How the pandemic may have caused Delaware to set record for overdose deaths
Hidden among the attention and resources paid to fighting the coronavirus this spring, Delaware suffered one of the biggest spikes in fatal overdoses in recent memory.
For some, contracting COVID-19 wasn't the biggest fear. Not when joblessness (including extra unemployment benefits), social isolation and an inability to access treatment made it much more difficult to control their addiction, said Dave Humes, policy director for the grassroots nonprofit, atTAcK Addiction.
Add in stress, anxiety and uncertainty, and the triggers for relapse skyrocketed, he said.
In the organization's New Castle County transitional living home for men, six of the nine residents left during the pandemic due to renewed drug use, Humes said.
"We anticipated that this isolation would be a problem and obviously be a trigger and cause relapse," he said. "People in recovery having money is a problem."
This spike comes the year after 2019, when Delaware set another record for accidental drug overdoses. A total of 431 people fatally overdosed, according to state data – 31 more than 2018, another record-setting total.
The numbers reflect a startling reality for Delaware, where despite ongoing efforts to curb overdoses, increase access to treatment and offer more outreach, more people continue to die. In the first quarter of this year alone, the state recorded 112 confirmed drug overdose deaths.
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"People just aren't used to this," said Lt. Gov. Bethany Hall-Long, who chairs the Behavioral Health Consortium, as well as the newly formed Pandemic Resurgence Advisory Committee, tasked with preparing for how Delaware will weather another wave of COVID-19 cases predicted in the fall.
In looking at this year's numbers, she said she's most concerned with the 47% increase in fatal overdoses in the first six months of this year compared with 2019.
"I cannot even imagine if we didn't have the telehealth [availability] ... if we did not have in place all these other systems," Hall-Long said, referencing the many access-to-care and outreach systems created in the last few years under the leadership of Elizabeth Romero, director of the Delaware Division of Substance Abuse and Mental Health.
Those systems are what Hall-Long credits with preventing even more people from slipping through the cracks and dying.
Even worse, COVID-19 and its effects remain a pressing issue for Delaware residents – and it doesn't don't show any signs of letting up, meaning leaders must act fast to curb this spike in overdose deaths.
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In the atTAcK Addiction's transition house for women, a resident opted to leave during the early months of the pandemic. Though Humes doesn't know the exact details, she fatally overdosed not long after.
"From the outside, looking at her, you would have thought she's going to be one of the ones who make it," he said, referencing the high prevalence of relapse that is associated with addiction. "That was one that we know we definitely lost due to this [pandemic]."
The effects of ongoing addiction efforts
Early in the pandemic, the state reported that it didn't believe any spike in drug overdoses was correlated with the stay-at-home orders.
But so far this year, Delaware is reporting on the state website a suspected 226 drug overdose deaths. In the first six months, the state recorded 190 suspected overdose deaths – a 47% increase over the same six months in both 2018 and 2019.
Should the first quarter numbers of 2020 continue, Delaware would once again be poised to shatter its death totals.
A New York Times story published last month identified Delaware as the leader nationally with drug overdose death increases up 60% from 2019 through the beginning of 2020.
"This is an epidemic in the middle of a pandemic," Hall-Long said. "You can see where in certain communities, it's hit even harder."
But that's not to say the efforts, especially in low-income communities and communities of color, aren't continuing.
Just last month, the state formally launched ATLAS, billed as "the first resource of its kind," to help those seeking addiction treatment find "high-quality and appropriate care," according to a release by the state. Delaware is one of only six states that partnered with Shatterproof, a national nonprofit focused on ending the addiction epidemic, on this initiative.
The online platform aggregates data on "evidence-based medical practices and patient experiences" at local addiction treatment facilities and makes it available for those in need of treatment and the loved ones supporting them.
“We are worried about the impact that COVID-19 is having on Delawareans who already are struggling with substance use disorder,” said former Delaware Department of Health and Social Services Secretary Dr. Kara Odom Walker when the initiative was announced.
Meanwhile, groups like atTAcK Addiction continue to offer virtual naloxone trainings via Zoom to ensure community members have access to the overdose-reversing medication. The Behavioral Health Consortium has continued similar outreach efforts during the pandemic, which have included getting food, clothing and naloxone directly into the hands of those in need.
The state also partnered with the Behavioral Health Consortium to provide health screenings for COVID-19 during outreach efforts and house the most high-risk people for catching and spreading the virus in rented hotel rooms in Wilmington and Georgetown.
The question will be just what the state can maintain as leaders try to prevent the spread of one pandemic while managing an epidemic that much more silently – and for much longer – has daily claimed the lives of Delawareans.
What's killing Delawareans
Reports by both the Delaware Division of Forensic Science and the federal Drug Enforcement Administration released in recent months show that fentanyl, a synthetic, highly addictive opioid, continues to drive drug deaths here.
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Not only was it present in 341 of the 431 deaths, but it's also being found in drugs other than heroin. Take cocaine, which appeared in more drug overdose deaths than heroin last year, according to state data.
Similarly, the DEA found fentanyl present in 95% of "heroin-positive" drugs seized by them and their law enforcement partners, according to the annual "Drug Situation in Delaware" report.
Between the allure of straight fentanyl for drug dealers hoping to reap a more profit and the high-purity heroin found locally – largely coming from Philadelphia – the DEA identified Delaware as a "critical chokepoint" for illegal opioids flowing along the East Coast, especially along I-95. Due to its location, drug availability in Delaware is especially high.
The state remains a hotbed for legally prescribed opioids, where despite a decrease in prescriptions, the state still ranks No. 1 nationally for the number of high-dose and long-acting opioids prescribed here.
New dollars in the fight against addiction
The high prescription rate is beginning to pay off in the form of the state's opioid impact fee, which in the first quarter brought in about $750,000 in tax revenue from the prescriptions.
The hope, according to advocates and state legislators who pushed for this fee, was to put the financial burden caused by opioid addiction back on the manufacturers and producers who created and brought this product to Delaware.
Funding recommendations for that money include a number of target areas like harm reduction, crisis prevention and quality treatment, as well as addressing social determinants of addiction and reaching special populations.
This could play out in the form of purchasing more naloxone, providing additional assistance for housing and employment to those struggling with substance use disorder, or obtaining more lockboxes for those using medication-assisted treatment to stave off withdrawal.
The key, Hall-Long said, is to identify the gaps in care that aren't already receiving state or federal funds and fill them with this new money, as the law prohibits these dollars from supplementing already existing efforts.
Humes, who lost his son to an accidental overdose and helped push for the creation of the impact fee, said he hopes those directly struggling with addiction will be included in determining where that money will be distributed.
How to get help
If you or someone you love is struggling with addiction, contact Delaware's Hope Line at 833-9-HOPEDE.
If there's a medical emergency or you believe someone is overdosing, call 911.
To connect with a specialist or get family support, go to drugfree.org/delaware for more resources.
You can also find more Delaware-specific information at HelpIsHereDE.com.
Brittany Horn is an investigative reporter at Delaware Online/The News Journal focusing on issues plaguing Delaware. Got a story she should tell? Contact her at (302) 324-2771 or email@example.com. Follow her on Twitter at @brittanyhorn.