Mind and Body

Drug ODs: Two new research studies, nine new strategies, and a new recovery facility

Will the opening of the new Lifespan Recovery Center open the door for a more public conversation about harm reduction strategies, such as safe injection sites, anonymous message boards, and fentanyl testing sites?

Courtesy of the Governor's Task Force on Overdose Prevention and Intervention

In her June 14 report to the Task Force, Traci Green identified the following select data trends related to how fentanyl had caused the number of overdose deaths to spike in 2016.

By Richard Asinof
Posted 6/19/17
Two new studies, nine new strategies, and the opening of a new recovery center provide an opportunity to make harm reduction part of the conversation when addressing the epidemic of drug overdose deaths in Rhode Island.
If fentanyl is the major cause of the spike in overdose deaths, what will it take to create a safe space for substance users to test their illicit drugs for fentanyl, as a public health strategy to save lives? Have the initial strategies of the Governor’s task force given too much weight to clinical approaches through medication-assisted treatment? What is the role that local communities can play in creating their own substance use policies, as Central Falls has done? Are the proposed sentencing policies under Attorney General Jeff Sessions to seek maximum drug penalties a step backward, in the belief that we can arrest ourselves out of this epidemic? How can the recovery community’s voice become heard as part of the strategy conversation?
To change the dynamics of how we use and abuse drugs requires a fundamental change in how we address pain – both as a physical sensation and a mental and behavioral condition. While there are numerous alternative strategies, such as yoga, physical therapy, acupuncture, the practice of mindfulness and exercise regiments, the success of those often depends on the ability to connect with insurance reimbursement strategies.
Pain is a very human condition. The use of prescription painkillers often masks pain, but when they wear off, they create a withdrawal that increases the symptoms of pain. The longer one uses the prescription painkillers, the worse the pain of withdrawal, the stronger the craving.
At some point, the rationale needs to be flipped. It is not about good drugs being used by bad people, as HBO documentary director Perri Peltz said. At some point, the pharma companies who have profited need to be held accountable, as do the doctors that prescribed the pills. And, at some point, the economic policies of de-industrialization need to be recognized as contributing the dramatic increases in the number of deaths of despair – deaths from drugs, alcohol and suicide. We need to have a broader conversation about these issues.

PROVIDENCE – On Monday morning, June 19, Lifespan will dedicate its new Lifespan Recovery Center, in a ceremony featuring Sen. Jack Reed, Rep. Jim Langevin, Gov. Gina Raimondo, Rhode Island Hospital President Dr. Margaret Van Bree, and Providence Public Safety Commissioner Steven M. Pare.

The new facility, located at 200 Corliss St. in Providence, nearby the main branch of the U.S. Postal Service, will serve as a new drug treatment facility focusing on assisting and treating those with opioid use disorders, according to the media advisory sent by Reed.

“The center is designed to be multi-disciplinary, evidence-based, and recovery-oriented to meet the full spectrum of clinical and social needs of individuals diagnosed with opioid use disorders,” the media advisory said. The team of providers will work collaboratively to effectively assess, diagnosis, and provide comprehensive treatment for more than 500 patients upon the center’s opening.

The questions are: how will Lifespan’s new drug treatment facility fit within the changing reality of the epidemic of overdose deaths related to fentanyl?

How flexible will its approach be in the efforts to integrate harm reduction as one of the newly recommended strategies of the task force?

Could the facility be expanded to include a safe injection site [sometimes referred to as a “medically supervised consumption space,”] or serve as a potential safe haven where substance users could use strips to test their illicit drug supply for fentanyl?

Rising death toll connected to fentanyl
The opening of the new Lifespan facility comes at a time when the epidemic of overdose deaths continues to climb, with 336 deaths in 2016, with many of those deaths blamed on the increased use of the illicit drug, fentanyl.

At the June 14 meeting of the Governor’s Task Force on Overdose Prevention and Intervention, Traci Green, a consultant to the task force who works at the Injury Prevention Center at the Boston Medical Center, in her Multidisciplinary Review of Overdose Deaths Evaluation team report, said: “Fentanyl continues to be a causal agent in the majority of unintentional drug overdose deaths [in Rhode Island].”

During the third and fourth quarters of 2016, Green continued, some “65.5 percent of unintentional drug overdoses were attributed to fentanyl [103 out of 157 deaths].”

That data reinforces two studies by Brown University researchers that were recently published in the International Journal of Drug Policy, that underscored the urgency of combating the misuse of fentanyl and contradicted a common perception that many users court the drug for its potency, according to an article written by David Orenstein for Brown University.

