Opioid overdose deaths jump in 2020

Advocates and healthcare workers point to isolation as a result of COVID and increase of fentanyl

Overdose deaths in Tennessee jumped nearly 50% in 2020 according to new data from the Tennessee Department of Health. Close to 80% of overdose deaths were caused by synthetic and prescription opioids.

Tennesseans living with addiction point to two major factors in the spike in overdose deaths: support systems interrupted by the COVID-19 pandemic and the increased presence of fentanyl, a highly potent synthetic opioid. These numbers put Tennessee on the leading edge of a rapidly progressing overdose crisis that claimed nearly 100,000 lives in the United States in 2020.

COVID-19 restrictions and precautions have threatened some of the most relied-upon tools for managing addiction: regular in-person meetings, peer-to-peer support, and the sense of connectedness that comes with a recovery community.  

Nathan Payne lives in Cookeville, Tennessee, where he works for the Lifeline Peer Project, a state-funded program staffed by individuals with personal experience managing addiction and recovery. “When COVID first hit, it was devastating to the whole recovery community, not just to the new people,” remembers Payne. “There were people with multiple years who are still not able to find their way back.”

Healthcare workers and individuals managing substance abuse note that addiction thrives on loneliness. Payne compared individuals managing addiction with canaries in the coal mine: highly sensitive to the larger trends in mental health exacerbated by a year of isolation. Per state prevalence data, 436,000 Tennesseans are living with a substance abuse disorder of some kind.

“Part of maintaining recovery for folks who have struggled with addiction is that you’ve built up support around yourself,” said Amie Little, a Peer Recovery Case Manager at the Sullivan County Anti-Drug Coalition in Bristol, Tennessee, an area of the state often overrepresented in opioid use and overdose data. “Some people need a lot of structure, rituals, to go to meetings—a lot of support that people build around themselves. When COVID happened it wrecked a lot of them.”

As rehabilitation centers and outreach programs have integrated COVID-19 safety precautions or deal with outbreaks, typical rhythms for accepting referrals have become less predictable and less reliable. Timeliness, predictability, and reliability are crucial to addiction healthcare.

“When someones ready to go to treatment, you got to catch them right then. That clarity comes and goes. Working with folks in the jail, we try to have them a bed and treatment for when they’re released,” said Little, who works specifically with individuals returning from incarceration. COVID-19 policies and protocols—requiring time for testing and quarantining—have extended and interrupted time-sensitive pathways to recovery. “I’ve had several clients die coming out of incarceration this year.” Individuals returning from incarceration are far more likely than the general population to die of overdoses.

According to Little, the continued criminalization of drug use has also contributed to the overdose crisis, particularly as it relates to fentanyl. Of the 3,032 overdose deaths that occurred last year, 66% involved fentanyl. That is up from 18% in 2016 according to the most recent data from the Tennessee Department of Health.

Those who work closely in addiction healthcare, like Payne and Little, are aware of the increased presence of fentanyl—“bad batches,” in Payne’s words. Fentanyl is a highly potent synthetic opioid that can trigger an overdose in very small quantities. Its presence in methamphetamines, cocaine, and heroin can be a deliberate attempt to heighten narcotic effects or the accidental result of cross contamination.

Marie Williams, Commissioner of the Tennessee Department of Mental Health and Substance Abuse Services, has overseen the State’s response to the opioid crisis since 2016.

 “We had a plan to deal with opioid abuse,” said Williams over the phone in late August. “However, as those came down, street drugs laced with fentanyl came up. The reason we’re seeing a lot of overdoses right now is not what we were seeing five or eight years ago around the pill overdose, it’s more the street drugs we’re seeing laced with fentanyl.” 

If fentanyl is present in a substance, individuals often don’t know beforehand and could face serious legal penalties for trying to find out. Test strips that allow users to determine the presence of fentanyl in street drugs are explicitly classified as drug paraphernalia under Tennessee law and carry potential felony charges. As jurisdictions around the country change punitive drug-testing laws, Tennesseans still can’t test street drugs for fentanyl without risking legal consequences.

There’s been isolation with COVID, yes, but this population is historically cut off from community. People with substance abuse disorder – the person of low socioeconomic status who’s smoking meth, especially with criminal justice involvement, are seen as drug addicts. Not community members. Making space for those people, bringing them in, enfranchising them, giving them their community and standin back . . . that works.

– Amie Little, Sullivan County Anti-Drug Coalition

When overdoses do happen, they do not have to be fatal. Naloxone, also known by its brand name, Narcan, is an effective way to reverse an overdose if administered quickly. Since 2018, the State of Tennessee has distributed over 200,000 Naloxone units that have been used to prevent an estimated 27,000 overdose deaths, per an internal report from August 2021. Narcan is effective but not always available and requires training for proper use. It can be found locally across Tennessee at the sites listed here.

If Narcan is not immediately on hand, calling 911 for emergency medical assistance while witnessing an overdose could come with a second degree murder charge. Tennessee’s Death by Distribution law, which went into effect in 2018, incriminates those involved in giving or selling someone drugs laced with fentanyl if that person fatally overdoses. The law was amended in 2019 to allow the state to pursue capital punishment.

Alongside its punitive laws, Tennessee’s response to the opioid epidemic includes a vast network of intervention initiatives, recovery resources, and addiction healthcare workers like Nathan Payne. The Department of Mental Health and Substance Abuse Services oversees an addiction services hotline (1-800-889-9789), administers Narcan and Narcan training, and employs and supports peer recovery specialists statewide. Its $498-million-dollar budget is likely to swell in the coming years as attorneys general close in on billion-dollar settlements with opioid manufacturers and distributors.

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