COVID-19 may be the fuel propelling an explosion in drug overdose deaths in Mississippi and nationally.
It’s been “like pouring gasoline on a fire,” as one law enforcement official said.
Drug overdose deaths soared nationally to the highest number ever recorded. In Mississippi, they rose 26% in the 12 months ending in May.
Provisional data from the Centers for Disease Control and Prevention shows 81,000 Americans died from a drug overdose, which included the months when cities were in lockdown because of the coronavirus.
In Mississippi, deaths rose from 360 between June 2018 and May 2019 to 453 between June 2019 and May 2020, according to the Mississippi Department of Health.
Steven Maxwell, director of the Mississippi Bureau of Narcotics, released even more startling numbers, showing the number of all overdose deaths is on track to double in 2020 what it was in 2017 — from 261 in 2017 to the preliminary 419 in 2020.
Those overdose deaths include prescription drugs, opioids, and illegal drugs such as heroin, fentanyl, methamphetamine and even marijuana.
“Part of the problem with COVID is with people not being able to see their physicians. And if you can’t get to your physician, you turn to street drugs,” said Susan McCoy, executive director of the Mississippi Board of Pharmacy.
Overdose deaths were already increasing in the months preceding the novel coronavirus disease pandemic, but the CDC says the latest numbers suggest an acceleration of overdose deaths during the pandemic.
Nationally, according to the CDC, synthetic opioids — primarily those illicitly manufactured — appear to be the primary driver of the increases in overdose deaths, increasing 38.4% over a year’s period leading up to June 2019 compared with the same period leading up to May 2020.
The CDC says overdose deaths involving cocaine increased by 26.5% and those involving psychostimulants, such as methamphetamine, rose by 34.8%.
Although surveillance data cannot answer what has caused the opioid epidemic, nationally and in Mississippi, it has been attributed first to prescriptions and then an increase in heroin overdoses, followed by increases in illicit fentanyl, said Meg Pearson, director of pharmacy at the Mississippi State Department of Health. “A fourth phase has sometimes been described to include methamphetamine.”
It has been speculated that reduction in access to prescriptions may "squeeze the balloon,” she said.
Dr. David Vearrier, professor of emergency medicine at the University of Mississippi Medical Center and toxicologist with UMMC’s Mississippi Poison Control Center, explained that the trends in Mississippi mirror the nation’s sharp increases in cocaine and methamphetamine deaths. UMMC has seen an increase in deaths from illicit opioids — fentanyl and fentanyl analogs — but not to the same extent as seen nationally, he said.
In 2018, he said, the national mortality rate for synthetic opioids was 9.9 per 100,000 — four times greater than the rate in Mississippi. The national mortality rate for prescription natural and semi-synthetic opioids was 3.8 per 100,000, which Mississippi trailed at 3.1.
Mississippi has also seen an increase in heroin-related deaths, “although we have a lower mortality rate than the country as a whole (1.3 per 100,000 in Mississippi versus 4.7 per 100,000 in the United States overall),” he said.
The opioid epidemic, spurred by over-prescribing, has been the focus of drug intervention in recent years. But a collaborative effort of various state agencies, stiffer regulations and education resulted in fewer prescriptions being written.
Vearrier said Mississippi operates a prescription drug monitoring program that allows physicians, pharmacies and certain state agencies to monitor the number of opioid prescriptions filled by patients in the state. Mississippi also shares that data with 31 other similar systems, mostly other states. Mississippi providers are required to check the program prior to writing any prescription for opioids.
Mississippi also has a standing order for naloxone that permits pharmacies to dispense it without a prescription, he said. That means anyone such as a family member who witnesses or is likely to witness an overdose an overdose to obtain naloxone to reduce the likelihood of death and other adverse health outcomes, he said.
The Mississippi State Board of Medical Licensure also requires prescribers with DEA certificates to undergo training related to prescribing of controlled substances every two-year cycle, Vearrier said. The board regulates prescribing of opioid medications.
For those already addicted, the decrease in prescriptions didn’t cure their addictions.
“It’s not just prescription drugs now. It’s street drugs mixed with fentanyl,” McCoy said.
Vearrier said synthetic opioids, including fentanyl and fentanyl analogs, are often sold as “heroin.”
“In some markets, 50% of interdicted heroin is actually fentanyl. The fentanyl is diluted, similar to what dealers do with heroin, but there is the potential for a strong batch of fentanyl to cause a jump in overdose deaths,” he said.
Addicts also may use prescription drugs in combination with heroin laced with fentanyl.
The pandemic also may have played a role in an uptick in opioid prescriptions.
Prescriptions of all opioid-containing drugs decreased almost 8% between 2012 and 2017 in Mississippi, while those of addiction treatment medications increased by more than 59%, according to the Health Department.
The number of prescriptions and dosage units began a steady decline in the third quarter of 2017 but began inching back up in the second quarter of 2018, according to the Mississippi Opioid and Heroin Collaborative.
By 2019, there were enough dosage units of opioids dispensed for every man, woman and child in Mississippi to have a supply of nearly 44 dosage units, ranking Mississippi fifth in the nation for per capita annual opioid prescriptions, according to Stand Up Mississippi, a statewide initiative to battle the opioid crisis in the state.
McCoy said she and others will have to analyze why the number of opioid prescriptions has risen after going through a steady decline since 2017 and keep an eye on the numbers.
Vearrier said he doesn’t think there’s enough data yet to tie increasing overdose deaths to the pandemic. There are other factors to consider, he said.
“To decrease the number of opioid deaths, we need to get Narcan (naloxone) into the hands of first responders” and then follow it up with treatment, said Shane Garrard, director of the Bureau of Alcohol and Drug Addiction Services for the state Department of Mental Health.
McCoy said there’s an ongoing problem of not enough treatment facilities to handle all these people needing help. Although stricter regulations and education in the medical community have helped, a lot of people still became addicted before those changes began.
Because Mississippi has not expanded Medicaid to low-income adults, many people affected by the epidemic without coverage lack access to medication-assisted treatment and other substance use disorder treatment, noted a May 2019 spotlight analysis, developed by Manatt Health in partnership with the American Medical Association and the Mississippi State Medical Association Mississippi.
In 2017, the Mississippi Department of Mental Health received $3.58 million in federal funding through the State Targeted Response to the Opioid Crisis to combat opioid addiction and overdose-related deaths.
“The federal grants DMH has received for opioid services have allowed for outreach and prevention services, such as Stand Up, but the majority of the funding goes towards treatment providers who are then able to provide services for people who would not otherwise have a payment source,” said Adam Moore, spokesman for the Department of Mental Health. “Funding also helps increase access to medication-assisted treatment. The prevention aspect of the Stand Up campaign has also included distributing Narcan, which can reverse the effects of an overdose, to law enforcement and first responders around the state.”
Moore said 2,416 people received medication-assisted treatment in fiscal year 2020, and the large majority of them, if not all, received that through the grant funding.
Also, Vearrier said, UMMC operates an Addiction Medicine clinic that offers medication-assisted therapy for opioid addiction and has a grant to start offering the therapy via telemedicine.
Garrard said expects the “true numbers” of opioid prescriptions will be up.
Because of education and regulation, physicians are rarely handing out 30-day supplies of opioids, he said. Now prescriptions are down to three- or four-day supplies, he said.
But, “we’re still on the forefront of this battle with opioids,” he said.
• Debbie Skipper is managing editor of the Mississippi Center for Investigative Reporting, a nonprofit news organization.