Alarm bells are being sounded as experts report that a combination of prescription drugs and/or recreational drugs now contributes to almost three-quarters of overdose deaths in the United States.
Reports of the use of
along with the animal tranquilizer
are making substance disorder prevention and related overdose deaths more complicated, experts said during a webinar sponsored by the National Institute for Health Care Management.
„Nearly 74% of cocaine-related overdose deaths are now attributed to synthetic opioids like Fentanyl,“ said Dr. Cecelia Spitznas, senior scientific policy analyst at the Office of National Drug Control Policy at the White House. „This type of combined drug use is part of a new trend driving the overdose rate, along with an increasing use of Xylazin or ‚Tranq‘.“
The White House declared the drug combinations an
to the United States in April.
Regarding overdose prevention: „If you are using a substance yourself or know someone who is, we want to encourage people to think,“ said Shawn Westfahl, coordinator of overdose prevention and harm reduction at Prevention Point Philadelphia, during the webinar. „Avoid using medications alone. Most people who overdose on opioids die without anyone nearby. We encourage people to use the buddy system and stagger the use.“
Westfahl also suggests that people who use substances „proceed slowly and carefully, especially when injecting. You can always put more in, but you can’t take it out. And we encourage people to avoid mixing other drugs with opioids.“
Medically supported treatment
Although equitable access is a challenge, „the most important thing we can do in the United States currently to combat the epidemic of substance use disorders is to improve access to evidence-based treatment, especially medically supported treatment,“ said Doug Henry, PhD, vice president of psychiatry and behavioral health at Allegheny Health Network in Pittsburgh.
Allegheny Health, for example, started a program in 2020 to improve access to medically supported treatment in rural and underserved areas of West Virginia. Offering telemedicine „was truly groundbreaking,“ said Henry, particularly in regions with specific geographical and population density challenges.
„It is enormously, enormously important to involve people in medically supported treatment and keep them engaged in treatment,“ said Henry. „These efforts have led to a reduction in opioid-related overdoses.“
What Worries the Experts
Henry agreed that drug combinations further exacerbate the challenge.
„The ongoing opioid epidemic and the emerging epidemic of combined molecules resulting in deadly toxins are leading to an increased frequency of overdoses,“ he said. He reported peak figures in his two professional positions – at Allegheny Health, a network with 14 hospitals in southwestern Pennsylvania and western New York, and at Highmark Health, the third-largest Blue Cross Blue Shield insurance company in the United States, primarily serving members in West Virginia, western New York, Delaware, and Pennsylvania.
Westfahl reported that in 2022, 1,413 people died from drug overdoses in Philadelphia, compared to 1,276 overdose deaths in 2021, representing a 10% increase. The majority of deaths in 2022, 83%, were due to opioids. Fentanyl and Tranq remain a major challenge for the population served by Prevention Point, he said.
„We have seen a tremendous increase in fentanyl use over the years,“ he said.
For example, in 2010, Fentanyl was involved in less than 10% of drug overdoses. Last year, Fentanyl played a role in 96% of overdose deaths.
The national picture is not much more encouraging, Spitznas said. According to national survey data, in 2022, approximately 25% or 70 million Americans used illegal drugs. More than 17%, or nearly 49 million Americans, reported a substance use disorder in the past year.
„Fentanyl is often used to adulterate certain substances, so it is unlikely that people really know whether they are consuming heroin or fentanyl,“ she said. If available, Fentanyl and Xylazin test strips can help determine which substances are present in the event of an overdose.
Good and Bad News on Treatment
National data also show that only about 24% of Americans aged 12 and older classified as needing treatment actually receive it. A glimmer of hope is seen in an age breakdown, Spitznas said. „We are somewhat more successful at getting 12- to 17-year-olds into treatment.“
Compared to the 25% of younger teens receiving treatment, „we are really bad at engaging 18- to 25-year-olds in treatment,“ she said. The rate is just over 16%. „And overall, we need to get more people into treatment.“
The provision of Naloxone is a priority, Spitznas said. In March, the FDA approved the first over-the-counter nasal spray with Naloxone. The agency also approved a second opioid reversal agent, Nalmefen, in May.
„If a person overdoses on both Fentanyl and Tranq, the opioid reversal agents can treat the effects of Fentanyl. But Xylazin or Tranq is not an opioid. It is an animal drug that leads to prolonged sedation, and the FDA has not approved its use in humans,“ she noted.