Since the onset of the Covid-19 pandemic in 2020, Vermont has experienced a surge in opioid overdose deaths — setting records in both 2020 and 2021 — and the greatest percent increase in the country.
During the same period, the state’s distribution of naloxone, an opioid overdose antidote known by the name-brand Narcan, also skyrocketed, nearly tripling between 2019 and 2021, according to the Department of Health.
In 2018, the state distributed 16,559 doses of Narcan, and that number remained relatively stable in 2019. But only a year later, the health department supplied 27,937 doses to community partners, and that number jumped again in 2021 to 47,157.
Data previously released by the Department of Health had suggested that after five years of increased availability, distribution of Narcan at public community sites declined in Vermont following the onset of the pandemic.
Now, though, the health department is changing how it measures naloxone distribution and is revising that past claim, said Stephanie Busch, injury prevention manager at the Department of Health.
The new measurement tracks the number of doses the Department of Health distributes to community partners, not data collected from the individuals who received Narcan at community distribution sites.
Narcan — whether in the hands of first responders or people who use drugs — has the power to convert a fatal overdose into a nonfatal overdose.
And due to the ad hoc nature of the reversal drug, counting nonfatal incidents proves difficult for authorities.
The Department of Health primarily tracks nonfatal overdoses via emergency medical service calls and emergency department visits, and anecdotally by talking to community partners, Busch said.
Using data the state collected on total emergency department visits from 2020 — the last available year — there were about 520 nonfatal overdoses leading to emergency visits in 2020.
But Busch acknowledged that the state’s metrics of tracking nonfatal overdoses are incomplete.
“It is believed that these numbers are underreported, given that not everyone who administers naloxone reports it, reporting at all is optional, and our Narcan distribution into the community is so high,” she said.
As the strength of Vermont's drug supply has changed, so has the relationship between drug users and overdoses.
According to Grace Keller, coordinator of the Howard Center’s Safe Recovery program, about a quarter of her clients in 2017 had witnessed an overdose. By 2018, that figure had risen to 81%.
“These overdoses are happening much faster and are much more severe, much harder to reverse,” Keller said, noting that since fentanyl became ubiquitous, overdoses typically require multiple doses of Narcan to reverse.
“My experience with people who use drugs and with the people who are responding to overdoses is that they're terrified, and that they want to do everything to help the person survive,” she said.
After receiving Narcan, the recipient is thrown immediately into opioid withdrawal — a physically painful state. As they come to, disorientation and discomfort often cause the person to initially resist help, or “come up swinging.”
In Windsor, Fire Chief Kevin McAllister believes the availability of Narcan is masking the overall number of nonfatal overdoses.
He said the department has heard about “narcan parties” during which one person stays sober in order to administer narcan to anyone who overdoses.
“We have also been told about delays in calling 911 because bystanders will administer the Narcan they have and will only call if the patient doesn't recover with those doses,” he said.
Yet Keller, the Howard Center’s recovery program coordinator, warns against finding fault in the availability of lifesaving opioid antidotes. She said it’s a “myth” that people who use drugs are unconcerned with the risks associated with fentanyl, something perpetuated in the idea of so-called “narcan parties.”
“We have a system that doesn't respond to overdose, in many ways, therapeutically, or compassionately,” Keller said.
“In an overdose situation every second counts and the best allies we have are the people at the scene.”