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In the past year, more people have died from drug overdoses than in any other year in the past decade — both in the U.S. and Washington state.
An increase in fentanyl and overall social isolation have added to the number of overdose deaths from opioids.
A Swedish addiction and recovery doctor talks about how Swedish is responding to overdoses and ways families can help loved ones struggling with addiction.
The U.S. has reached a grim milestone: This year, more people have died from a drug overdose than ever before.
In Washington state, overdose deaths increased by 28% from June 2020 to June 2021. Almost 2,000 people died — more than in any other year in the past decade.
What’s causing the spike in overdose deaths? And what can help reduce the number? We spoke with Jim Walsh, M.D., from Addiction Recovery Services at Swedish, to learn more.
Opioids, addiction and overdoses
For a long time, drug overdoses were associated with illegal street drugs like heroin and methamphetamine. But that’s shifting, with a skyrocketing number of people overdosing on opioids, which are drugs usually prescribed to treat pain. Examples include oxycodone, oxycodone-acetaminophen and hydrocodone-acetaminophen. These are sold under the brand names Oxycontin, Percocet and Vicodin, respectively. In 2017, the U.S. Department of Health and Human Services called the opioid crisis a public health emergency.
Overuse of opioids for too long can lead to physical dependence. According to the American Psychiatric Association, opioids’ high level of positive reinforcement (in this case, pleasurable feelings) increases the odds that people will continue using them despite negative consequences. Opioid use disorder, a chronic lifelong disorder, can, if left untreated, result in increasingly negative consequences, including death.
It’s estimated that opioid use disorder affects some 16 million people worldwide and over 2.1 million people in the United States. Over the last few decades, the United States has seen a steady increase in deaths from an opioid overdose. The National Institute on Drug Abuse reports opioid deaths grew from fewer than 20,000 in 1999 to over 90,000 in 2020.
The opioid crisis didn’t happen overnight. Several factors contributed to it over time, including a lack of alternatives for pain management, under-regulation and over-prescription of opioids. Also driving the crisis has been the absence of laws around monitoring and educating prescribers about medication risks and woeful underfunding of substance abuse treatment programs.
“Opioid use disorder has been a growing addiction problem. It’s possibly related to the pain-prescribing practices of the nineties and early 2000s,” says Dr. Walsh. “Though these drugs were effective at helping with short-term pain, many who used the drugs found themselves unable to quit. And while doctors have really cut back on pain prescribing, opioid use disorder has continued to snowball and skyrocket.”
The rise of fentanyl
One factor adding to recent overdose deaths is the drug fentanyl, a powerful, chemically made (synthetic) opioid. Fentanyl is 80 to 100 times more powerful than morphine. In lower amounts, fentanyl has a greater effect than other painkillers, including Percocet and Vicodin. Doctors originally prescribed fentanyl to treat severe pain from long-term conditions like cancer or surgery. But now, fentanyl has entered the illegal drug market.
According to the U.S. Drug Enforcement Administration (DEA), fentanyl started being smuggled into the United States illegally because of how powerful and cheap it is. It’s easy to mix fentanyl with other drugs to increase their effects. Illegal drug producers also disguise fentanyl, manufacturing the deadly street drug into pills that look like actual prescription opioids. Since there’s no regulation of the illegal drug market, it’s hard for buyers to know how much fentanyl is in counterfeit pills and other drugs, like heroin.
“The more recent transition to mostly using fentanyl has added to overdose deaths because the strength of drugs is unpredictable,” says Dr. Walsh. “When the drugs are so unpredictable, it’s hard for people to moderate their use, so they don’t overdose. People usually aren’t trying to overdose. They buy a pill that ends up being something else. And it’s more than their body can handle.”
The pandemic has also been a driver of the growing number of overdose deaths. The pandemic forced people to stay home, often alone and isolated from others. Some studies have linked social isolation and opioid use. The CDC also reported that in over 60% of overdose deaths, no bystander was present.
“For people who are alone, the risk of overdosing is much higher,” says Dr. Walsh. “When people are homeless, the risk for overdose goes up too.”
This is especially important in Seattle, which has one of the largest homeless populations in the United States.
“When people are homeless, it’s harder for them to get treatment as reliably as they need — especially for something like addiction,” notes Dr. Walsh. “The homeless population is also more likely to be alone, which makes it more difficult for someone to intervene in the event of an overdose.”
Swedish is working to prevent and treat overdoses
For Dr. Walsh, one of the most challenging aspects of the rise in overdose deaths is that opioid use disorder is treatable. But the key is making treatments available and accessible. Swedish has several initiatives to prevent and treat drug addiction:
Getting medication to people with addictions
“There are many meaningful ways to treat addiction. But the most profound impact for sobriety and avoiding death with the opioid disorder is medication treatment,” says Dr. Walsh. “There are medications for opioid use disorder that both help people not overdose and help people maintain their lives, jobs and families.”
Swedish is getting more involved in efforts to make medications more available — especially buprenorphine and naloxone. Buprenorphine is a drug commonly used to help treat opioid addiction. Naloxone is an opioid reversal drug that can be given as an injection or nasal spray. Many people know naloxone by its brand name, Narcan.
