Overdoses a growing concern in Delaware amid virus

As COVID-19 continues to unravel across the state and country, Delaware is facing a second challenge to overcome — a spike in overdoses.

“So we’ve been watching this very closely, particularly because we know that COVID-19 is affecting people’s emotional and physical wellbeing, particularly those who are suffering from financial consequences and then also have substance use disorder,” said Dr. Kara Odom Walker, secretary of the Delaware Department of Health and Social Services, and a practicing family physician. “And unfortunately, it can be a trigger for people who suffer from addiction that causes increased stress for many Delawareans.”

In May, 39 people died for suspected overdoses in Delaware — a number that ties with the monthly high of overdose deaths in August 2018. In June of this year, an additional 30 people lost their lives due to suspected overdose, said Dr. Walker. In the first six months of the year, 199 people have died due to overdoses — a 47% increase over the same six month period in 2018 and 2019, she said.

The state reported a total of 431 overdose deaths in all of 2019, which was up 8% from the year previous, she said.

“We are very worried about this increase and very worried about what we will continue to see,” she said.

A study released last year examined the statistics of 2017, finding that the overall rate of overdoses had increased 144% between the period of 2012 and 2017. The report noted that the “rate of drug overdose deaths among males was twice as high as the rate among females,” and the highest rates of overdose death occurred among 25- to 34-year olds. In 2017, a total of 343 people died of overdose.

In that data, findings show that the top two fields of men who died of drug overdoses were construction (36%) and the installation, maintenance and repair industry (9.1%). For women, the top two industries of those who died of drug overdoses were food service (14.7%) and office support (12.8%).

Analyzing the demographic information for this year will come later, Dr. Walker said, but there are concerns for those who are essential workers.

“We have seen in the past overdose impact those who are in, what we would now call, the essential workforce, people who are in the restaurant industry and construction jobs,” she said. “With the pandemic it may be that those individuals are at greater risk, but we won’t know until we do a full analysis.”

When positive coronavirus cases began to rise, the day-to-day shifted greatly as businesses closed and social distancing took affect. Services evolved to fit that mold, including health platforms.

“We also know that there are barriers right now, in terms of people getting into treatment or maintaining treatment, and addiction can be a cyclic event in someone’s life where they’re doing well and then something happens, maybe a barrier to treatment, and then they have a recurring cycle,” she said. “So we’re really focused on making sure that people know how to access and get treatment, including via telemedicine.”

Under the state of emergency first issued in March — which was recently extended for another 30 days — certain restrictions pertaining to telemedicine were loosened to allow more access to care. Many services continued in-person treatment.

She also noted that the economic recession created pressures, but “not to the same extent as we’re seeing right now,” she said.

“When we think about the historical view of pandemics and disease in our global population, there are dramatic impacts that you see with things like war and major waves of poverty, and the Great Depression, but the drugs were different,” she said. “They weren’t fentanyl that kills you with it with the amount that’s less than the size of a coin. So I think that’s really the challenge, tracking what to do with our opioid addiction is very similar to COVID. The opioid addiction has been a wave that has been unprecedented, and its impact and death toll has been dramatic. And so we’re now combining the two, which is unprecedented.”

Recently, the state rolled out the Hope Line — 1 (833) 9-HOPEDE, or (833) 946-7333 — which is dedicated to assisting Delawareans cope with stress and address behavioral health needs during the pandemic.

The line, which is free, is available 24/7, and connects callers with a variety of resources for information, including support from clinicians and peer specialists plus crisis assistance.

“The Hope Line, the initial concept behind it came honestly out of the COVID virus and the response there and the perceived need for more access for people in the community, not only to have people they can speak to for help, but just to be able to connect and reach out,” Glenn Owens, DHSS administrator for crisis service, said in a recent conversation with NAMI Delaware.

The line is currently staffed by “peers” — individuals with lived experience with behavioral health.

“That could be substance issues, it could be mental health illness. It could be, and frequently is, a combination of the two,” he said. “It’s generally somebody who is in recovery who has tools, internal tools, and that [they are] frequently more effective than clinicians in terms of relating to people as they’re going through difficult times.”

The line has received 60 calls since its launch in May, a DHSS spokesperson said.

As overdoses experience an uptick, the volume of those seeking help appears to be down. From her perspective at the Gateway Foundation in Smyrna, Dr. Karen Fitzhugh, senior executive director of operations, said admissions to the treatment facility are down. The men who are coming in for treatment are “markedly worse,” she said.

“The patients that we see are who are coming in are markedly more likely to have behavioral health and psychiatric issues, in addition to their substance use disorder than maybe a year ago,” she said.

She noted that people are isolating in ways that lead to increase in substance use, compounded with financial and familial or household stressors.

Speaking to crisis intervention, Mr. Owens noted that in April, the community response facet of crisis response, dropped off significantly. He attributed that to the virus, and people being apprehensive about having others in their homes.

“Since June 1 was the beginning of Phase One, the numbers have jumped up precipitously in terms of the need for community response,” he continued. “I expect that this summer will be quite busy for us, both in terms of call volume, as well as community outreach and community responses. As things ‘go back to normal,’ at least in terms of COVID, people are more likely to start reaching out again and engaging.”

But a trigger is still a trigger, said Dr. Walker.

“I think the one thing we certainly know is that the impacts of COVID-19 are challenging and the challenge with substance abuse is that a trigger such as this could have someone in need of care longer. We are encouraging anyone who has a need to get connected,” she said, adding that as things open, she’s not sure that will necessarily mean people will seek care once a routine resumes.

“What we are seeing is that, with these Bridge Clinics, the peer recovery coach and the peer who has been through recovery themselves is really critical to help people maintain their connection to care and to help them when they do hit ups and downs,” she said. “I think that the uncertainty along with COVID-19 is hard. We don’t know what the fall will look like, we don’t know what the winter will look like, we don’t know that jobs are completely back in full swing.”

To address concerns about substance use and mental health, a lot of the state’s response is on making connections with people, “whether it’s after an overdose, in the ER, after leaving prison,” Dr. Walker said.

She noted that the state has three Bridge Clinics, located in each of the counties, to help connect people to treatment. Kent County’s is located in the James W. Williams State Service Center, at 805 River Road, Dover; Sussex’s is at Thurman Adams State Service Center, 546 S. Bedford St. and New Castle’s is at 14 Central Ave. (just off U.S. 13), New Castle.

Other resources for prevention, treatment and recovery are listed here at www.helpisherede.com.

“We’re really fortunate that 98% of people have been connecting virtually during COVID-19 and during our response,” Dr. Walker said.
“This is really important to make sure people are able to connect and stay in care and treatment, but we’re very worried about what this impact of the pandemic has done on people with substance abuse, and treatment needs.”

Beyond those resources, Dr. Walker said that the state has partnered with organizations to canvass neighborhoods that have seen higher rates of overdose. Since April, 520 Naloxone — or Narcan, a life-saving medication that can reverse an opioid overdose — kits have been handed out at events. A partnership with the Food Bank of Delaware’s mobile pantry has allowed them to distribute information about substance abuse and mental health within communities, she said.


Helpful Coronavirus links

Delaware Division of Health Coronavirus Page
CDC: About the Coronavirus Disease 2019
CDC: What to do if You Are Sick
Johns Hopkins Coronavirus Resource Center
AP News Coronavirus Coverage
Reopening Delaware: Resources for Businesses
Delaware Phase 2 guidance

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