corona-overdose

Washington Post

Suspected overdoses nationally jumped 18 percent in March, 29 percent in April and 42 percent in May, data from ambulance teams, hospitals and police shows.

“Nationwide, federal and local officials are reporting alarming spikes in drug overdoses — a hidden epidemic within the coronavirus pandemic. Emerging evidence suggests that the continued isolation, economic devastation and disruptions to the drug trade in recent months are fueling the surge.”

sanitizer

When the machinery of justice is halted abruptly, some of the people trapped inside are not supposed to be there at all.

Barbara Bradley Hagerty
Contributing writer at The Atlantic

It’s tempting to think that what happens in prison stays in prison. But a virus doesn’t respect boundaries. It sneaks in with the guards and staff: Each day, three shifts a day, hundreds of potentially infected people walk into a prison and handle the inmates, shackle them, transport them, give them food and medicine. Once the virus gets inside prison doors, “it will go through the prison like a hot knife through butter,” said Rich, the Brown professor. Soon enough, transmission will run in the other direction. As prisoners are infected, they will infect the otherwise healthy staff, who return to their families.

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By Josiah RichScott Allen and Mavis Nimoh
March 17, 2020 at 4:01 p.m. EDT

Josiah Rich is professor of medicine and epidemiology at Brown University. Scott Allen is professor of medicine emeritus at the University of California at Riverside. Mavis Nimoh is executive director of the Center for Prisoner Health and Human Rights at the Miriam Hospital, of which Rich and Allen are co-founders.

Unless government officials act now, the novel coronavirus will spread rapidly in our jails and prisons, endangering not only prisoners and corrections workers but the general public as well. As the country prepares for further spread of the pandemic, authorities should take immediate steps to limit the risk posed by mass confinement, including releasing those detained on bail, along with elderly prisoners who pose little danger to the public.

Early on in this pandemic, we learned that, as with other closed spaces such as cruise ships and nursing homes, the covid-19 coronavirus spread rapidly in Chinese correctional facilities. Now the United States, which leads the world when it comes to incarceration, faces that same challenge.

It is essential to understand that, despite being physically secure, jails and prisons are not isolated from the community. People continuously enter and leave, including multiple shifts of corrections staff; newly arrested, charged and sentenced individuals; attorneys; and visitors. Even if this flow is limited to the extent possible, correctional facilities remain densely populated and poorly designed to prevent the inevitable rapid and widespread dissemination of this virus.

At the same time, jails and prisons house individuals at higher risk than in other settings, such as schools and restaurants, that have been closed to mitigate contamination. Although corrections facilities cannot be closed, they must be included in any plan aimed at slowing the surge in infections and protecting public safety.

Reassessing security and public health risks and acting immediately will save the lives of not only those incarcerated but also correctional staff and their families and the community at large. There are several steps that authorities should implement as quickly as possible.

They must screen incoming individuals to prevent and delay infected individuals from entering facilities. They must rapidly identify cases and isolate exposed groups to limit the spread, as well as quickly transfer seriously ill patients to appropriate facilities.

But that won’t be enough. Authorities should release those who do not pose an immediate danger to public safety, while also reducing arrests and delaying sentencings. These moves carry inherent political risks, but they are for the greater good of the public at large. The abrupt onset of severe covid-19 infections among incarcerated individuals will require mass transfers to local hospitals for intensive medical and ventilator care — highly expensive interventions that may soon be in very short supply. Each severely ill patient coming from corrections who occupies an ICU bed will mean others may die for inability to obtain care.

Our ability to release people rapidly will vary by type of facility and jurisdiction. Those being held in jails simply due to their inability to afford bail, or for minor infractions or violations, can generally be released promptly by the judiciary or even the local sheriff. Some jurisdictions are already discussing such mitigation efforts.

Already sentenced individuals pose a greater challenge — one compounded by the punitive policies of the past few decades (mandatory minimum sentences, three strikes and life without parole) that have led to a large, aging incarcerated population especially vulnerable to severe disease. Additionally, half of all incarcerated people suffer from at least one chronic illness, which means even more will be at risk of a poor prognosis if they become infected.

Those eligible for parole can and should be released. Provisions for “compassionate release/parole” exist in every state; however, that process is typically slow, underutilized and very limited. Fortunately, the people at highest risk for severe complications of covid-19 who are incarcerated (the aging and chronically ill), are, on average, the least likely to commit a new crime or need to be re-incarcerated. In some states, governors have the ability to commute sentences or pardon individuals, as does the president in the federal system.

