West Virginia has the highest per-capita drug-overdose death rate in the country. And while the Centers for Disease Control and Prevention has reported a recent decline in overall drug overdose deaths nationwide, deaths involving fentanyl, a synthetic opioid, are on the rise. West Virginia leads the nation in that rate as well.
According to the CDC, fentanyl can be up to 100 times more potent than morphine, many times stronger than heroin, but drug users are often unaware that the heroin they’ve purchased has been laced with the drug.
Health care professionals are understandably alarmed at the rising prevalence of fentanyl, and in West Virginia they’re acting on several fronts.
In a recently released paper, researchers at the West Virginia University School of Public Health report on a joint effort of the WVU schools of public health and pharmacy and the state’s chief medical examiner to monitor drug-related deaths in order to more accurately pinpoint life-saving initiatives.
They’re mining a forensic drug database maintained at the WVU Health Sciences Center that includes every drug-related death in the state. It documents cause of death and demographic information and other medical conditions, with the objective of detecting trends in drug-related deaths.
The researchers also advocate for wider distribution of naloxone, a drug that reverses the effects of opioid overdose, an effort in which the school of public health has taken an active role.
“Naloxone really is the miracle drug,” said Gordon Smith, an epidemiologist in the School of Public Health. “We have this very, very effective reversal agent that can keep people alive.”
“While in the long-term, effective treatment and getting people off drugs is the answer,” Smith said, “you have to be alive to be able to get you off the drugs and get you into long-term treatment.”
The School of Public Health is also actively involved in addressing that longer-term objective, with a model program that uses peer recovery specialists to engage overdose victims and others with opioid-use disorder and helps get them into treatment and recovery.
With his WVU colleagues Marie Abate and Zheng Dai, Smith coauthored “Fentanyl and fentanyl-analog involvement in drug-related deaths,” funded by the National Institutes of Health and just published in the journal Drug and Alcohol Dependence.
The research team found that deaths from fentanyl in West Virginia continue to rise, with 368 in 2016 and 553 in 2017. One factor, they write, is a surge in illegal fentanyl imports from China.
The CDC reports that of the more than 70,200 drug overdose deaths estimated in the country in 2017, the sharpest increase was in deaths related to fentanyl and fentanyl analogs, with more than 28,400 deaths.
Smith believes detailed data can help curb this trend.
“We’ve been working for a while now here at WVU in collaboration with the medical examiner’s office to develop what’s really a very unique database,” he said. It’s aimed to provide health care providers and law-enforcement officers with insight into trends as they unfold.
The data can, for example, help decipher the chemical makeup of a fentanyl analog that just hit the streets or the combination of drugs involved in an overdose.
“West Virginia is one of a very limited number of states that has a very complete death investigation system,” Smith said, “and as a result, we have very, very good statistics.”
Statistics from the National Center for Health Statistics, Smith said, generally simply state that someone died of a drug overdose, “and it’s often very difficult to know the multiple drugs that are involved.”
This research was launched, he said, when medical examiners began noticing an increase in the number overdoses in which the level of each individual drug wasn’t sufficiently high enough that you would expect a person to die. It was, rather, a mixture of drugs.
“One of our significant findings is that it’s not just fentanyl,” Smith said. “It’s a whole mixture of different drugs that people are taking.”
“What we think is the most important part of our research is the ability that we have to monitor the changes in drug use over time,” he said.
What “really frightens us,” Smith said, are the fentanyl analogs. “There’s a particular drug called carfentanil that’s 100 times stronger than fentanyl. This was never used in humans; it was developed for anesthetizing elephants.”
“We’re absolutely terrified,” he stressed, of not only this drug but others that have never been tested. “An important part of our program of research is to be able to monitor, ‘What are the current drugs that people are dying from? And how do we need to modify our strategy?’”
Breaking the Cycle
The Health Sciences Center database can also suggest where greater access to naloxone is most urgently needed. Naloxone, Smith asserted, is “an important part of this multifaceted prevention program to stop people from dying of drug overdoses.”
Herb Linn, the WVU Health Research Center’s program director for collaboration and communication, helped launch the West Virginia Rapid Response Program when he was with the WVU Injury Control Research Center and has continued this work at the research center.
The Rapid Response Program was a partnership of the state Department of Health and Human Resources and the Injury Control Research Center that received funding from the federal Substance Abuse and Mental Health Services Administration to purchase and distribute naloxone kits throughout the state.
Linn believes hundreds of West Virginians have been saved through the administration of naloxone. But, he added, “we’ve got to think more systematically about how to … take these opportunities to engage people to try to help them break out of the cycle of addiction.”
Among the initiatives in which Linn’s involved is a CDC-funded project through the West Virginia Bureau for Public Health to engage overdose survivors in emergency departments, connecting them with peer recovery coaches, treating them with buprenorphine for their withdrawal symptoms and helping them get into long-term treatment.
“We’ve got to keep getting [naloxone] out there,” Linn said, “and then we have to build up a systematic approach to helping people break that cycle.”