Opioid Harm Reduction Programs in Michigan as Overdoses Continue to Rise

The fact that Michigan is experiencing an opioid epidemic has been well-established. With fatal overdoses on the rise, particularly in Washtenaw and Wayne counties it is vital to not only acknowledge that the epidemic is in fact in full swing, but that there is hope by way of harm reduction practices. According to the US Centers for Disease Control, “harm reduction is a public health approach that focuses on mitigating the harmful consequences of drug use, including transmission of infectious disease and prevention of overdose, through provision of care that is intended to be free of stigma and centered on the needs of people who use drugs.” Harm reduction activities include naloxone distribution, provision of sterile syringes, education and prevention regarding overdoses and safer drugs and other activities that can lessen the risk of adverse outcomes associated with using drugs. 

Several harm reduction activities are offered throughout Michigan, and administered through various organizations. For example, in Michigan various places have naloxone portal kits that have been distributed through the Michigan Department of Health and Human Services (MDHSS). A naloxone portal kit typically contains two doses of naloxone, two nasal misters and directions on use. Naloxone is a medicine that reverses the effects of opioid overdoses, restoring normal breathing and consciousness of a person experiencing overdose symptoms (Narcan is the nasal spray version of this).

According to MDHHS, Wayne County had the highest number of naloxone kits distributed to various organizations by the end of 2022 at 52,464. Macomb County had the second highest number of kits at 35,328 and Livingston County had the lowest number of kits distributed to various organizations by the MDHHS by the end of 2022 at 2,148. The type of organizations these kits were distributed to include first responders, courts, treatment and recovery centers, correctional facilities, health departments, academic institutions and community organizations and non-profit organizations. Throughout Michigan, community organizations and non-profit organizations received the highest number of kits. Of the 334,152 kits distributed throughout Michigan by the end of 2022, 198,780 (or 59%) of the kits were distributed to community organizations and non-profit organizations, according to the MDHHS.

Academic institutions were also included in the list of organizations that receive and distribute naloxone kits. Through Wayne State University’s Center for Urban Studies, the AmeriCorps Community Training for Overdose Rescue (ACT) administers free training for Southeast Michigan community members to prepare people to provide aid during an overdose emergency while waiting for help to arrive. All training participants receive a free Overdose Preparedness Kit containing Narcan. Such training is part of the Strategies and Tools for Overdose Prevention (STOP) program, which is a harm reduction initiative conducting research, delivering training and distributing naloxone in Southeast Michigan. Since October 2019, the ACT/STOP program through the Center for Urban Studies has hosted 235 overdose rescue training sessions and equipped 3,501 people with the skills and knowledge to provide first aid during opioid overdose emergencies.

Another harm reduction tool for opioid use in Michigan is the standing order issued the by the MDHHS that allows licensed pharmacies to dispense naloxone to the public. Of the percent of registered pharmacies in each of the seven counties in Southeast Michigan, St. Clair County had the highest percentage of pharmacies participating the in the standing naloxone order at 79 percent (26 pharmacies). Wayne County had the lowest participating at 50 percent (319 pharmacies).

An additional harm reduction practice is the existence of Syringe Service Programs. These data below shows the percent of the population within a 15-minute drive of a Syringe Service Program funded by the MDHHS. These programs are considered a form of harm reduction because they offer sterile injection equipment and provide a linkage to substance use disorder treatment.

Washtenaw County had the highest percentage of the population that lived within a 15-minute drive of a Syringe Service Program in Michigan at 82.9 percent. Wayne County had the second highest percentage of the population within a 15-minute drive of a Syringe Service Program at 81.7 percent.

Livingston County had the lowest percentage regionally with 0.5 percent of the population being with a 15-minute drive to a Syringe Service Program. While this percentage was much lower than the other counties’, Livingston County had the 53rd highest percentage of the population within a 15-minute drive to a program.

The use of Buprenorphine is harm reduction to meant to treat opioid disorder.  Buprenorphine is a medication approved by the Food and Drug Administration to treat opioid use disorder.

In Southeast Michigan, Monroe County had the highest Buprenorphine prescription unit rate per 1,000 people in 2020 at 3,950.5, followed by St. Clair County with a rate of 2,978.5. Higher rates of Buprenorphine are viewed as favorable in the calculating the MI-SUVI rate because the drug aims to treat addiction. Oakland County had the lowest Buprenorphine prescription rate at 1,485.6 per 1,000 people.

The Buprenorphine rate is based on the prescription units.

As shown, harm reduction programs and policies are in motion in Michigan. And while opioid use still continues, these approaches, according to the CDC, have been proven to prevent death, injury, disease, overdose, and substance misuse.

Even with such programs in place, overdoses do still occur. It is important to be aware of the signs and to know what to do in the event someone has overdosed. According to the ACT/STOP training, signs of an opioid overdose are:

  • Pinpoint pupils
    • Not breathing normally (infrequent or no breathing at all, deep snoring or gurgling)
    • Pale – lips and fingertips may be blue/gray
    • Not responsive to touch or sound
    • Signs of substance use around: syringes, pill bottles, other substances.

