Data and health directors' observations suggest that pandemic lockdown increased overdoses, which declined as state reopened

Graph from Kentucky Injury Prevention Research Center, University of Kentucky

By Melissa Patrick

Kentucky Health News

Apparent overdoses reported by Kentucky hospitals and ambulance services shot up in the two months after Gov. Andy Beshear declared a state of emergency because of the covid-19 pandemic, and have been on a downward trend since the state started reopening in mid-May.

"I don't want to give false hope," Dana Quesinberry, research core director for the Kentucky Injury Prevention and Research Center, said as she explained the data on hospital emergency departments' and emergency medical services' reports of "overdose encounters," a term KIPRC uses because overdoses may be suspected but not necessarily confirmed.

"We are still at higher levels than we've ever been, but the fact that we are seeing that decline over the last few weeks is very important," Quesinberry said. "There is hope that we are making progress again, so whatever triggered the increase is being managed or mitigated in some way." 

She said the data coincides with preliminary reports that also shows an uptick in overdose deaths during April and May. Quesinberry said official 2020 overdose death numbers are not yet available, but "Preliminary data indicates that we have had increases in drug overdose deaths during covid." For April, "We are still looking at a monthly count that exceeds at least anything in the prior couple of years, in a month total." She added later, "We are seeing increases in May as well." 

Quesinberry, an assistant professor for the Department of Health Management and Policy at the University of Kentucky, said researchers will need to explore what triggered the peak in overdose encounters and then look at what slowed it down.  

"We know that there has been an impact on the opioid epidemic during covid and we are working very hard to understand what that impact has been," she said, adding later, "This is a time of tremendous uncertainty driven by the pandemic. It's important to understand that it has consequences beyond the spread of infectious disease."

Public health reports coincide

"Covid has had a huge impact on substance use because it has led to more isolation," John Moses, team leader for harm-reduction services at the Lexington-Fayette County Health Department. "I have a feeling that we are seeing a lot more people relapse and go back to using again. I think that people who maybe work full time and only did drugs on the weekend were laid off and now may be doing drugs seven days a week. We know that when people are isolated like that, there is a lot more depression and that always has an effect on drug use."

Moses said his county is on pace to equal the number of overdose deaths in 2017, which were the most ever. "Last year Lexington-Fayette County had a total of 122 overdose deaths; we are already at 107 for the year," he said. "Last year we did a really good job of getting the overdose rates down, but thanks to covid, I believe that we are seeing more overdose deaths." 

Moses also noted that anytime there is an interruption in the drug supply, which has been seen during the pandemic, more fentanyl comes into the community.  He said it is being mixed in with heroin, methamphetamine, cocaine and even THC vape cartiridges, and "This disruption in the drug supply has caused more fentanyl to be here, and more overdoses."

Christie Green, public-health director of the Manchester-based Cumberland Valley District Health Department, said she had heard anecdotally that there were several overdoses about three weeks ago related to a batch of pressed pills that were being sold as Xanax, but were mostly fentanyl -- a synthetic opioid that is much stronger than heroin. 

"This is the first time that I've gone through something that is socially stressful like covid . . . while working so closely with people who are active in substance-use disorder, and it's just been really hard on them," Green said. "A lot of their social supports are gone. I really worry about them, honestly."

Marcy Rein, public-health director of the Whitley County Health Department, said her health department signed up for a system called ODMap in May to track overdoses in the community, along with about 40 other counties and health departments in the state.

"The system allows us to look at the big picture, to look at the maps to see if we have hotspots in a particular area or not," she said. She said a rash of overdoses in May prompted them to join the system. 

Rein said preliminary data shows that the pandemic is having an impact on rates if suspected overdoses: "We're not saying that covid causes the increase in overdoses, but certainly some of the factors that go along with covid most certainly put people at higher risk, like the isolation and also the economic impact."

Andrea Brown, public-health director of the Bourbon County Health Department, said it saw an increase in overdoses in April, and started keeping track of those numbers more diligently in May after signing up for ODMap, which she said only records EMS-related encounters, at least for now.

She said the EMS-only data shows that from from May 5 to July 19, almost two and a half months, Bourbon County had 28 overdoses and five fatalities. Brown estimated that the county had 11 overdoses in April but wasn't sure how many died.

"We are still getting overdoses," she said. "I feel like last year we may have had 12 overdose deaths, something in that ballpark, so if we've already had five between May and July, then I think we are really, once the data actually comes out, we're probably going to see a much higher increase." 

Brown said the health department's harm-reduction syringe exchange has been giving out more Narcan, which can block the effects of an overdose, "so I think the word on the street is probably getting around that there has been an increase of overdoses in our community. The Narcan is definitely a hot ticket item right now."

Jamey Whaley, harm-reduction and-peer support specialist with the Maysville-based Buffalo Trace District Heath Department, said some of his syringe-exchange participants have reported an increase in overdoses where they have had to administer Narcan. He said he is also seeing people relapse and return to the program. 

"I don't know if that's because of the covid and the mental-health side of it that has made them decide to go back to using," he said. 

Scott Lockard, public health director at the Hazard-based Kentucky River District Health Department, said Eastern Kentucky has seen an influx of pressed tablets with fentanyl and carfentanyl, noting that Lee County saw a huge uptick in overdoses from a substance called "smurf dope" just a few weeks ago. WLEX-TV reported July 1 that smurf dope is a bright blue substance that is a mixture of methamphetamine or heroin and fentanyl. 

"I think any time you see a different substance than what people normally utilize, there is an adjustment period in how they use it and the strength, the purity level of it when it is a fentanyl or carfentanyl," Lockard said. "If somebody has been abusing Suboxone, which is a pharmaceutical-grade substance, and then now they are dealing with these pressed tablets, that's where I think it increased a lot of the issues that we were seeing with the increase in overdoses."

He said anecdotally, based on what he hears from EMS, law enforcement and harm-reduction people, there have been fewer overdoses near the end of June and in July.

For help in finding treatment for substance-use disorder for yourself, a friend, or loved one, the state has a website: findhelpnowky.org.