Undetermined

 

Opioid deaths are generally classified as accidental overdoses. In 2017 Massachusetts began reporting opioid deaths as “All Intents” where they previously reported them as “Unintentional/Undetermined.” They point out that adding suicide deaths only marginally adds to the count. By their statistics only 2 percent of the total opioid deaths were confirmed as suicides.

Massachusetts Opioid Death Data

Connecticut reports opioid deaths under the term accidental drug related deaths. If a person left a suicide note, and then injected themselves with heroin, they would not count in the state’s totals.  In most cases, it is hard to say with determination the overdose was a suicide.

An article published on March 28 in Medscape asks “How many Opioid Overdoses Are Suicides?” It offers fairly persuasive arguments that the numbers are much higher than reported.

How Many Opioid Overdoses Are Suicides?

Dr. Maria Oquendo, the past president of the American Psychiatric Association, is quoted as saying based on published studies, the suicide rate could be anywhere from 24 to 45 percent of all opioid deaths.

Should this change the way we view the current crisis? I don’t think so. There is a strong link between addiction and mental illness. I have read many articles that speculate that many users use not just because their brain has been rewired by the opioid overloading their circuits, and replacing the normal human drives for food, sex, and protection of our children with the need to use heroin, but because fundamentally many people use opioids to escape loneliness, shame, and despair.

One argument made along these lines is the fact that supposedly 90% of Americans addicted to heroin in Vietnam came home and were able to kick the habit because they were put back in places where they had strong support networks, families and jobs so they could function as members of society.

What Vietnam Taught Us About Breaking Bad Habits

The other argument involves the famous rat park study. Previous studies showed rats would drink drugs until they died. Another researcher on learning that the rats, social animals by nature, were kept confined in small cages with no interaction with other rats, went ahead and built a rat amusement park where they had food, running wheels and lots of companionship including rats to mate with. Guess what? The rats drank 19 times less opioid solution than the rats that were kept in isolation. Even rats that had been in isolation and were addicted, when put in the rat park, stopped using the drugs.

Rat Park Addiction Study

What did that experiment show? Isolation and despair led to addiction while social interaction helped avoid it.

When we treat users like human garbage and berate them, and then release them from the ED two hours later in withdrawl with the instructions to stop using heroin, how can we expect them not to use a drug that if only for a short while will make them forget about how bad their life has become?

I think many people addicted to drugs who have fallen to the bottom may not have the strength to climb back up. Some may just give up. Maybe one night, instead of doing five bags of No Evil, they decide to do ten.  Goodbye world.

Accident or suicide?  You can call it undetermined.  But either way, another human being is lost to us.

Connecticut Overdose Deaths Plateau

 verdose deaths are declining in some states, and they appear to be plateauing in Connecticut.

Overdose Deaths Fall in 14 States

In data released by the CDC, covering the time period July 2016-June 2017, 14 states showed a decline in overdose deaths, while nationwide deaths rose 14 percent. The data showed an 15.9% increase in Connecticut, but even more recent data released from the Connecticut Medical Examiner’s office tells a more promising story. 

Number of Connecticut overdose deaths surpassed 1,000 in 2017

While deaths increased by 11.7 percent in Connecticut between 2016 and 2017, the last six months of 2017 showed a 8.7% decrease from the first six months of the year.

This is still a horrendously high level of overdose death, and it may only represent a temporary lull before escalating, but it does reflect what I have been sensing lately.   Over the last several months, 911 calls for overdoses are still abundant, but they don’t seem to be getting worse.

As to why the death rate may have plateaued, it is an open guess. The increased availability of community Naloxone may be a contributor. Also, perhaps, the knowledge that much of the heroin in Connecticut is either heroin (and cut) laced with Fentanyl  or just plain cut and Fentanyl, has caused users to use more caution, doing test shots and making certain they are using with someone else, and have Naloxone available.   Without better data, it is hard to say for sure.  At any rate, the decline in the latter half of 2017 is at least promising.

Graphs by P. Canning based on Medical Examiner's data and published news stories.

(Note:  These graphs were updated on March 1 to refelect Medical Examiner's official number released on this day.  They were slightly different from previously published news reports.)

Calendar Years 2012 to 2017 Accidental Drug Intoxication

Connecticut Drug Deaths Top 1,000 Last Year; Fentanyl Jumps As Heroin Declines

Mother and Son

 

She curls on the couch sobbing. She found her son not breathing when she came home from her midnight shift. He is on the floor now.  The fire department first responders do compressions on his bare chest.

