the state, Dacey said it wasn’t until he entered the medical profession that “I realized how much of a problem it is here.”

According to the HEALTH website, “Alcohol was found to be a common contributing factor to accidental overdose fatalities when combined with either illicit drugs or prescription medication.”

Fine said Rhode Island is ranked 15th in the country for binge drinking, which is defined as a male having five drinks in one sitting within the last 30 days. The definition for a female binge drinker is four drinks in a single sitting in the last 30 days.

“I wonder if you would see those deaths,” Fine asks of the overdose fatalities if alcohol was not involved.

Fine considers drug and alcohol usage and their effects on health a “more significant health problem for Rhode Island than heart disease, cancer and HIV.”

“These,” he said of those with addictions, “are brothers and sisters, neighbors and friends, parents and family … not somebody else. It is so common that it affects everyone in Rhode Island.”

Apart from measures to ensure people get treatment, educate people and reduce the supply of illicit prescription and illegal drugs, Fine believes the solution is in community and bringing people together. On an individual basis he said it requires confronting those who are afflicted and standing by them.

“Make sure treatment is available and realize it’s really hard,” he said. He said it is often a matter of being patient and understanding that the first treatment and successive treatments may not work.

“The person addicted is not the person you know,” he said. “This is all of us taking care of each other.”

He also said it’s understanding that our health is often a consequence of the choices we make.

He pointed out that it is considered acceptable to have beer parties and to allow underage youth to have alcohol. He said 11 percent of drinkers are under 20 years old and of that number, 90 percent participate in binge drinking episodes.

In addition to the monitoring program, the department notes as an intervention strategy that Naloxone, a medication that reverses an overdose from opioids (e.g. heroin, morphine, oxycodone) is now available without a prescription so that a layperson can help reverse a drug overdose of a friend or loved one. Emergency medical professionals have used this safe and effective antidote for decades. In 2013, Walgreens became the first and only pharmacy chain to make Naloxone available without a prescription.

The department also observed that Rhode Island expanded its Good Samaritan Law. Callers to 911 now have immunity from prosecution if illicit drugs are involved in the emergency. Fine said this has made it easier for friends and family to get medical attention for those suffering from an overdose.


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