“If you are, in fact, overdosing and there’s someone near you who has naloxone, they can give it to you and save your life,” says Dr. Walsh. “The tricky part is most people aren’t expecting to overdose. They also need to be with another person.”
Supporting people with addictions in and out of the hospital
Swedish offers several recovery programs. Some are inpatient, where patients check into the hospital. Others are outpatient, where patients live at home and visit the clinic regularly. Highlights include:
- Addiction Recovery Program: This program helps assess and treat people who are impaired or negatively affected by substance abuse problems. Patients have access to a team of experts. These include doctors who specialize in addiction medicine, chemical dependency counselors, psychiatrists, dietitians and others.
- Chemically Using Pregnant Women’s Program: For over 30 years, this program has focused on the needs of pregnant women and newer mothers using drugs or alcohol.
- Addiction Bridge Clinic: This is a walk-in transitional clinic ready to help anyone with medication addiction treatment, mental health support, overdose prevention and other resources.
Training more health care providers to treat people with addiction
Despite how common addictive disorders are, many doctors often feel undertrained. They aren’t sure how to help patients with drug or alcohol addiction. Swedish is working to decrease this knowledge gap, so there aren’t any missed opportunities for treatment.
The Swedish Addiction Medicine Fellowship is available to family medicine doctors. The doctors work at addiction recovery centers. They learn what medicines and treatments to give to patients struggling with addiction.
Swedish is also focused on mixing addiction treatment with mental health services. That way, any provider who encounters a patient with addiction can offer the best treatments.
“We’ve done some amazing work, leveraging integrated mental health treatment,” says Dr. Walsh. “And we’re looking at what extent providers throughout the whole health system are offering treatment for opioid use disorder. It’s becoming more and more normal and effective to treat people for opioid use disorder who get hospitalized anywhere in our system. Everyone is happier when patients get the right treatment.”
Ways families can help loved ones struggling with addiction
Addiction is not only hard for the person facing it; it’s also a struggle for their loved ones. Dr. Walsh has some advice for helping anyone facing opioid addiction, whether it’s themselves or a loved one:
Recognize addiction as a health care issue
“When you think about someone who’s developing an addiction problem, traditionally, they wait to get treatment until something awful happens: They have an overdose, get sick, get arrested or lose their job,” says Dr. Walsh.
“But now we have effective treatments that we can offer in a medical setting that work really well. We need to make getting treatment a normal part of health care, like a normal illness. Try to help remove the stigma by not judging people for getting treatment for an addiction — just like you wouldn’t judge someone for getting treatment for depression.”
Know that recovery is not linear
Treatment and recovery from drug addiction is an ongoing process. There is no ultimate cure for addiction, but there are helpful ways to manage the disease. Addiction treatment looks a little different for every person. There also are chances for relapse, just like with other health conditions.
“It’s important to recognize that addiction is a lifelong condition,” says Dr. Walsh. “Like other health conditions, addiction can wax and wane. People can do well for a while and then need more help getting back on track. Recognize that setbacks are a normal part of healing and recovery.”
The National Institute on Drug Abuse offers more information on what you can expect from addiction treatment and recovery.
Talk about it
Support can go a long way for people with an addiction disorder. Often, when people know they have someone to turn to for help and encouragement, they’re more successful on their road to recovery.
“If you have a loved one with an opioid use disorder, you should talk to them about it,” advises Dr. Walsh. “It seems so scary and painful to talk about these things, so people tend to shy away from the conversations. But of course, people get well because someone who loves them talks to them.”
Be prepared with Narcan
There is a statewide standing order to dispense naloxone (Narcan) in Washington State. This means anyone can take the standing order to a pharmacy to get Narcan instead of going to a health care provider for a prescription.
“If you think you’re at risk of an overdose, or you’re concerned that someone you live with might be at risk of overdose, get some Narcan,” says Dr. Walsh. “If you have Narcan and someone overdoses, you can apply the Narcan to revive them.”
Stopoverdose.org provides locations where you can find Narcan closest to you.
Celebrate any recovery
Addiction recovery is hard. It’s important to celebrate milestones — no matter how small they may seem. Support groups can help with this. Recognizing sober anniversaries and finding ways to reward yourself help you focus on progress and continue the work.
“Treating addiction can be a real delight because people can end up healthier than they were before they ever had their addiction problem,” says Dr. Walsh. “Often, people engage in a recovery journey to help them think about what they really care about and what’s meaningful in their life. It makes them healthier and stronger overall. When you notice improvements and recovery, it’s important to celebrate them.”
Find a doctor
If you have questions about support and treatment for addiction, contact the addiction recovery program at Swedish. We can accommodate both in-person and virtual visits.
Whether you require an in-person visit or want to consult a doctor virtually, you have options. Swedish Virtual Care connects you face-to-face with a nurse practitioner who can review your symptoms, provide instruction and follow up as needed. If you need to find a doctor, you can use our provider directory.
Join our Patient and Family Advisory Council.
This information is not intended as a substitute for professional medical care. Always follow your health care professional's instructions.
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