The man is lean and muscled with jailhouse tattoos on his arms, chest, and neck. It isn’t a stretch to think heroin.

His mother’s boyfriend confirms this to us. The man on the floor was a user.  They argued about it every day, but he kept using. Two torn heroin bags are found on the floor.

We work him for twenty minutes with no response.  Asystole throughout.  His skin is cool, his pupils fixed and dilated. There is already some stiffening in his jaw. We call the hospital for permission to cease the resuscitation. It is granted.

We remove the airway,  electrodes and defib pads and place them along with our gloves in the bag the ambu-bag came in.

His mom kneels over him now, kissing his face, her tears falling on his cold skin. “Vente conmigo, vente conmigo, “ she cries.  Come with me, come with me.  “No te vaya, no te vaya.” Do not go, do not go. “Mi nino, mi amor, mi corazon, te quiero.” My son, my love, my heart. I love you. “Vente conmigo, no te vaya.”

I stand by his feet holding a clean white sheet.  I am motionless.

Mother and Son

 

She curls on the couch sobbing. She found her son not breathing when she came home from her midnight shift. He is on the floor now.  The fire department first responders do compressions on his bare chest.

The man is lean and muscled with jailhouse tattoos on his arms, chest, and neck. It isn’t a stretch to think heroin.

His mother’s boyfriend confirms this to us. The man on the floor was a user.  They argued about it every day, but he kept using. Two torn heroin bags are found on the floor.

We work him for twenty minutes with no response.  Asystole throughout.  His skin is cool, his pupils fixed and dilated. There is already some stiffening in his jaw. We call the hospital for permission to cease the resuscitation. It is granted.

We remove the airway,  electrodes and defib pads and place them along with our gloves in the bag the ambu-bag came in.

His mom kneels over him now, kissing his face, her tears falling on his cold skin. “Vente conmigo, vente conmigo, “ she cries.  Come with me, come with me.  “No te vaya, no te vaya.” Do not go, do not go. “Mi nino, mi amor, mi corazon, te quiero.” My son, my love, my heart. I love you. “Vente conmigo, no te vaya.”

I stand by his feet holding a clean white sheet.  I am motionless.

Happy New Year

 

On a private employees’ group Facebook page, an EMT posts a video of a man standing on a street corner, clearly on the nod, asleep on his feet. Another man sneaks up on the nodding man.  He reaches back and then slaps the heroin user hard across the face with an open fist. The victim grabs his head and starts running blindly down the street as if he has been attacked by aliens. The assailant meanwhile has hidden on the other side of the street. The video is captioned: The New Narcan.

The video gets a few almost instantaneous laugh out loud positive comments before it is taken down by a board administrator for being inappropriate.

An EMT has a bumper sticker on his car that reads “I Narcaned your honor student.”

A first responder gets suspended for 90 days for a Facebook rant about how he hates giving Narcan and declares, “Let the s-bags die!”

When people talk about the stigma of being a heroin addict, this is what they are talking about.

Nearly every case where I bring someone back with Narcan, the response is “I don’t do drugs. I don’t know what you’re talking about." Addiction is a club not even its members want people to know they belong to.

Imagine:

A paramedic posting a video of a stranger stomping on an old woman laying on the ground with a hip fracture.

A bumper sticker that says "I CPAPed your grandfather!"

A paramedic posting on Facebook: "I hate giving epi to anaphylactics. They chose to eat those cookies without checking to see if they were produced in a place that processes nuts."

In the HBO documentary Heroin Cape Cod USA, a mother jokes that when a family member is sick, neighbors usually bring casseroles. She has never gotten a casserole, sympathy card or offer of help for her daughter's severe illness-- an addiction to heroin.

Imagine the note:

"Thinking of you, hope Sally Ann beats the Dragon. We're praying for you."

I try to imagine a better world.

A video of EMTs giving jackets to homeless people.

A peace sign bumper sticker.

Facebook posts about volunteering at the local shelter.

A Go Fund Me page for a family devastated by addiction.

I look around. I have seen all of these things too.

It is easy to complain about the bad, but the world is full of goodness and good people.

I hope 2018 brings out our country’s best.

Happy New Year everyone!

Stay safe.