14 minute read
The Overdose Event
THE Overdose
As we appear to be in the waning stages of the COVID-19 pandemic, drug abuse and overdose-related deaths continue to rise at alarming rates on both the local and national stages. Every day in Pennsylvania ten people die as a result of some form of substance abuse disorder. The National Institute on Drug Abuse reported that in 2019 close to 50,000 people in the United States died from drug overdoses. And the Center for Disease Control recently released data that pushes drug overdose deaths to over 90,000 in 2020. Upon hearing drug overdose statistics, victims receive very little empathy from those in the general public who don’t understand the nature of the problem.
Prescription opioids are especially dangerous. According to the pa.gov website, long-term dependence on a prescription opioid becomes a very real possibility after only five days of use. That means the problem could become a reality for just about anybody being treated for serious pain. As a result, abuse of opioid drugs has been on the rise since the 1990s when healthcare providers began to prescribe opioid pain relievers at an increasing rate.
EV ENT
By David A. Kostival
Berks County has not been immune to any part of the crisis. According to the overdose fatality reports provided by the Office of the Berks County Coroner, in 2020, there were 130 confirmed deaths from overdoses, which was up from 126 the previous year. And the fatality reports, as of October 31, 2021, have reached 137. While the toxicology reports are still outstanding for 2021 overdose fatalities, the crisis in Berks County continues to escalate.
BATCH OF DRUGS CAUSED OVERDOSE SURGE
The impact of the crisis was really driven home the weekend of September 11 and 12 when Berks County experienced an extreme surge of 101 overdoses and three deaths from what was reported as a bad batch of drugs. Berks County District Attorney John Adams said this was an isolated incident because of the uniqueness of the drug combinations that were discovered in the packets that caused the overdoses.
“I think that this incident brought to light that this was a blackeye on our community and we really need to address the use of drug use and drug abuse,” Adams said. “So many overdoses in such a short period of time is somewhat of a black mark, but it hits home that we need to make the efforts from a global perspective, not only from law enforcement, but also treatment facilities and resources to attack this problem.
“We can’t let our foot off the pedal,” Adams emphasized. “We have great resources in our community. We have to engage those most in need and make sure they get the appropriate services and hopefully stop using controlled substances.”
NO QUALITY CONTROL IN STREET DRUGS
The September overdose incident was a result of a lethal mix of drugs sold to unsuspecting users. “When buying drugs in the street, there is no quality control,” Adams noted. “I am fairly certain that no one knew that this drug (Butonitazene) was in there, as this drug has not been seen very often.” But the incident does raise a lot of concerns for those involved in enforcement and treatment. “In this situation, we reacted and we stamped out the source quickly, but that does not mean the source has been stamped out completely,” Adams shared. “For our purposes, this is an on-going investigation which will continue until we can stamp out what we believe is the ultimate source.”
Adams explained that after he was tipped off that there was a problem that weekend in September, he contacted his detectives who responded immediately.
Within 24 hours, a search warrant was issued which closed down one of the suppliers.
“This was quick work by the detectives from my office and from the Reading Vice,” Adams continued. “And that led to a second search warrant to be executed within 48 hours, which stamped out the two sources.” By Sunday afternoon, two individuals were taken into custody and charged with felony drug charges and on Tuesday, three others were arrested and charged with possession with intent to deliver.
DANGEROUS AND POTENTIALLY LETHAL SIDE EFFECTS
Dr. William Santoro, chief of the division of addiction medicine at Tower Health, explained the dangers of Butonitazene, saying it has a high dependency potential as well as dangerous adverse side effects. “Butonitazene is an analgesic opioid of the benzimidazole opioid class, which acts as a powerful analgesic, hypnotic, and sedative,” Santoro said. “Vomiting and respiratory depression may occur at high doses. You can only buy Butonitazene online as a designer drug for chemical research.” Santoro warns that the adverse effects can potentially be fatal, and the real danger for drug users is the unknown factor. But Santoro added that it is still unknown what proportion of butonitzazene was used in the September overdose concoction. “Although it appears that butonitizene was the culprit, it is still not a one-hundred percent certainty that it was the sole cause of the problem,” Santoro said. He also noted that Fentanyl is a typical adulterant to almost any illicit product sold on the street. But there are others.
“This includes methamphetamine, cocaine and even marijuana,” Santoro added. Although the mixtures often use over-the-counter drugs, Santoro advised it is best not to publicly identify them. “Since we don’t know what chemicals these drugs are mixed with, we don’t know what the interactions are or even what the action of the original substance will be,” Santoro said. “We end up treating symptomatically based on how the patient presents until we can definitively determine what drugs are in play.”
