A 9 percent decline in opioid-overdose deaths during the first eight months of 2017 compared with the same period the previous year shows Rhode Island is on the right track in combating the opioid-abuse epidemic, say health care clinicians and state officials.
Between January and August 2017 there were 208 accidental drug-overdose deaths in Rhode Island, according to state records. During the same period in 2016, there were 227 accidental drug-overdose deaths. Full-year statistics for 2017 aren’t expected until March 2018, according to Joseph Wendelken, spokesman for the R.I. Department of Health.
But the partial-year comparison is an accepted tool for measuring effectiveness used across public health and other fields of study, said Dr. Jeffrey Bratburg, a clinical professor at the University of Rhode Island’s College of Pharmacy.
Dr. Brandon D.L. Marshall, associate professor of epidemiology at the Brown University School of Public Health, agreed. He said that since the release of the first eight months of data, confirmed statistics for September also show a decrease.
“We do seem to be tracking pretty strongly on an 8 percent decrease, year to year,” said Marshall, who also serves on the Governor’s Overdose Prevention and Intervention Task Force.
Gov. Gina M. Raimondo in December issued a statement saying health officials “are cautiously optimistic” about the decline in opioid-overdose deaths. “There is still an enormous amount of work to do to overcome this epidemic.”
Rhode Island, said Bratburg, “is a national leader in its unified strategy” to combat the opioid epidemic. The decrease in deaths shows the strategy is effective, he said.
That strategy, set by Raimondo’s Overdose Prevention and Intervention Task Force’s action plan, splits its approach into four pillars: prevention, rescue, treatment and recovery.
Prevention initiatives include working to ensure all prescribers participate in the state’s prescription-drug monitoring program database. The state also issued clinical guidelines limiting most opioid dosing to a contained period of time and restricting opioid prescriptions from emergency rooms to three days or less.
Rescue efforts focus on ensuring access to the overdose medication naloxone, cooperating with pharmacies to make the drug available over the counter, and providing insurance coverage for naloxone purchased by family or friends of overdose victims.
Treatment examples include expanding medication-assisted treatment. In November, Butler Hospital was designated as the state’s latest Center of Excellence for treating overdoses and opioid addiction using medication. The Butler program joins COEs CODAC Behavioral Healthcare, which has sites in Cranston, Newport, South Kingstown and two in Providence; Community Care Alliance in Woonsocket; and Continuum, with sites in North Kingstown, Cranston and Providence.
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In the recovery arena, Butler’s program provides 24/7 access to opioid-addiction treatment and six months or more of interdisciplinary outpatient services for recovery stabilization.
“We have an extraordinary recovery community in Rhode Island,” Marshall said, adding health officials should seek their advice on steps to further curb opioid abuse and overdose deaths.
“We are one of the only states that are reporting a decrease in overdoses,” he added, noting Massachusetts as the only other example he is aware of. In Massachusetts, the estimated number of opioid-overdose-related deaths in 2017 was down 8.3 percent compared to the previous year, according to the Massachusetts Department of Public Health.
Dr. Joshua M. Sharfstein praised Rhode Island’s opioid strategy in the JAMA Forum column, “A New Year’s Wish on opoids” published last month: “Three years later, after developing a terrific dashboard, investing in access to effective treatment, developing programs to improve prescribing of opioids and benzodiazepines, and setting standards for hospital activities, the state is one of a few actually seeing a decline in overdoses,” wrote Sharfstein, associate dean of public health practice at Johns Hopkins University.
For Rhode Island to get even better results, Bratburg suggested supervised injection sites, legally sanctioned spots where people can inject pre-obtained drugs under medical supervision, shown to reduce overdose deaths by 35 percent; respite sites such as Boston Healthcare for the Homeless’ SPOT, where over-medicated people can recover under medical care; expanded public syringe disposal and more syringe exchange programs.
“Finally, we need to integrate infectious-disease prevention efforts, and soon,” he said. “Many indicators across the country show that infections [such as] hepatitis C and B, HIV and syphilis are on the rise. Optimizing prevention means thinking about these risks at the same time, and working to reduce them in concert with co-occurring substance use disorder and other chronic physical and mental disorders.”