On the federal level as well, there is a parallel public health danger lurking in the immigration detention system, where thousands of people are being held in jail-like conditions that pose similar risks. The Trump administration could, if it wished, institute a simple and even temporary policy change to release those individuals into the community rather than contain them in an environment where rapid spread is likely. As unlikely as this may be given the administration’s approach to immigration detention, this may be the easiest fix, given the broad discretion of the Department of Homeland Security to change policy.

The spread of the coronavirus may only be the tipping point for what can happen when we fail to consider all the costs and consequences of our system of mass incarceration. We justify locking people up to protect public safety. Yet public safety will be at even greater peril if we fail to mitigate risks associated with confining too many people in jails, prisons and detention facilities during a pandemic.

Dr. Jon Soske

The COBRE welcomed Dr. Jon Soske on Monday, March 9th to speak about Stigma, Discrimination, and Addiction: Ideas for Systemic Interventions.

Dr. Jon Soske is the Community Engagement and Education Coordinator at RICARES. A person in long-term recovery from alcohol and drug addiction, he is author/editor of four books on race, discrimination, and inequality and has published widely on social movements, political theory, and qualitative research methodologies.

In his presentation, he discussed the benefits of this new approach and review what the current scholarship does–and does not–tell us about effective anti-stigma interventions. He offered three proposals that could be implemented immediately and would transform the conversation around stigma.

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Doctors have own problems in recovering from opioid abuse, including denial of access to key medication

When Dr. Sylvester Sviokla speaks to physicians at Harvard about the dangers of opioid addiction, they pay attention. He is in recovery from addiction himself.

“I went to Harvard College, Harvard Medical School, I played football, I was a big doctor,’’ he relates, before adding: “If it could happen to me, it can happen to you.’’

Medical professionals are far from immune to opioid misuse. In fact, due to their easy access to pain medication and the high stress levels that come with treating patients, they may be especially susceptible. But for many clinicians, overcoming an opioid dependence can be even more challenging than for those in the general population. They say they are often denied access to medication approved to help them recover from opioid addiction, precisely because they practice medicine.

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Geoff Capraro, MD, MPH is an Associate Professor of Emergency Medicine at Brown (https://vivo.brown.edu/display/gcapraro).

He is co-founder of NaloxBox (www.naloxbox.org) whose mission is to furnish naloxone as a community rescue asset so anyone can rescue victims of opioid overdose. In his Fall, 2019 TEDxBrownU talk he wished to share his passionate belief that armed with the proper tools, anyone can be the hero and provide second chances for individuals struggling with opioid use disorder.

cato

The Health and Medicine panel of the National Academy of Sciences, Engineering and Medicine (NASEM) released its report Opportunities to Improve Opioid Use Disorder and Infectious Disease Services on January 23.

Dr João Goulão from Lisbon, Portugal visited Providence in early January. A medical doctor by profession, Dr. Goulão has over 30 years’ experience regarding drug-related issues, working in this field since 1987 as general practitioner, and since then his professional life has been devoted to drugs and health.

NEJM_Logo

Written by COBRE Affiliated scientists Elizabeth Samuels, MD, MPH, MHS, Otis Warren, MD, Corey Davis, JD, MSPH and Paul Christopher, MD.

The opioid overdose crisis has claimed more than 400,000 lives in the United States since 1999. As part of efforts to reduce overdose deaths and increase enrollment in treatment, law-makers in some states are contemplating enacting or expanding emergency hold laws that permit some patients with severe substance use disorder to be involuntarily detained for short-term observation and, in some cases, treatment.

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Federal funding will allow for creation of a center to help combat opioid epidemic

Rhode Island Hospital announced today that it has received an $11.8 million federal grant to address the nation’s opioid epidemic by establishing the Center of Biomedical Research Excellence (COBRE) on Opioids and Overdose at the hospital. The center, to be funded with a five-year, Phase I grant from the National Institute of General Medical Sciences, will work in partnership with Brown University and Women and Infant’s Hospital to develop and sustain a critical mass of investigators specializing in opioid use disorder. The center will be led by principal investigator Josiah Rich, M.D., M.P.H. and Traci Green, Ph.D., M.Sc., who are both affiliated with Rhode Island Hospital and are recognized as national experts in the epidemiology of opioid and other illicit substances.