Should someone be experiencing an overdose, you should decide to help. Michigan’s Good Samaritan Laws protect you from legal action and lawsuits if unintended consequences result from your assistance.

Ways to help include, if someone is not breathing normally, begin hands-only CPR right away and call 911 immediately. If someone is unconscious but breathing normally, administer Narcan then place them in the recovery position.

For more information on Wayne State University Center for Urban Studies’ ACT program click here. You can also find information on Syringe Service Programs and how to receive naloxone here.

Synthetic Opioid Overdose Deaths in Michigan Continue to Rise, Outpace Other Opioid Related Deaths

Michigan’s opioid epidemic is no secret, and it is not just prescription pills that are contributing to the rise in overdoses. Opioids include prescription pain relievers such as oxycodone (Oxycontin), hydrocodone (Vicodin), codeine, morphine, fentanyl, methadone, and the illegal drug heroin. However, pain killers that are not prescribed or are used outside of the prescription are considered illegal. Furthermore, pain killers such as fentanyl are being illegally manufactured and distributed at an increasing rate. As the first chart below shows, the number of overdose deaths for all opioids has increased since 2000, but synthetic opioid overdose deaths have risen the most over the last several years, according to data from the Michigan Department of Health and Human Services.

In 2000 there were 17 synthetic opioid overdose deaths (not including methadone) in the State of Michigan. Comparably there were 60 prescription opioid overdose deaths in Michigan in 2000 and 89 heroin overdose deaths. In 2021 there were 2,287 synthetic opioid overdose deaths, 512 prescription opioid overdose deaths and 145 heroin overdose deaths. In Michigan, synthetic opioid overdose deaths increased the most between 2014 and 2015 and 2019 and 2020. Between 2014 and 2015 synthetic opioid overdose deaths increased by 465 deaths, from 175 overdose deaths to 465 overdose deaths. Between 2019 and 2020 opioid overdose deaths increased by 466, from 1,445 to 1,911. Although heroin and prescription overdose deaths have also increased since 2000, the number of overdose deaths for both categories have not grown by the amounts that synthetic opioid overdoses have, nor have they reached (individually) as high an overdose death number as synthetic opioid overdose deaths.

The yellow line in the chart represents the total number of opioid overdose deaths between 2000 and 2021, as reported by the Michigan Department of Health and Human Services. The yellow line often falls below the total number of opioid overdose deaths calculated when combining prescription and synthetic opioids and heroin. According to the Michigan Department of Health and Human Services, the summing of categories will not always result in more than the number of all opioid drug overdoses and the categories of death are not exclusive as deaths might involve more than one drug.

It is also important to note that prescription overdoses includes both prescription opioid pain relievers (e.g., hydrocodone, oxycodone, and morphine) and opioids used to treat addiction (e.g., methadone)

The first chart shows the sheer number of opioid overdose deaths by category, and the chart below shows the rate of opioid overdoses by category, again highlighting the increase in synthetic opioid overdoses. The rates below are calculated per 100,000 people. Prescription opioids regularly had the highest overdose mortality rate up until 2015. In 2015 the overdose mortality rate for prescription opioids was 4.5 overdoses per 100,000 people and for synthetic opioids the rate was 4.7. From there, the overdose rate for synthetic opioids grew to a rate of 23.9 overdose deaths per 100,000 in 2021. Prescription opioid overdose rates and heroin overdose rates also grew for a few years beyond 2015, both peaking after then. The prescription opioid overdose rate peaked in 2016 at 7.7 and the heroin overdose rate peaked at a rate of 8.2 overdoses per 100,000 in 2017. Overdose rates for prescription opioid overdoses and heroin overdoses have decreased since then.

The data clearly shows opioid overdoses continue to increase in Michigan, and synthetic opioid (such as fentanyl) overdoses are playing a large role in that. An obvious question may be, why fentanyl? Well, fentanyl is a highly potent opioid that only requires people to ingest a tiny amount to overdose.

According to Rutgers University, in many areas, fentanyl has nearly completely replaced heroin and can be found in many counterfeit prescription opioid and benzodiazepine pills bought on the street. Methamphetamine and cocaine may also contain undeclared fentanyl.

As shown, Michigan is not immune to its population gaining access to this highly dangerous drug. And while it is still found on the streets, law enforcement agents are working to stop production and distribution. According to the US Department of Justice, more than 65 kilograms of fentanyl powder and 88,000 fentanyl laced pills were seized by federal agents during May 23 and Sept. 8, 2022. The USDOJ said this was enough to provide 4.7 million deadly dosages.

According to the USDOJ,  fentanyl is 50 times more potent than heroin. Just two milligrams of fentanyl, or the amount that could fit on the tip of a pencil, is considered a potentially lethal dose.

The risk of overdose remains high with opioid use, as do other negative consequences from using opioids. So, while law enforcement officials work to eliminate illegal production, distribution and use of opioids there are also organizations working to help those with an opioid addiction. As we have noted throughout this series, to end the opioid epidemic we need a multi-faceted approach and treating addiction is part of that approach. In our next post we will discuss these programs and their impacts.