America’s ‘Other’ Health Emergency Needs Attention Too

Drug overdose deaths could surpass 100,000 in the U.S. for the first time ever

By John Meigs, Jr., MD

For the past 12 months, the nation’s medical community correctly and understandably focused nearly all its attention on the COVID-19 pandemic.  Now with millions being vaccinated, we are hopefully about to turn the corner and can begin returning our focus to a different health crisis that never went away and actually got worse during COVID.

That crisis is the drug overdose crisis, the epidemic inside the pandemic.

Research shows that more than 13 percent of American adults started or increased substance use to cope with stress related to COVID-19.  Unfortunately, many of the socially isolating steps that were necessary to combat COVID-19 are the same conditions where substance abuse flourishes.  

In Alabama, Jefferson County alone saw drug overdose deaths increase by 25 percent in 2020 to their highest level ever.  This mirrors national data, with the Centers for Disease Control (CDC) reporting the highest number of fatal overdoses ever recorded in the U.S. in a single year in the 12-month period ending in May 2020.  It’s likely the U.S. will surpass 100,000 drug overdose deaths this year for the first time ever.

Fortunately, Alabama is working with the CDC and other states to take statistics like these and turn them into action that ultimately reduces overdose deaths.

Through the Overdose Data to Action program, Alabama is improving its collection of comprehensive and timely information on non-fatal and fatal overdoses.  This helps the state to monitor and understand emerging trends, then drive effective prevention and response solutions tailored to the needs of individuals and communities.

For example, before becoming part of the Overdose Data to Action initiative, Jefferson County received data on overdoses only once a year.  Now it has access to that important information within 24 hours.  With that data in hand, the Jefferson County Department of Health identifies overdose hotspots and mobilizes rapid response teams with physicians, addiction specialists and peer counselors to target recovery and prevention resources to those neighborhoods being hit hardest by drug overdoses.  Plans to replicate this model for other Alabama counties are being developed.

Timely, evidence-based information and collaboration are essential for success in preventing overdose deaths.  First responders, mental health providers, community organizations, public health leaders, medical personnel and others all bring resources and expertise to this effort.

Physicians in Alabama and across America are certainly part of this effort.  We’ve fought to pass legislation to reduce prescription drug abuse and diversion.  Thousands have accessed continuing medical education and other intensive courses on substance use disorders.  In fact, the Medical Association of the State of Alabama was one of the first in the nation to offer an opioid prescribing education course.  Since 2009, we have reached more than 5,000 prescribers with information on the safe prescribing of opioids.  Since 2018, the number of times health care professionals in Alabama have accessed the state’s Prescription Drug Monitoring Program has increased by more than 20 percent, and Alabama physicians have reduced their prescriptions of opioids by more than 34 percent since 2014.  

All these collaborative efforts and more are needed as our nation’s drug overdose crisis evolves into an even more complicated and dangerous epidemic, due primarily to the pervasiveness of fentanyl.

Overdose deaths involving prescription opioids have steadily declined, but overdose deaths related to illicitly manufactured fentanyl and related fentanyl analogs increased nationwide by more than 500 percent between 2015 and 2019, according to the CDC.

Fentanyl, a painkiller that is 100 times more powerful than morphine, is the number one cause of overdose deaths in the United States today.  So powerful and lethal is fentanyl that if you were to swallow, inhale or absorb just two milligrams of it through your skin, you would die.  To appreciate just how small two milligrams is, consider that the packet of sweetener you’ll find on most restaurant tables is about 1,000 milligrams.

When police in Brookwood recently seized two pounds of fentanyl during a traffic stop, the former U.S. attorney who said it was enough to kill nearly every resident of Jefferson County was not exaggerating.

For years, fentanyl has been mixed with illegal drugs like heroin.  Today, however, we are seeing more instances where fentanyl is pressed into counterfeit pills to resemble prescription opioids.  Such was the case in Muscle Shoals last year where police found pills that were being sold by a drug dealer as Oxycodone but were actually pure fentanyl.  This takes the drug overdose crisis to a new and more dangerous level.  Everyone who obtains any drug from an illicit source should know they are at tremendous risk of a fatal fentanyl overdose. 

With the number of new COVID cases and deaths finally heading in the right direction, we must renew our attention and focus on America’s “other” health emergency, the overdose epidemic.  Significant efforts by health professionals, advocates, law enforcement and government are being made to address this crisis.  With even more attention, collaboration and resources, countless lives can be saved.

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Dr. Meigs has practiced family medicine in Bibb County for more than 30 years and serves as President of the Medical Association of the State of Alabama.