This commentary is by Jeanne Zimmerman of South Burlington, a retired clinical mental health and addiction counselor, and a parent and housing advocate.
It’s time to stop thinking of the “overdose problem” as part of the “opiate crisis.” Much, if not a majority, of the current street drug supply is not only tainted with fentanyl and xzylazine, which is not an opiate, but it often consists of mostly fentanyl and xzylazine, with less actual heroin.
There has also been a sharp rise in the availability, use of and addictions to methamphetamine. This has created social and medical problems far beyond that of an opiate crisis.
A few points to consider:
First, the overdose numbers are misleading. Reported overdoses are but the tip of the iceberg. Given the wide availability of naloxone and Narcan, many overdoses are reversed by friends and families with no calls to emergency services, and thus remain uncounted.
Second, though opiate overdoses, including fentanyl, can often be reversed though the application of Narcan, xzylazine overdoses cannot. It is always recommended to administer Narcan to all suspected overdoses, because even though it cannot reverse the effect of xzylazine, it will reverse the effects of any opiates that may be present in the body at the time, thus perhaps saving a life.
Third, though fentanyl and opiate addiction can, for some individuals, be treated with conventional (think our current hub-and-spoke treatment system) detox and treatment programs, and overdoses often reversed with the timely application of Naloxone, xzylazine will not respond to these protocols. Hence the continuing rise of both use and reported overdoses.
As well, detoxification/withdrawal/long-term residential treatment programs with protocols in place for xzylazine addiction remain extremely limited and largely unavailable. Across a five-state search in the Northeast last week, I was unable to find one treatment center offering these services.
Xzylazine, originally a veterinary medication, is a substance never intended for human consumption. It does not respond to conventional opiate withdrawal and treatment protocols, nor is easily transitioned to “bridge” program drugs such as suboxone or methadone.
Further, users, in addition to their addiction, suffer terribly from open wounds created by injection or ingestion of the drug, compounded by life-threatening infections requiring oral and/or IV antibiotics, and sometimes amputation of arms or legs. These infections are difficult to control, most especially for individuals with little or no access to shelter, clean clothing, medical supplies, clean water for bathing, changing bandages, treating wounds, or washing clothing, a place to store these items, and regular intensive medical care that includes doctors’ visits and possible hospitalization.
Many individuals lack these basic resources and are even less able to face medical treatment such as hospitalization for fear of severe withdrawal and the stigma endured at the hands of understandably overwhelmed medical personnel.
Of course, the more serious the dependence on these drugs, the more use of the drugs, as sedation afforded through use offers brief moments of respite from both the painful effects of withdrawal and wounds, as well as the daily traumas of life on the street. It is terrifying for those of us observing a seemingly inescapable vicious cycle of trauma, pain, momentary relief, and withdrawal and craving, and a true nightmare for those living it.
I applaud Burlington Mayor Miro Weinberger’s recent call upon Vermont’s treatment system and providers to immediately reevaluate the approach to substance use treatment in this post-opiate era. The current opiate treatment system was not created for and is unable to effectively respond to or sufficiently offer hope for recovery for individuals caught in addiction through the introduction of xzylazine into the street drug supply.
As the parent of an adult child who is suffering terribly and has found no effective relief, my family and I stand with the many, many other families whose sons, daughters, brothers, sisters, mothers, fathers, aunt, uncles and friends of all socioeconomic classes and walks of life are suffering and lost.
We are the invisible, unable to speak publicly due to ongoing stigma resulting from a lack of understanding from those who believe themselves untouched by this epidemic. If we as a community speak openly with each other about these problems, we quickly learn that there are people we already know within our own social orbits who are victims of this crisis.
Many families are suffering ongoing grief and hopelessness. Despite our most heartfelt best intentions and searches for treatments that may offer a chance of hope, the reduction of suffering and stigma, and possibility of recovery, there is little among the research literature or within the current system to be found.
I call upon our medical, housing and human service systems to do better. As is always the case, we as a community are only as strong as the manner in which we care for our most vulnerable members.
