Why do so many opioid overdose deaths across the country appear to occur at once? Experts warn that the answer is more complicated than it may seem.
How fentanyl plays a role
Sometimes, the abuse of opioids can begin when patients are prescribed pain medication in a way that puts them at risk for addiction. As some patients continue to take the medication and enjoy the euphoria that might come with it, it can mark the beginning stages of a deadly addiction.
“That said,” he added, “in some very specific cases, we can identify an underlying cause for multiple opioid overdoses in a short period of time: for example, after the appearance of an illegal drug with unusually high potency.”
“It’s the extent to which these high-potency opioids are being distributed within the illicit drug markets,” he said, adding that people who are using opioids might congregate in certain communities in an attempt to purchase higher-potency versions when they are available.
Combining opioids with alcohol or other drugs, such as Xanax or other sedatives, can increase these symptoms of an overdose, Fiellin said.
“In the state of Connecticut, we’re seeing that over 40% of individuals with opioid-related overdose deaths also have other substances in their body at the same time,” he said.
Yet Fiellin thinks more can be done to treat those who overdose.
“I think, too often, there is too much of a focus on Narcan and naloxone as a fix. That treats the acute episode but doesn’t address the underlying condition,” Fiellin said.
“Survivors of opioid overdose are at multiple-fold risk for repeat events and ultimately having a fatal overdose. So resources need to be brought to decrease their subsequent risk,” he said. “Typically, what happens in individuals who have opioid use disorder is, their level of physical tolerance develops to the point where they are rarely continuing to use opioids for the high or euphoria. They are oftentimes using the opioids to help with the withdrawal.”
A dramatic surge of opioid deaths nationwide
The recent increase in opioid overdose deaths nationwide may be attributable to a number of factors, said McGill’s King. They include the dramatically increasing use of prescription opioids among patients and the combined use of opioids with other, licit and illicit, drugs and alcohol, he said.
Yet one of the most common misconceptions is that the opioid overdose epidemic is amenable to simple, one-size-fits-all solutions, such as better training of physicians or use of prescription drug monitoring programs, King said.
“Certainly, these are important steps, but reducing opioid-related deaths will require cutting down both the supply of the drugs and the demand for them,” he said.