Providence

The city of Providence in Rhode Island was founded in 1636 by preacher Roger Williams. Thanks to its easy access to water, the city became a seaport and entrepreneurial town. Today, the city boasts a flourishing cultural and academic community. Despite its history and the strides it has made as a community, Providence has not escaped the overdose epidemic that has swept the United States and the New England region.

Rhode Island’s leadership has taken steps to address the negative impact the epidemic is having on its residents, including those in Providence. Several reports, for example, have been put together and released with information that the public can use. The Center for Health Data and Analysis released the June 2019 Rhode Island Municipality Overdose Data Report for Providence, which contains statistics about drug-related emergency department visits, emergency services rendered and fatal overdoses.

The National Institute for Drug Abuse also keeps tabs on statistics for each state against national averages.

The Drug Overdose Epidemic

The drug overdose epidemic hit the United States in three waves. The first dates back to 1999. Pharmaceutical companies began manufacturing prescription opioid medication in the 1990s. Their representatives were able to successfully lobby doctors, who began to give opioids to patients. Opioids are a pain-relieving medicine, and they were usually prescribed to patients who had suffered an on-the-job injury or an accident. The medical community did not realize how potent the new prescriptions were until it was too late.

2010 marks the second wave of the overdose epidemic. Emergency rooms saw an uptick in cases that involved heroin. Whether it was overdoses or car accidents, the trend was heroin-related incidents. At this point, the medical community still did not have enough information to make the connection between opioids and the overdoses as well as misuse. In the 1960s, heroin was a go-to drug for some Americans. At that time, opioids were used to wean heroin users off the substance, so the medical community made the assumption that heroin was simply back in style. A few years later, medical professionals realized that those who were abusing heroin had been previously prescribed an opioid.

2013 began the third wave of the overdose epidemic, which has been the deadliest of the three waves because synthetic opioids can be purchased on the street without a prescription from a doctor. Plus, the synthetic version is made from fentanyl, which is 50 to 100 times more potent than morphine. This means that synthetic opioids are more addictive, more accessible and, for many, worth the price. It is always a bad idea to procure any illicit drug on the street. This is especially true of synthetic opioids. A user never really knows the combination of the substance they are going to consume. There have been cases where fentanyl was combined with heroin and cocaine, and resulted in fatalities.

The 2018 Data

When it comes to the drug overdose epidemic, it is important to point out that there is a lot of talk about opioids. Other drugs are in the mix, too, such as cocaine, heroin and marijuana. Alcohol is still a substance that is abused as well. The reason why so much focus has been placed on opioids is because it accounts for a large percentage of the overdose deaths reported. In 2018, at least one opioid was found in 70% of the cases.

The 2018 data showed a little promise of recovering from the epidemic. That year, there were 67,367 overdose deaths in the United States. This represented a 4% decline from 2017, which was welcome information. The 2018 number, however, was four times higher than the number from 1999, so there is still a lot of progress to be made.

The 4% decline in overdose deaths was a result of:

• 2% decrease in opioid-involved deaths
• 13.5% decrease in prescription opioid-involved deaths
• 4% decrease in heroin-involved deaths

Synthetic opioid-related deaths saw a 10% increase, though. The significant decline in prescription-opioid involved deaths is explained by new prescription guidelines that were released. In Rhode Island, for example, providers wrote 43 opioid prescriptions for every 100 persons. This was below the national average of 51.4 prescriptions. It was also the lowest prescription rate in Rhode Island since 2006 when the data was first tracked.

Additional Rhode Island statistics from 2018 include the following:

• 267 drug overdose deaths involved at least one opioid, a rate that has remained steady.
• 213 drug overdose deaths involved synthetic opioids other than methadone, a trend that continues to increase.
• 85 drug overdose deaths involved prescription opioids, a rate that has remained steady.
• 24 drug overdose deaths involved heroin, a rate that has remained steady.

The Rhode Island Municipality Overdose Data Report for Providence found the following information for 2018:

• The city saw a total of 460 opioid overdose emergency department visits, an increase from 2017 when it was 400.
• 51% of the total opioid overdose emergency department visits were individuals under the age of 35 from 2016-2018.
• 69% of the total opioid overdose emergency department visits were made by males from 2016-2018.
• 65% of the total opioid overdose emergency department visits were successfully discharged from 2016-2018.
• 52% of the total opioid overdose emergency department visits were administered Naloxone from 2016-2018.

From 2016-2018, there were a total of 237 accidental overdose deaths in Providence. 47% of the cases were between the ages of 35-54.

The CDC is also concerned about Neonatal Abstinence Syndrome, Neonatal Opioid Withdrawal Syndrome and injection drug use.

NAS or NOWS occurs when a pregnant woman consumes opioids. The medical community has found that newborns have opioid withdrawal symptoms at birth. In 2016, that national rate was 7 cases per 1,000 hospital births. For Rhode Island, the rate was 11.7 cases per 1,000 hospital births in 2017.

Injection drug use is an increasing concern because sharing needles has always been dangerous. The sharing of drug needles increases the risk of contracting AIDS/HIV as well as Hepatitis C.

