Is the COVID epidemic causing increased opioid overdose deaths? No one knows for certain, but the head of the White House Office of Drug Policy is speculating that it has, citing increased death statistics from a few states such as Kentucky.
Here in Connecticut we won’t have an official answer until the Connecticut Medical Examiner’s Office releases its first six months of 2020 data (likely at the end of August).
I am involved with a statewide SWORD program that tracks EMS reported opioid overdoses. Unfortunately, this program under reports fatal overdose deaths. There are several reasons:
- EMS compliance with reporting is estimated to be only 70%.
- EMS often cannot ascribe the cause of a death to an overdose lacking eyewitness accounts of visible paraphernalia on scene. (Example –A fifty year old lying dead in bed with rigor mortis and dependent lividity could have died from any number of causes from a heart attack to sniffing a bag of heroin that was either flushed down the toilet or removed from the scene by a friend prior to EMS arrival).
- Some EMS reported nonfatal overdoses turn into fatal overdoses after the patient is delivered to the emergency department.
Based on the last four months of 2019 and the first four months of 2020, the SWORD statistics show roughly the same number of fatal overdoses. April had the highest number of fatal overdoses for the first six months of 2020, but deaths reverted to the mean in May and June.
It is hard to know for certain if fatalities are increasing because of COVID when you lack year to year monthly comparisons as well as a full understanding of all the factors (strength of supply, for instance) that could be at play.
The worry with COVID-19 is that increased overdoses could be caused by loneliness, isolation, decreased access to services, and possibly changes in the drug supply causing users to find unfamiliar dealers.
From the anecdotal perspective of the paramedic on the street, I can’t say there are more or less deaths. There are still too many. I did three presumptions in the last month, one in a port-o-potty, on a mattress in a vacant apartment, and one in a halfway house where the victim still had the needle in his arm. All there were long dead when I got there.
I worked the city yesterday in the fly car, and while there were no fatals when I was on, I still responded to six overdoses (seven patients) in ten hours. Three were opioid-related (two heroin–both received bystander narcan!, one unknown opioid), one was PCP (two patients on PCP at same call), one was cocaine, and one was vodka. Now, yesterday was a Friday of a holiday weekend, shortly after the first of the month so there were plenty of reasons to expect a busy day beyond people trying to escape the COVID blues.
My friends on Park Street say there is no shortage of supply, and that prices have actually dropped from $30-35 for a bundle of ten bags to $25. Is that because it has been harder for people to get to Park Street to buy their drugs because of lockdowns? Are people short on cash (and unable to afford drugs) because they’ve lost their jobs? Not that losing a job has been a hindrance to people finding drugs. Are dealers are having to drop their prices to get rid of excess supply? Or maybe more drugs are getting through?
All I know is there has been no let up in the dispatches for overdoses.
COVID-19 has killed many Americans both directly and indirectly.
Hopefully, this crisis is bringing to light the holes in our health care system, and will move us closer to becoming a country with a health care system that leaves no one behind.
Happy July 4th!