Santoro emphasized a very real danger of unknown chemicals in the drugs is that the administration of Naloxone doesn’t always have the desired effect. Naloxone – more commonly known by its brand name Narcan – is a medication which is designed to rapidly reverse opioid overdose. When it comes to the source of powerful drug mixes, Santoro shared that he stays away from speculation as to what is the philosophy of those amateur chemists. But Santoro said he worries about the users. “These people who are using are not in a normal frame of mind,” he added. “It worries me when we see depictions on TV which show people using drugs thinking straight.”
TOO MUCH STIGMA ATTACHED TO DRUG ABUSE
Santoro emphasized that he has been a big anti-stigma campaigner for many years.
“People who are addicted do not want to be addicted, and because of the stigma, they don’t get treatment,” he said. Santoro related a conversation he once had with a friend who indicated he was frustrated with the overdose situation and how it was taxing the health care systems. “He believed a solution would be to limit the number of times a person could be saved to three,” Santoro shared. “Six months later, this same person was reaching out for prayers for his son who had overdosed. Until it affects them personally, they feel like it is someone else’s problem. I don’t want people to have a moment like that,” he added. “We have to learn about it without having to see first-hand the pain and devastation it causes.” Santoro stressed that people should not be defined as addicts,
but rather as having a medical condition. “I may have high cholesterol, but I am not defined as high cholesterol,” he explained. Santoro noted that the COVID-19 pandemic only made the opioid crisis worse.
“Addiction is a disease of isolation,” Santoro explained. “Because of the pandemic, people were appropriately told to shelter in place and isolate. While this might be good for the pandemic, it was not very good for people with a substance use disorder.” He likened it to telling a person with an alcohol problem to hang out in a bar. “It’s setting them up with a difficult situation,” Santoro said. “People use when they are alone.”
BRINGING FOCUS TO THE DISEASE
But Santoro said he remains the eternal optimist that progress is being made.
“We are making ground in that we are turning the lights on this disease,” Santoro concluded. “My friends in oncology are not looking to cure cancers, but looking for better treatment and better outcomes. The same can be said here. We have better treatments and are making progress.” Marcia Goodman-Hinnershitz, the director of planning and resource development for the Council on Chemical Abuse said a takeaway from the September overdoses is to better strategize. “We have to make sure all the data is collected so that we are able to understand the nature of the overdoses, which will better enable us to target our strategies to the problems more directly,” Goodman-Hinnershitz said. While the user never really knows what mix of chemicals they may be taking, Goodman-Hinnershitz advised that it is not effective to use this as a scare tactic. “We don’t use scare tactics, but rather educate people with their decision making,” she noted. “We have to be realistic in knowing that people will use, so we have to make education accessible to everybody.” Goodman-Hinnersitz said that in the wake of the September overdoses, she has seen growing concerns in communities.
INCREASED ACCESSIBILITY OF NARCAN
“I think there has been continual concerns that we have to build our resources,” she shared. “One of the areas we focus on is to expand accessibility to Naloxone (brand name Narcan®), a medication that can reverse an overdose caused by an opioid drug (i.e. prescription pain medication or heroin). The Council on Chemical Abuse, in collaboration with the SOS Berks Opioid Coalition, promotes the availability of Narcan® to the community on
the whole through community wide informational mailings and distribution at health fairs. Initiatives have also been targeted to populations at higher risk for opioid overdoses including individuals served by the criminal justice and drug and alcohol systems.
OUTREACH TO THE UNDERSERVED
Bernice K. Hines-Corbit, the case-management supervisor for COCA, said it is important to reach out to the groups who are underserved. “We have stepped up our outreach efforts and are working more collectively with Centro Hispano (the Hispanic Center in Reading) and the NAACP,” Hines-Corbit said. She added that COCA is trying to get education into the community through health fairs and community events. “COCA is here for the community,” she explained. “We’re here and we can help the uninsured and the under-insured. We want to see more treatment access and remove the barriers. It’s a work in progress and we are always looking for new groups to reach out to.”
UNDERSTANDING THE DEPTH OF THE PROBLEM
Stanley J. Papademetriou, COCA’s executive director, stressed that the results of the September overdoses clearly demonstrated a true collaborative effort in Berks County. “The system worked,” Papademetriou said. “The hospitals responded and law enforcement was able to cut off the supply in a relatively short period of time. Only three deaths occurred. That’s three too many, but that could have been a lot worse.” Papademetriou added that a key to combatting the crisis is the availability of the resources in the community and the stakeholders in the community working collaboratively and highlighting the work to let people know they are there. “We’re cautiously optimistic that we will start to see the numbers coming down,” he shared. “We don’t know and can’t tell what effect the pandemic has had. We can’t assume one way or another.”