“There is a tremendous need for greater scientific understanding of the mechanisms underpinning opioid use disorder and a need for more effective interventions to treat and prevent opioid misuse and overdose,” says Rich, an infectious disease physician with Lifespan and Brown Medicine and the director of the Center for Prisoner Health and Human Rights at Lifespan-affiliated The Miriam Hospital. “This center will bring together experts from institutions across Rhode Island to support excellence in the research needed to combat the opioid epidemic hampering and taking the lives of our friends and neighbors.”

Rich and Green have more than 40 years of experience between them conducting research with people with opioid use disorder. The intent of COBRE grants is to establish leadership and mentorship by experienced researchers, overseeing and supporting the work of three to five junior investigators at once in thematic, multidisciplinary centers, until those researchers establish a body of work to enable them to secure their own independent funding. Over the possible 15-year span of COBRE’s three phases, this builds the institution’s capacity and expertise in a given area.

“Rhode Island continues to be a national leader in innovative approaches to addressing opioid use disorder,” says Green. “The unique political and public health climate that has been cultivated over decades of collaboration among members of this research team, community partners, and key stakeholders makes Rhode Island an ideal location to establish the COBRE on Opioids and Overdose.”

Rhode Island has high stakes in the success of this research. According to the NIH’s National Institute on Drug Abuse, Rhode Island is among the top ten states for rates of opioid-overdose death, with more than double the national rate in 2016. Rhode Island suffered nearly 300 deadly overdoses that year. A host of other public health threats come along with addiction, including neonatal abstinence syndrome, HIV and Hepatitis C.

Both Rich and Green serve as expert advisors to Gov. Gina M. Raimondo’s Overdose Prevention and Intervention Task Force.

“The establishment of the COBRE on Opioids and Overdose in Rhode Island is another concrete step toward combatting this public health crisis,” says Raimondo. “Dr. Rich, Dr. Green and so many of the leaders involved with this center have brought their medical and public health expertise to the table in our statewide efforts on opioids. I congratulate them on securing this funding to develop and sustain a research center devoted to this issue, and look forward to continuing work with them to marshal all of the needed resources to save the lives of Rhode Islanders.”

Three research projects by early-career project leaders have been identified to be supported with the inception of the COBRE on Opioids and Overdose. They are:

  • “Informed opioid prescribing for acute musculoskeletal pain after motor vehicle collision: A support tool for assessing risks and benefits of analgesic medications before prescribing (STAAMP)”; Francesca Beaudoin, M.D., M.S., Rhode Island Hospital
  • “Contingency Management in Combination with MAT for Opioid Use Disorders”; Sara Becker, Ph.D., M.A., Brown University School of Public Health
  • “Neonatal Abstinence Syndrome (NAS): Fetus to First Years”; Adam Czynski, D.O., Women & Infants Hospital

In addition, Rhode Island Hospital will fund 15 junior investigators with a $600,000 pilot program.

The funding for the COBRE had the vital support of Rhode Island’s Congressional delegation.

“This NIH grant will advance research and help Rhode Island accelerate efforts to effectively treat opioid addiction,” U.S. Senator Jack Reed, a senior member of the Appropriations Committee said. “Further, this federal funding will help build a research infrastructure in the state for combatting opioid addiction.”

U.S. Sen. Sheldon Whitehouse, who co-authored the landmark bipartisan Comprehensive Addiction and Recovery Act (CARA), sweeping legislation that guides the federal response to the opioid epidemic, said, “We still have a lot to learn about how to prevent and treat opioid addiction. That’s why medical research is a huge part of the battle against the opioid crisis, and why I’ve been fighting to unlock research funding like this for Rhode Island. This new center will help outstanding researchers at Rhode Island Hospital and other Rhode Island institutions expand work to answer tough questions about opioid addiction. It’s an important victory for those confronting addiction or walking the difficult, noble path of recovery.”

“Effectively combatting the opioid overdose epidemic requires investments in biomedical research to better understand the nature of addiction and develop targeted methods for prevention, treatment and recovery,” said Congressman James Langevin. “Congratulations to the team of researchers at Rhode Island Hospital for securing this federal funding and for your efforts to help bring this devastating public health crisis to an end.”

Congressman David Cicilline said, “This federal funding will support vital research aimed at combatting a serious epidemic facing our state and country. Opioid addiction affects all communities and is devastating so many families. It is a serious public health crisis that requires urgent action. Establishing this COBRE will help us better understand this disease and identify real solutions to address it.”

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Richard Salit
The Miriam Hospital
401-793-7484
richard.salit@lifespan.org