Understanding Rhode Island’s Unending Epidemic Opioid Overdose is Now a Public Health Crisis

By Patti Shaffer

This is my family’s story. King Shaffer Jr. died last October at the age of 49 from an overdose of heroin and fentanyl just three days before he was going to enter rehab for the second time. He was a devoted family man with two loving children. He received strong support from his family, but he couldn’t fight the temptation to stop using drugs. He was my nephew.

As a young boy, he suffered abuse by his stepfather and began drinking alcohol and smoking marijuana at the age of 14. In his 20s, while enlisted as a Navy SEAL living in California, a Jet Ski accident left him with severe back pain, which sparked the beginning of his drug dependence. His doctor prescribed the opiate Percocet. When that stopped working, he began using and then abusing prescription painkillers by buying Oxytocin, also an opiate, on the black market to help his pain. When that stopped working, he entered rehab and started on methadone, another opioid medication. Over time that did not get him high enough, and 10 years ago he began using illicit heroin. Heroin was cheaper and easier to buy. He was up to using 30 bags of heroin a day—a $500 a day habit. He did everything and anything to get it, and it killed him. Toxicology reports showed heroin and fentanyl in his blood.

Sadly, this experience happens to too many, and too often.

Did you know that nearly 80 percent of people addicted to heroin first started using prescription pain medications? And that drug overdose from opioids is the leading cause of accidental death, not only in the U.S. but right here in Rhode Island?

In fact, Rhode Island topped all other New England states in overdose deaths over the last five years. During that period, we have lost more than 1,000 Rhode Islanders to drug overdoses. They came from every community in the state, from every age group. Just last year alone, 296 people lost their lives in accidental drug overdoses. However, even that number isn’t final yet and is expected to rise to more than 300. During that time, EMT’s administered more than 1,000 doses of Naloxone (also known as Narcan), a medication that will reverse an opioid overdose.

What are opioids?

Opioids are a class of powerful prescription pain relievers marketed under brand names such as OxyContin, Vicodin, Codeine, Percocet and Fentanyl, and many others.

Heroin, of course, is an illicit opioid that has been around for decades. More recently the heroin supply has been invaded by illicitly manufactured synthetic fentanyl. This drug is often added to heroin to make supplies more profitable and is now showing up in other street drugs as well. Fentanyl is about 30 to 50 times more lethal than heroin.

Nationally, opioid overdoses killed more than 33,000 people in 2015, more than any year on record—and nearly half involved prescription opioids.

In Rhode Island, this overdose epidemic has created a public health crisis. Believe it or not, we have one of the highest overdose rates in the nation and are in the top four according to the Substance Abuse and Mental Health Services Administration (SAMHSA) data.

In Rhode Island there has been a 135 percent increase in deaths due to illicit drug overdoses since 2012, overshadowing the 34 percent decrease in prescription drug overdose fatalities. And the total number of drug overdose deaths continues to rise steadily.

What has caused this epidemic?

Michelle McKenzie, MPH, Sr. Project Director at The Miriam Hospital explains, “The dramatic increase in opioid overdose is directly related to increased prescribing of opioids for pain. In the U.S., between 1999 and 2010, the rate of prescription sales increased threefold, and the number of overdose fatalities increased comparably. The rate of prescription sales began to drop in 2011; however, overdose deaths did not. By 2012, as prescribing practices became more conservative and people with opioid use disorder progressed in their disease, fatalities from illicit use began to rise, and by 2014 the majority of fatalities in Rhode Island were related to illegal use.”

The variability of illegal drugs makes the problem worse. The Drug Enforcement Administration (DEA) issued a national report last year revealing that since 2014 hundreds of thousands of counterfeit pills have been entering the U.S. drug market, some containing deadly amounts of illicit fentanyl and fentanyl analogs.

More potent than morphine, fentanyl is a legal opioid used for anesthesia, and many different versions have made their way onto the illegal drug market. Combined with heroin, Oxycodone or counterfeit Xanax pills, fentanyl can lead to an almost immediate overdose death. This past year alone more than half of overdose deaths in Rhode Island were fentanyl-related.

According to Dr. Nicole Alexander-Scott, Director of the Rhode Island Department of Health (RIDOH), “People are injecting, swallowing and snorting fentanyl without realizing they are often breathing their last breaths. Fentanyl kills – and it kills quickly. In many instances, people don’t know they are taking fentanyl. If someone around you uses heroin or fentanyl, make sure you have naloxone, and if you think someone around you overdoses, call 911 as soon as possible.”

How can we prevent drug abuse, addiction and death before they start?

“Education regarding the addictive nature of opioids is very important,” states McKensie. “One of the things that have contributed to the prevalent use of opioid pain relievers is the belief that since it is prescribed by a doctor, then it must be OK. Educating parents and youth about the importance of taking medication as prescribed is important.”

Equally important to McKensie is to focus on teaching young people to make healthy decisions in regards to their bodies. “The messages that youth receive from the media imply that they are better living through chemicals,” she explains, “ It is important to recognize that youth will be negotiating how to, and whether to incorporate the use of all kinds of substances, not just illegal substances into their life.”

“My belief is that we need to focus on health and wellness,” McKensie says. “and making sure that youth and their families have the resources they need to make healthy decisions.”

Joseph Wendelken, Public Information Officer at RIDOH, offers up an immediate step that people can take right now in their homes to protect themselves and their loved ones. “Get rid of medication after it is no longer needed. Empty out the bottle, use a pen to cross your name and personal information off the bottle, mix the pills with coffee grounds, and then throw it all away.”

What are we doing in our State to help?

In 2015, Governor Raimondo created an Overdose and Intervention Task Force to actively address the crisis. Through four areas of focus—treatment, rescue, recovery and prevention – the Task Force aims “to reduce opioid overdose deaths by one-third within three years.”

Researchers at Brown University are also working in close partnership with colleagues at the RIDOH to pinpoint where overdoses are occurring, who is most affected, and how we can best intervene to reduce drug-related deaths. With its online overdose “dashboard” (www.PreventOverdoseRI.org), Rhode Island is very quickly becoming a national leader in using real-time data to address this crisis.

To offset the dwindling social work support available in public schools, nonprofit organizations such as Rhode Island Student Assistance Services (RISAS), the Providence Prevention Council, and other regional prevention councils have stepped in to fill the void.

Most importantly, free, confidential help is available for anyone using illegal drugs, or anyone who thinks they may have a problem with their prescription medication. To get help, call (401) 942-STOP. Even if you don’t have insurance, there are still resources available.

In the eyes of my niece, Anne Gutos, sister of King Jr., the situation is dire. “Nothing will stop the epidemic anytime soon because the influx of heroin into America is beyond the rate at which it can be stopped. My hope is for stricter control of doctors and pharmaceutical companies; vaccines for those who are genetically at risk; and early education and intervention before one even turns to opiates.”