Health Care

New report shows how the system couldn’t save Vermonters who overdosed

A bag of fentanyl tablets. The drug has been a major factor in Vermont drug overdose cases. Wiki photo

Overdose victims almost always had some interaction with the system before they died, research published by the state Monday shows. Of the 109 people who died of overdoses in 2017, 98% had some encounter with a government agency, whether they were seeking medical treatment for their addiction, being visited by emergency services or running into police officers.

The new report published by the Vermont Department of Health examines what happened to people who lost their lives at the height of the national opioid crisis, in a year where more than 47,000 Americans died of prescription opioids, fentanyl, heroin and other opioid drugs.

Concerns about access to addiction treatment have been raised since the beginning of the opioid epidemic. VTDigger found that some people waited more than a year for substance abuse treatment in 2015. 

By 2017, the state had expanded its hub-and-spoke model of opioid treatment and had eliminated the waitlist in Chittenden County. The number of deaths peaked in 2018 at 130. 

But while the number of overdose deaths fell in 2019, addiction experts and advocates have raised concerns about the possibility of a crisis due to the Covid pandemic. The Department of Health reports that 72 people died of overdoses from January to June of this year, compared to 48 in that time last year.

Fentanyl was a top cause of death and remains high in recent data. 61% of overdose victims had fentanyl in their system, alone or in combination with heroin or cocaine.

The median age of a victim was 37, and 72% were men. The victims were disproportionately likely to be in the construction or service industries and more likely than the average Vermonter to have a high school education but no college.

Close to help but falling short

This report highlights the times that overdose victims came across people who had the power to help them, yet still failed to prevent their deaths. 

The data suggests these victims tried to get treatment. Of the people with Medicaid, nearly half had an insurance claim related to their substance use.

Others had run into the health system in other ways: 51% had had a previous call from emergency services personnel, half of which were related to their substance use. More than a quarter had had a previous overdose before the one that killed them.

The victims had often interacted with the criminal justice system as well. Eighty-two percent had some interaction with the Vermont State Police before. Those 89 people racked up 790 state police involvements, an average of nine per person, most of them for noncriminal reasons.

Overall, the reports reveal a pattern of interactions with state agencies and systems, sometimes multiple times over. Two-thirds of the victims had interacted with three or more agencies. 

The report recommends that state agencies coordinate to ensure continuity of care for people being released from prison and to connect police officers with addiction recovery counselors.

Prescribed opioids, then dying

Another system the victims interacted with? The Vermont Prescription Monitoring System, set up to monitor the prescription of controlled substances such as opioids and benzodiazepines. 

Eighty-four percent of the victims had at least one prescription logged in the monitoring system between 2012 and 2017, and most had one in the prior year. Not all of them were necessarily trying to abuse the drugs: many were taking a medical opioid alternative, such as Suboxone, intended to curb cravings for illegal opioids.

Others may have been prescribed the opioids for health conditions: 16% of the victims had a history of chronic pain, such as back pain.

But data suggests that the victims were often taking a higher dosage than the average opioid prescription. Their prescriptions averaged 81 morphine milligram equivalents, the standard unit of opioids, compared with 59 for the average opioid prescription at the time.

The report recommends improving data collection and using the prescription monitoring system to inform doctors about non-opioid pain management.

The report also includes a more emotional disclaimer: A dedication to people who have died of overdoses, and their loved ones.

“While this is a data-driven report, we must not lose sight of the fact that behind each data point is a Vermonter who unnecessarily lost their life,” it said. “The Vermont Department of Health, along with all departments that contributed data and time to this project, believe that the findings and recommendations within this document are valuable assets as we work to prevent future losses of life due to overdose.”

Katie Jickling contributed to this report.

Erin Petenko

Erin Petenko is VTDigger's data and graphics reporter, bringing numbers to life to help Vermonters understand the state they live in.

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