“Most people are not asking for it,” said Jennifer Carroll, the lead author of one of the studies and an adjunct assistant professor of medicine at the Warren Alpert Medical School of Brown University, according to Orenstein’s story.

“They can’t avoid it, and their desire to avoid it is not reducing their risk, Carroll said.”

Changes in attitude
Nine new changes in strategies were recommended as part of Green’s report to the Task Force. Two, for the first time, deal with specific strategies to address harm reduction, including potentially creating a safe injection site:

The R.I. Department of Health should develop and implement an enforcement plan for the existing policy requiring physicians to check the state’s Prescription Drug Monitoring Program with all new opioid prescriptions.

Encourage medical examiners to report suspicious prescribing activity, if uncovered during their investigations of decedents who overdose, to the Department of Health’s licensing unit.

Encourage detoxification facilities to provide treatment options to all clients prior to admission, including options for induction onto methadone or buprenorphine.

In addition, prior to discharge from medical detoxification, where sufficient length of stay, encourage facilities to promote initiation of injectable naltrexone, or, where insufficient length of stay, promote referrals to Centers of Excellence for initiation.

Further, provide all clients with recovery supports, including peer support service, [as well as] receipt of overdose prevention education and naloxone distribution to the client prior to discharge, as required by the R.I. Department of Behavioral Health, Developmental Disabilities and Hospitals.

Explore the feasibility of opening a medically supervised consumption space for persons who use drugs, specifically looking to locales with greater density of overdose deaths, especially public overdose deaths.

Improve overdose prevention strategies within homeless shelters, sober housing units, and public housing, including access to naloxone and training in its use by staff, implementation of policies aimed at overdose prevention, and ensuring best practice screening and treatment for substance use disorder for residents.

Encourage naloxone training for employees and personnel in semi-public locations and surrounding public spaces where an overdose has or may occur.

Implement organizational protocols for using naloxone in public and semi-public locations to prevent and respond to overdoses.

Recommend that pharmacies offer naloxone at every syringe purchase.

Support the dissemination of harm reduction messaging that encourages drug users to not use alone and to not use simultaneously [i.e., take turns, wait two to three minutes before using to avoid overdosing at the same time].

Finding the recovery community’s voice
The results of a series of focus groups with members of the recovery community are soon to be released publicly, in the next few weeks, according to Monica Smith, the executive director of RICARES.

ConvergenceRI shared the two studies by Brown researchers with Smith, to get her feedback on the findings, from the recovery community perspective.

Here are Smith’s observations:

“I am glad that the governor’s task force is pursuing research that seeks additional response measures to the opioid overdose epidemic.

[For me,] the results of the Task Force-funded study demonstrate three things:

The need for safe injection sites;

The ability for active users (and dealers) to test their product, and

A desire to have treatment on demand.

“The study funded by the Centers for Disease Control and Prevention had some important take away as well: for instance, 18-29 year olds are overdosing at a rapid rate.

“The R.I. Senate Education Committee has a bill (S 306-Substance Abuse & Suicide Prevention Education) that would require the R.I. Department of Elementary and Secondary Education to consider incorporating evidence-based substance abuse and suicide prevention education into their health education.

“I would like to see that bill expanded for Secondary Education students to include training on naloxone/narcan, and offer these tools on site. I also want to see naloxone become as available as free condoms.

“The CDC study also demonstrated the need for safe injection sites, and treatment on demand, incorporating peer-based recovery programs.

“The clusters of urban-related deaths in visible public settings is concerning. My gut says we need to work with people that are actively using to create some grassroots harm reduction.

“For instance, I have seen the sex worker community use anonymous message boards and GIS mapping to keep one another safe. They report johns that are threatening, that steal from them, or seem risky.

“I would love to see a similar sort of anonymous message board where active users can communicate with each other about product safety, suspected contamination, coordinate safe use together, and report overdoses in public spaces. Agencies in the community could use the real-time location information as a tool to deploy narcan/naloxone. We are missing a crucial component of technology being used as a tool to address the epidemic.

“What impressed me more than anything about the studies is how smart people are! The studies demonstrate that active drug users are taking an active role in trying to stay safe by using touch, taste, smell, and molecular breakdown, systemic approaches to decreasing their risk.

“They are [attempting] to control their environment, practicing moderation and cognitive based therapy. [Think about how much frontal lobe engagement it takes to work through a craving; now imagine working through that and using a small amount of what you’re craving at the same time. That’s admirable]."

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