State officials recently flagged the presence of an anti-seizure medication in some opioid deaths in 2022, a year when a record-breaking 237 Vermonters died from accidental opioid overdoses.
Thirty-one of the fatalities, or 13% of the total, had taken gabapentin, a prescription drug used to control convulsions and relieve nerve pain, according to a Vermont Department of Health report issued Monday.
It was the first time state health officials called attention to the drug, which comes on the heels of public concern over the animal tranquilizer xylazine being mixed with illicit opioids. The report shows gabapentin became a known factor in opioid deaths last February and has since become more common.
Gabapentin’s misuse has been reported to produce anxiety-reducing effects, as well as a euphoric feeling similar to that of opioids, a study shows.
But at the same time, the anticonvulsant causes respiratory depression, which the study said can lead to a significantly increased risk of death when it’s taken with opioids.
Because gabapentin is not an opioid, the Vermont health department wants the public to know that it blunts the efficacy of the opioid antidote naloxone, popularly known as Narcan. Test strips for fentanyl — Vermont’s biggest opioid killer since 2016 — also won’t be able to detect any gabapentin used to cut opioids.
“It has major implications for those who are witnessing an overdose, because they can actually realize that giving Narcan is almost never going to be sufficient,” said the state health commissioner, Dr. Mark Levine.
“You need to begin to think about rescue breaths. You need to begin to think about calling 911 from the start,” he said.
These new details about gabapentin came alongside the revelation that 237 Vermonters died from an opioid overdose last year — 20 more than in 2021 — and the third straight year that the death toll has broken the existing record.
The fatality numbers are preliminary and are likely to rise as last year’s pending death certificates are processed.
As in recent years, the highest death rates were in southern Vermont. Windham County, which registered the highest rate based on population, had 26 deaths, followed by Rutland County, with 33 deaths.
“It’s just a mess, and it’s very sad,” said Tracie Hauck, director of the Rutland Turning Point recovery center. “I think it's going to get worse before it gets better, especially with the presence of xylazine that's now in everything.”
Recovery experts and health officials say the rise in opioid deaths remains related to the social isolation that began when the Covid-19 pandemic hit in 2020.
A state health department data analysis found that 60% of overdose deaths in Vermont that year occurred at home, and 52% of those who fatally overdosed were on their own.
“You get kind of in that zone of isolating yourself and not reaching out and maybe feeling like crap about what you're doing and ashamed,” Hauck said, “and it just becomes a pattern.”
Health officials also cite the prevalence of fentanyl, a powerful synthetic opioid, which figured in 221, or 93%, of last year’s opioid deaths.
The second most common drug linked to fatal opioid overdoses was cocaine, followed by xylazine. In cases of overdose, more than one drug is usually found in a person’s system.
Now, with tens of millions of opioid settlement dollars headed Vermont’s way, the health department is expected to make significant updates to the state’s substance use mitigation programs.
Levine said these include expanding outreach efforts that encourage users to seek treatment, growing the Narcan distribution system and adding locations that offer opioid medication, especially in remote communities.
“We must remain vigilant in our efforts to address this issue, which obviously includes adopting very innovative approaches,” he said.
Advocates for setting up overdose prevention sites in Vermont believe these centers are a missing piece in the state’s battle against opioid addiction: a place where people can use previously purchased drugs under trained supervision. Legislators and policy makers have recently signaled more openness to this approach.
“It has to be one in a multipronged harm reduction approach to the most grave public health crisis, I think, Vermont has ever seen,” said Ed Baker, host/co-producer of the Addiction Recovery Channel on CCTV in Burlington, who also is in recovery from substance use.
“Vermonters are dying, and we as a state are not doing everything we can,” he said.