A recent report from Allegheny County’s medical examiner on the number of overdose fatalities in 2017 contains both good and bad news.
For the fourth year in a row, the number of overdose deaths was the highest on record -- more than 735 people in 2017 -- but the rate of fatalities decreased in each subsequent quarter of last year.
Alice Bell, coordinator of the Overdose Prevention Project of the health care nonprofit Prevention Point Pittsburgh, said she believes the apparent improvement is due to increased access to naloxone, a medication that can revive people from overdoses.
“The Allegheny County Jail started giving naloxone to people leaving jail at the end of 2016,” she said. “And Pittsburgh city emergency medical services just recently started a program where, if they respond to an overdose, they can leave a naloxone kit behind. “
Hospital emergency rooms in the county are also giving naloxone to overdose patients to take home after they’re discharged. Bell said people might also be learning how to use opioids, including the fetenyl-based substance, more safely.
"Throughout history, with any kind of drug that becomes commonly used, people learn how to do it," said Bell. "So it may be that people are learning how to cut it more carefully or be more aware of it."
If there was cheaply available technology that allowed people to test the potency of their drug, Bell said that too would further reduce deaths.
County Medical Examiner Karl Williams, who issued the report, agreed the positive trend is likely due to increased naloxone use. Williams said he's also not sure it will continue, because he’s seeing new fentanyl-related opioids in autopsy results all the time. Drugs must be scheduled, he explained, meaning they are classified into different categories based on potency and toxicity. The schedule number of the drug often determines its legal status.
“You can’t even begin to understand the complexity of what’s out there available to be consumed," Williams said.
Both Williams and Bell said that to make a lasting dent in the epidemic, leaders will need to expand rehabilitation services using evidenced-based practices, which includes treatment programs that use pharmaceuticals to lessen opioid dependency and ease withdrawal. Many programs are only abstinence-based, Bell said.
"The evidence shows that what's effective is suboxone and methadone," said Bell. "Yet there are many programs that offer those types of treatment, we even see residences, recovery houses, different places that don't even allow people to live there because they're taking methodone or suboxone."