How can Washtenaw County turn around a startling rise in opioid overdose deaths?

Recent data released by the Washtenaw County Health Department revealed a 28% increase in opioid overdose deaths in the county between 2020 and 2021. Across the U.S., opioid-related deaths have continued to rise since the start of the COVID-19 pandemic. In Washtenaw County, these deaths had decreased by 26% between 2018 and 2019.

"There's a saying that we have: the opposite of addiction is connection," says Sara Szczotka, recovery coach coordinator and Washtenaw Recovery Advocacy Project (WRAP) program manager for Home of New Vision, a substance use disorder and mental health treatment agency in Ann Arbor. "Obviously, with COVID-19 happening, people were very isolated. Everyone was isolated, but more so people in recovery or people that were struggling with a substance use disorder. Being able to find resources and a sense of support was very difficult."

Now Szczotka and others across the county are pursuing a number of strategies to turn around the startling rise in overdose deaths and reconnect county residents to support.

Fentanyl renders all illicit drugs more deadly

The synthetic opioid fentanyl, which can be 50 to 100 times more potent than heroin, was involved in 82% of Washtenaw County’s opioid overdose deaths from January 2021 to May 2022.

"Most opioid-related deaths involve fentanyl, additional substances, or other drugs added to illicit opioids," says Jimena Loveluck, Washtenaw County Health Department health officer.
Jimena Loveluck.
Other substances contributing to these overdose deaths included cocaine, methamphetamine, and xylazine, a non-opioid tranquilizer that is not approved for human use and is often added to illicit opioids, especially fentanyl. 

"I think there's this misconception that people are using fentanyl knowingly. What we're finding in a lot of our overdose reports is that people are using fentanyl without knowing about it," Szczotka says. "They're putting fentanyl in pressed pills. They're putting it in cocaine. We've even had some people that have bought marijuana off the streets, and it's been in that as well. People are using other substances recreationally and unintentionally overdosing."
Sara Szczotka
In her work, Szczotka has had conversations with Washtenaw County-area overdose survivors who are shocked to find out that they had fentanyl in their systems. Home of New Vision is amping up educational efforts to warn area residents, high school age and up, that illicit drug dealers are cutting product with the deadly opiate to decrease costs and create a larger customer base of people who are physically addicted to opioids.

"It's a sinister way to get people more apt to use this substance," Szczotka says. "Lucky for us and Washtenaw County, we have a ton of support, resources, and programs that are available."

Szczotka notes that the county has two major SUD treatment facilities (Home of New Vision and Dawn Farm), many local primary care physicians incorporate mental health and substance use services into their practices, and University of Michigan and St. Joe’s hospitals both address substance use in their emergency departments. 

"Our major emergency departments in Washtenaw County are now prescribing medications for opioid use disorder, getting people started on that in the emergency room. Then they'll connect them with a provider for ongoing maintenance," adds Matthew Hill, program manager for the Ann Arbor-based Center for Health and Research Transformation, which facilitates the Washtenaw Health Initiative Opioid Project. 

Hill notes that positive changes on that front are also afoot at the state level. State House Bill 5163 would require emergency departments that see 50 or more patients related to opiate use disorder to have policies and procedures in place to prescribe medications for opioid use disorder in the emergency rooms. The bill passed the state house in October 2021 and was assigned to the state Senate Committee of the Whole in June 2022. 

Harm reduction saves lives

Local providers also emphasize the importance of a harm reduction model in mitigating local opioid overdose deaths. Hill notes that traditional treatment, typified by a "Come get help when you're ready to stop using" approach, doesn’t work for everyone. Harm reduction strategies welcome people who are actively using, build relationships with them where they are at, and keep them alive until they are ready to beat their addiction.

For example, WRAP is repurposing old-school newspaper boxes in every Washtenaw County community to distribute free naloxone. Also known by the brand name Narcan, naloxone rapidly reverses an opioid overdose by quickly restoring normal breathing in a person whose breathing has slowed or stopped.
A free naloxone vending machine at the downtown Ann Arbor District Library.
"We've had a dramatic expansion of access to naloxone," Hill says. "That switch to the harm reduction model has been huge in Washtenaw County. Unified [an Ypsilanti-based harm reduction organization] is doing great work with their syringe service exchange program, naloxone distribution, and getting people connected to health resources when they have other health events related to substance use."

Free naloxone vending machines are also available at the Washtenaw County Health Department, 555 Towner in Ypsilanti; Ann Arbor District Library, 343 S. Fifth Ave. in Ann Arbor; and the Washtenaw County Sheriff's Office Reentry Center, 4101 Washtenaw Ave. in Ann Arbor. Ann Arbor Fire Departments have free naloxone kits available for residents over the age of 18. Both individuals and community organizations can order free naloxone online via the Michigan Department of Health and Human Services and Next Distro. The Community Mental Health Partnership of Michigan (CMHPSM) provides naloxone and naloxone trainings. Naloxone is also available at major pharmacy chains without a prescription. Training on how to use naloxone is available at www.overdoseACTION.org and on the CDC website.

"People may unknowingly ingest fatal doses of fentanyl or other substances, which can seriously increase the risk of a life-threatening overdose," Loveluck says. "It’s incredibly important to use extreme caution: never use alone and have naloxone on hand."

Experts recommend carrying naloxone if one has a prior history of overdose or opioid use disorder, takes chronic daily opioids, uses sedatives with opioids, experiences a change in tolerance due to opioids, or uses substances, like cocaine, which may be laced with an opioid like fentanyl. Those who know someone with the above risk factors are also encouraged to carry naloxone.

Challenges ahead

Although Washtenaw County residents already have access to many resources to prevent opioid overdoses, there clearly are still many challenges to overcome in turning the statistics around. Hill notes racial disparities in overdoses as one major challenge. While 81% of deaths between 2020 and 2021 were among white residents, the percentage of Black residents dying from overdoses, 19%, is still disproportionately higher considering that Black people only make up 12% of the county's population.

"When we start looking at new supports and services, if we can start engaging communities of color better and figure out what resources we could implement to help them where they're at based on what they need as defined by them, then we can start making a difference in that disparity of overdose rates," Hill says.
Center for Health and Research Transformation Program Manager Matthew Hill.
Hill also sees a need for more — and more realistic — education about substance use disorders.

"The ‘just say no’ philosophy is really harmful. That didn't work. I myself came from the DARE era. Being a person in recovery, I can tell you, that didn't work for me," he says. "We know that young people are going to experiment. If they're going to experiment with drugs, they should know to do that with a group of people. They should know to have naloxone on hand just in case, even if they're not ingesting opioids. Having some practical knowledge and practical education can really reduce the effects of accidental overdose."

Recovery is possible. Find local stories of recovery, medication disposal sites, materials, and more harm reduction and treatment resources at www.washtenaw.org/ItIsPossible.

Estelle Slootmaker is a working writer focusing on journalism, book editing, communications, poetry, and children's books. You can contact her at Estelle.Slootmaker@gmail.com or www.constellations.biz.

All photos by Doug Coombe.