In 2017, 3,690 of the 38,226 new HIV diagnoses were believed to be a result of injection drug use. Of those new diagnoses, 83 were from Rhode Island. In 2017, there were an estimated 44,700 new cases of acute HCV. It is estimated that 86.6% of those new cases were a result of injection drug use. There is no data for 2017 Hepatitis C cases in Rhode Island, but it is estimated that there were 10,000 people living with HCV in the state from 2013-2016.

Providence, RI, Self-Help Resources

In Providence, RI, there are several self-help resources for those who are experiencing a substance use disorder. Help begins with calling the Rhode Island hotline, which connect individuals with licensed counselors in chemical dependency. These counselors believe that addiction is a disease and that recovery is possible.

There are also several medically assisted treatment service centers located throughout the state that administer the following medications to help prevent relapse:

• Methadone
• Buprenorphine
• Naltrexone

Rhode Island and Medications for Addiction Treatment

Even though Rhode Island is a tiny state in the United States, it has received accolades for a program it began for inmates and medications for addiction treatment, or MAT. The program launched in 2016. A six-month period before the program and after resulted in a 61% decrease in post-incarceration deaths. Researchers published their findings in JAMA Psychiatry. The subjects for the program are thought to be among the most vulnerable at a hard time in their life, so administered opioid use disorder treatment was optimal at that point. The researchers were exploring whether MAT for a prison population would decrease overdose deaths at the state level. They found that the answer was yes because it led to a 12% reduction statewide.

There are several questions left, but it was seen as a step in the right direction. A person who is incarcerated does not have access to their substance of choice. Once they leave, however, their brain is still wired by their addiction. Since their tolerance is down, too, it raises the risk of a fatal overdose.

Once a brain is wired to crave a substance, treatment that helps the individual get back to a sober state is recommended. Today, there are several treatment options to consider.

Treatment Options

An individual who is experiencing an overdose must seek the help of a first responder or nearest medical professional. In Rhode Island, medication that reverses the effects of the overdose is widely available.

Patients who have realized that they are suffering from a substance use disorder but are not in any immediate danger have some time to research their options. In Providence, residents can call the Rhode Island hotline, and a licensed professional will offer guidance. Some of the options include:

• Outpatient treatment
• Inpatient treatment
• Medication-assisted treatment
• Medical detox
• Anonymous meetings

Outpatient treatment is recommended for individuals who live in a healthy environment that will not have a negative impact on their recovery. The patient attends scheduled meetings every week for typically a 90-day period. Progress is measured, and if adjustments need to be made, they will be.

Anonymous meetings are suitable for individuals who have gone through an outpatient or inpatient program and require relapse prevention. Meetings are spaces of support for people who need some reinforcement or need to talk.

Inpatient treatment programs tend to be the most successful because they accept individuals who are low-risk as well as high-risk. Individuals with addictions are taken out of their day-to-day environment and placed in one that has no distractions. Green Mountain Treatment Center in New Hampshire, for example, is situated near the White Mountains and Lakes region. Patients are in a therapeutic space so that they can heal, build a foundation for sobriety and then re-gain control of their life.

At a facility such as Green Mountain Treatment Center, patients can also detox. Detox is a necessary step before rehab treatment can begin. If a patient is completely sober through group therapy or counseling sessions, it is much easier to finish the program successfully.

Medical detox is recommended for those who have high to mid-range risk substance use disorder. This means that the patient is addicted to a potent substance such as meth or opioids. It is also likely that the patient has been misusing a substance for an extended period of time. Drugs are chemicals, and they alter the central nervous system, brain and receptors. Every hit of a substance or drink of alcohol sends a rush of euphoria or dopamine to the brain. The brain enjoys it and so begins the cycle of craving the substance.

Some patients begin to experience withdrawal symptoms as little as six hours after their last hit of a drug or drink. The most intense part of detox is the first 24 to 48 hours. Thereafter, the intensity fades. Withdrawal symptoms can last up to three weeks for meth and 10 days for cocaine. Medical detox at Green Mountain Treatment Center gives a patient access to trained staff around the clock. Based on a patient’s symptoms, medical history and other factors, the staff’s job is to make substance users comfortable so that they can get to the other side.

Medication-assisted treatment is often used in conjunction with therapy. It depends on a patient’s substance of choice. For meth, for example, there is no medication that is proven to work, but for opioids, it is recommended.

Today, substance use disorder rehabilitation is customized to each patient. While one person may benefit from anger management, another goes through cognitive behavioral therapy. At Green Mountain Treatment Center, the curriculum is based on the 12 steps. A treatment plan may include holistic therapy so that patients can focus on healing themselves spiritually, too.

Amenities include yoga, meditation and access to an onsite gym because exercise is great for oxygen and blood flow. Plus, it releases natural endorphins that are great for the brain.

In Providence, RI, there are many addiction treatment resources available to residents. There are also private treatment options that help individuals learn how to live in a sober manner again. If you or a loved one is struggling with substance use disorder, don’t hesitate to reach out for assistance.