“But I do believe that services are out there and more and more people understand the depth of the problem,” Papademetriou explained. “Many people don’t realize how pervasive the problem really is, as many people do not look at local news. Community awareness is a big part of this.”
Papademetriou said the September overdoses amounted to poisonings of unsuspecting users. “That’s why it was extremely important that local law enforcement found where the source was and stopped it,” he noted. “We’ve done some outreach and found many do not realize what they are actually buying.”
Papademetriou places an emphasis on the idea that what happened in September can’t just be forgotten but has to remain at the forefront of the whole community education process. “When it happened, it made a big splash in the media and then it just disappeared,” Papademetriou concluded. “We never hear the aftermath; it is just dropped.” “It goes beyond the initial story,” he added. “This was a bad drug that really hurt people and that could hurt people for years to come. This really has to be about community awareness.”
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THE OVERDOSE EPIDEMIC IN BERKS COUNTY
by Coalition Co-Chairs: Kevin S. Barnhardt, Commissioner, County of Berks, and Stanley J. Papademetriou, Executive Director, Council on Chemical Abuse
The overdose epidemic in Berks County continues to rage and as is fitting much attention has been given to the crisis. The number of deaths continue to rise and in fact 2021 looks like it will eclipse the previous two years as the worst year for overdose deaths in Berks County. An added stressor to our community was the recent ‘overdose event’. During a 36-hour period in September over 100 individuals experienced an overdose, most of whom required hospitalization. The ongoing wave of overdoses in our community does not appear to be receding. It is imperative that the community continues to face and address the overdose crisis here in Berks County. However, there is an issue that is lurking in plain sight and not receiving the attention it deserves. That is alcoholism and alcohol use disorders.
The SOS Berks opioid coalition focuses primarily on opioids and overdoses. However, we have seen the need to bring to light the fact that alcohol use has been and continues to be an issue in our community. Studies show that alcohol use has increased dramatically during the COVID-19 pandemic and the stress that comes with uncertainty has given rise to increased alcohol use.
However, to be clear, the COVID-19 pandemic has not caused alcohol related issues – they have always been here with devastating effects. According to the Centers for Disease Control, alcoholrelated causes are the third leading cause of death in the United States. Health related issues, motor vehicle crashes, suicides and accidents account for thousands of deaths each year.
Excessive alcohol use and alcoholism are significant contributors to violence and crime. Assaults, homicides, domestic violence, as well as other crimes, can be linked back to excessive alcohol use. It is no secret that the jails and prisons have a significant number of inmates who committed crimes while under the influence of alcohol.
Excessive alcohol use over time can create many adverse health effects. High blood pressure, liver disease, heart disease and digestive problems are not uncommon for those with an alcohol use problem. Families are significantly impacted, in some cases for generations, due to the effects of alcohol use disorder and alcoholism. The emotional, physical and psychological toll that alcoholism has on families is enormous.
Alcohol use disorders tremendously impact individuals, families, loved one and the community as a whole. But there are also significant economic impacts. The CDC estimates that alcohol use-related issues costs our society $200 billion annually (that is a two followed by eleven zeros). These costs are related to law enforcement, prisons, and healthcare as well as job-related lost productivity.
While alarming, none of this is news. These problems have been with us for decades. What makes alcohol-related problems so insidious is that alcohol use is socially acceptable and, depending on the venue, is promoted. Most people who use alcohol can do so responsibly and without devastating consequences. But not everyone who uses alcohol can do so in that manner. Some develop an alcohol use disorder marked by the diminished ability to control one’s alcohol use and/or undergo physiological changes in response to the alcohol use.
There are others who may not develop an alcohol use disorder, but who experience binge drinking. The National Institute on Alcohol Abuse and Alcoholism defines binge drinking as a pattern of drinking alcohol that brings the blood alcohol concentration to 0.08 percent or higher. While not all those that binge drink automatically develop an alcohol use disorder, a consistent pattern of drinking in this manner very well could result in health, legal, interpersonal or economic problems.
Again, alcohol-related problems are not new. The consequences of such problems can be disastrous. However, the good news is people can and do get better from an alcohol use disorder. Receiving appropriate treatment and making healthy lifestyle changes is the first step for many in getting better. There is no magic pill or single road for someone to overcome such a problem. Our community has tens of thousands of individuals who have overcome an alcohol use disorder. They are living proof that people can and do get better. There is plenty of help available in Berks County. For those experiencing an alcohol problem and for those living with someone with an alcohol problem, there is always hope.
