Substance abuse treatment expert on overdoses: ‘You have a recipe for disaster’

“This might get into a taboo conversation, but we are at a place, with the deaths of more than 100,000 people in 12 months, where I’m not too concerned about hurting people’s feelings. The harm reduction conversation is one that we need to have as a society. What that means is making sure that when, not if, people overdose by using narcotics, we as a society are prepared to help them,” he says.

Medications are available to reverse opioid overdoses, and individuals should be prepared to administer them, Mathews says. “Treatment is a long-term proposition. When someone is overdosing, that is a medical emergency, and there are life-saving drugs on the market. There are nasal sprays that can reverse an opioid overdose immediately and save someone’s life. I constantly encourage people, if you are in a community where overdoses are happening more and more frequently, get certified on the administration of Narcan—have Narcan readily accessible and available.”

Hospitals have a key role to play in the overdose crisis, he says. “Case management departments in hospitals can have resources available for somebody post-overdose if they make it to the emergency room. Hospitals can make sure that all emergency room staff and emergency medical technicians are trained on the administration of Narcan. They can make sure that Narcan is available at all times in the ambulance and at the hospital, so that they can bring somebody back from an overdose.”

After patients have been medically stabilized following an overdose, hospitals should be prepared to refer them for follow-up services, Mathews says. “There should be referrals to an addictionologist, to methadone clinics, to intensive outpatient programs, to residential detox programs, and to something as basic as an Alcoholics Anonymous meeting. An AA meeting can show these people that there is light at the end of the tunnel and there are resources to get help.”

Why overdose deaths are soaring

Although the cause of the spike in overdose deaths is multifactorial, Mathews says two primary factors stand out.

1. Increased abuse of fentanyl: “The first and most obvious factor is we have a meteoric rise of the new opioid fentanyl, which is 100 times more powerful than morphine. There are many instances of accidental overdose—even by people who did not know they were taking fentanyl. They think that they are taking something else, but it is fentanyl disguised. It is insidious,” he says.

The increased abuse of fentanyl is the result of a “logical progression” in the human body’s ability to build tolerance to opioids, Mathews says.

“For individuals who have a physical addiction to opioids, tolerance starts with taking more and more of the drugs. Then it moves to taking opioids in a different way such as crushing pills and snorting them. There is always a point where that particular substance stops giving the addict the desired effect. So, people find the next best thing. For a long time, that process ended with intravenous heroin abuse—that was the most powerful opioid that was readily available. Now, there is fentanyl, which makes traditional heroin seem safe,” he says.

2. Strain of the coronavirus pandemic: “The pandemic has been very depressing and anxiety inducing. For many people, their livelihood has been at risk, and they did not know what their future was going to look like. People had anxiety just going to the grocery store—they feared catching COVID-19 and giving it to their family,” Mathews says.

For many people, the temptation to self-medicate during the pandemic has been overwhelming, he says.

“Anxiety is a powerful motivator when it comes to a desire to escape, whether that is a beer, or a pill, or smoking a drug. Whatever it is, these drugs will do exactly what they are supposed to do and alleviate anxiety. With the coronavirus pandemic, I have never seen such a clear-cut example of society-induced anxiety. All at once, everybody walked into a new environment. We did not have the tools to cope. We did not know what was safe. There has been misinformation and the lack of information. On top of those factors, everything was closed down. So, you take people who are riddled with fear, and they are stuck in their homes. They could not even get out and see family. They could not engage in healthy coping skills that could alleviate anxiety such as physical exercise. Once positive coping skills were stripped away, anxiety reached levels higher than we have ever seen before,” Mathews says.

Coupling fentanyl with the pandemic has had cataclysmic consequences, he says. “You take people, you stick them at home, you remove their jobs, you increase their anxiety, and you give them the most powerful drug we have ever had. You have a recipe for disaster.”