Kentucky’s number of overdose deaths increased at one of the highest rates in the nation in 2020, according to federal data, confirming a dreaded reality many in addiction recovery saw coming.
Fatal overdoses spiked by 50% in the state between September 2019 and September 2020 — the third highest state escalation in the country, behind Louisiana and the District of Columbia, preliminary data from the U.S. Centers for Disease Control and Prevention show.
Nationwide, the number of overdose deaths during that time went up by 29%. An estimated 90,237 people nationwide died from an overdose.
The CDC reports Kentucky saw 1,956 fatal overdoses during that 12-month period, compared with 1,304 the year before. Neighboring West Virginia saw 1,287 fatal overdoses last year, up from 874 — an increase of more than 47 percent. The data isn’t final, and Kentucky hasn’t released its annual overdose fatality report for 2020.
The staggering increase in overdoses isn’t surprising to people who work on the frontlines of addiction response and recovery. When COVID-19 besieged Kentucky in March of 2020, it was already years into an epidemic of substance abuse that had killed thousands of people across the commonwealth.
In many ways, measures taken by states to stem the spread of coronavirus fanned the flame of addiction, a disease that metastasizes in isolation.
Though a variety of factors have contributed to this spike, many in Kentucky’s recovery communities last spring saw a rise in overdoses and demand for services after Gov. Andy Beshear began enacting executive orders to slow the spread of COVID-19, many of which kept people in their homes.
“Everything we know about recovery and people that are able to achieve it is all about connection. And COVID-19 has turned our world upside down,” said Julie Breitigan, director of Substance Use Services at New Vista, a non-profit that provides substance use recovery services to 17 counties, including in Fayette County. Kentucky’s second-largest city saw a record 209 overdose deaths last year, up from the one-time high of 187 in 2017.
Guiding people toward recovery is already a battle, Breitigan said. But, “when you deconstruct all the things we’ve been using that we’ve found to be successful,” all of which rely on in-person connection, “there’s just a learning curve.”
A revocation of those in-person support services undoubtedly drove some out of active recovery, she said.
In 2020, New Vista saw an increase in both people seeking medication-assisted treatment from substance use disorder, as well as a greater demand for residential treatment options.
Matt Brown, senior vice president for administration at Addiction Recovery Care (ARC), which has programs in 20 counties, said the surge in overdose deaths started in the early days of the coronavirus pandemic in March and April 2020.
In a four-week period, four former ARC clients died of overdoses and a fifth died in a wreck. That was an unusually high number, he said, and it wasn’t the end of the deaths.
Brown, like Breitigan, said he believes a number of factors fueled the increase, including increased isolation; the fact that churches and recovery groups could not meet in person; less court intervention to push people to treatment; and increased unemployment payments and federal stimulus checks.
People needed that financial help and it did a lot of good, but one unintended consequence was putting money into the hands of people struggling with addiction, Brown said.
“It has been a very, very difficult time,” Brown said.
Nancy Hale, a retired educator who is president and CEO of Operation UNITE, said she believed the stress of losing jobs and difficulties finding child care were among the factors that figured in the jump in overdoses.
School closings aimed at keeping down the spread of coronavirus have been a factor as well, she said, because of the added stress on parents, many of them juggling working from home with helping children with school.
“There’s been a lot of pressure on them,” Hale said of parents.
While the opioid epidemic has devastated families and communities, it’s also been a financial drain on state resources.
Though the data is not yet finalized, close to 2,000 fatal overdoses last year in Kentucky is a head and shoulders above the state’s previous deadly peak in 2017, when the state Office of Drug Control Policy reported 1,565 fatal overdoses.
That year, opioid use disorder and overdose deaths cost Kentucky nearly $24.5 billion. Kentucky’s per capita cost for addiction and overdoses that year — $5.4 billion — was the fourth highest combined per capita cost in the nation, according to another new federal analysis. West Virginia, Ohio and Kentucky held three of the top four spots, the CDC found.
The estimated financial toll of addiction in 2017 was based on cost for health care health care, addiction treatment, the criminal justice system, lost productivity and reduced quality of life.
In recent years, Kentucky has secured hundreds of millions of dollars in grant money to help reduce overdoses and provide wrap-around and treatment to people suffering from addiction. That effort is buttressed by an $87 million HEALing Communities study grant, awarded to the state in 2019, aimed at reducing overdose deaths in 16 counties by 40 percent by 2023.
Fatal overdoses across the commonwealth fell slightly in 2018, but rose by 15 percent in 2019, before the pandemic.
‘Isolation is horrible’
Though it’s clear COVID-19 spurred behaviors that feed addiction, it’s too soon to parse out the exact role of the pandemic in the increased deaths.
Dana Quesinberry, an assistant professor in the University of Kentucky College of Public Health, said the CDC model may overestimate the number of overdose deaths, but there is no question there was a dramatic increase in fatal overdoses in Kentucky in 2020.
Quesinberry said it will take some time to properly test the theories on what caused that, such as the role of isolation, economic stress and changes in the potency and availability of drugs such as fentanyl and crystal methamphetamine.
Van Ingram, director of the Office of Drug Control Policy, agrees.
“In addition to the stress caused by the pandemic we believe the increase is due to a rise in illicit fentanyl and its analogs within the drug supply,” he said. “The problem is also exacerbated by the widespread availability of potent inexpensive methamphetamine.”
But is is clear that isolation is not healthy for people with substance abuse disorder, said Quesinberry, the principal investigator for drug overdose surveillance for the Kentucky Overdose Data to Action Program, a program funded by the CDC at the Kentucky Injury Prevention and Research Center as agent for the Kentucky Department for Public Health.
”We do know that individuals who use alone die alone,” Quesinberry said.
There was likely a combination of factors behind the increased deaths, she said.
Fentanyl, which is far more powerful than heroin, and meth have become much more prevalent in Kentucky in recent years. Police say traffickers smuggle the drugs into the U.S. from labs in other countries.
“The cartels are bringing it in, just flooding us,” Hale, the UNITE CEO, said of the drugs.
JoAnn Vanzant, who directs the Rural Health Opioid Program in seven counties in southeastern Kentucky, said she believed the isolation created by shutdowns aimed at curbing the spread of the novel coronavirus was a key factor in increased overdoses in 2020.
The shutdowns meant people couldn’t take part in support activities such as in-person church services and group counseling.
“For people that are in active addiction, isolation is horrible,” Vanzant said. “They lose hope. I think it was just the shock of everything closing down, the immediate isolation.”
Treatment providers who were used to meeting in person with people in recovery struggled to reach them, but adapted as the pandemic wore on, hosting virtual counseling sessions, for instance.
Vanzant said group participation in virtual recovery sessions she led during the pandemic grew. She had 120 people in a session on a Monday night at one point.
Things are starting to open up a bit. Vanzant led her first in-person Celebrate Recovery session last week.
“I’m hopeful that 2021 will look better,” she said.