Thursday, Jan. 11, 2018 12:08 am
Grim numbers, real people
Overdoses take their toll in 2017
Consider the 63-year-old man found dead last March in his basement apartment on South Fifth Street. An experienced junkie, he recently had declined an offer of a meal from a neighbor, explaining that he’d had his fix for the day, so he didn’t need food. The rescue squad found six syringes, some razor blades and two spoons next to his body, along with a dose of Narcan that might have helped if someone had been able to administer it. A cardboard sign was stuffed down the back of his pants: “Lost everything. Please help. Thank you. God bless.” Toxicology tests showed cocaine, methamphetamine, heroin and carfentanil, a synthetic opiate that’s 5,000 times more potent than heroin and is used to sedate large animals such as bison and elephants.
Then there’s the retired manager for the Capital Development Board who was found dead in his suburban Springfield home, syringe still in hand, by his wife on the Fourth of July. He was 58 and left behind three sons, a $53,000 pension and a bass boat – the cops found the spoon on the bow. Tests showed acute levels of cocaine and a fentanyl analog. His wife told police that he had a history of heroin and cocaine use.
Forty-one people died of drug overdoses in Sangamon County last year that involved opioids, according to coroner records. That ties a record set in 2015, when 41 people also died from opioid-related overdoses. The victims were mostly white. One dozen overdoses were caused by illicit drugs alone, the others included deaths from prescription drugs, a mix of prescription of illegal drugs and a combination of drugs and alcohol.
Benzodiazepines were something of a common denominator, with more than a third of overdose victims with opioids in their systems also testing positive for drugs that are among the most commonly prescribed in America. Alprazolam, sold under the brand name Xanax, was found in the blood of at least 14 overdose victims. Fatal alprazolam overdoses are rare, but interactions between opiates, alcohol and other substances that depress the central nervous system can turn otherwise benign benzodiazepines into catalysts for tragedy.
Numbers in Sangamon County mirror national statistics: An estimated 75 percent of overdoses involving opioids also involve benzodiazepines, according to a 2015 study funded by the National Institutes of Health. There is no way of knowing whether someone would have lived if they had not taken alprazolam along with opiates, alcohol or both, says Cinda Edwards, Sangamon County coroner.
“People think they’re not as scary as opiates,” Edwards said. “People use them in combination, and that’s where you get in trouble.”
Edwards’ office last year handled a case of a man who died after ingesting a staggering amount of alprazolam along with oxycodone. His relatives said that he would eat as many as 40 alprazolam pills in a day and had turned from pharmaceuticals to a street-made variety.
Despite concern about the dangers of benzodiazepines, regulators have been slow to act. Not until 2016 did the Food and Drug Administration recommend that doctors not prescribe opioids and benzodiazepines at the same time, even though evidence of the potentially lethal combination had been building for years.
In Alabama, legislators last year rejected a bill that would have put benzodiazepines in the same category as oxycodone, fentanyl and other potentially dangerous opioids so that refills wouldn’t be automatic and more doctor visits would be required to continue on the drug. That would have made Alabama the first state in the nation to put benzos in the same regulatory basket as opioids. The legislative battle pitted the Alabama Pharmacy Association, which argued that no change was needed, against the Alabama Board of Medical Examiners, which warned that overdoses involving benzodiazepines were on the rise.
“When you take a medicine like Xanax, along with something else, whether it’s alcohol or an opioid, it magnifies it – it multiplies the effect,” Dr. David Herrick, president of the Alabama Medical Association and also a member of the medical examiner board that pushed for the change, told the media last year. “It may affect you way more than you’re hoping. It may put you to sleep forever.”
The legislature was not persuaded. The pharmacists won.
Contact Bruce Rushton at email@example.com.