Medical Director Charts Tragic Path Town by Town From Opioids To Autopsy

Hartford Courant, Dec. 14, 2015

BY CHARLES ATKINS

Hundreds of mostly younger CT residents taking fatal mix of opioids and depressants

Over the years, I've become a connoisseur of autopsy reports. Reading them is part of my job as a medical director, and I have a drawer full. They paint a picture of what's killing people decades too early. In the past, it's been heart attacks, stroke or cancer, but in recent years it's mostly accidental overdoses with heroin and prescription opioids, usually combined with other sedating drugs.

These are young people from teens to those in their 40s. Their obituary pictures — often snapped before the addiction took root — show them clear-eyed and happy. Google searches pull up stories of high school achievements, or Facebook posts of family events and pets, or less happy stuff in articles and police blotters, like drug arrests, prostitution and petty crimes to support a habit. I've worked with people with addictive disorders for decades; most of them have also had one or more mental health problems.

As I'd do admission physical examinations, I'd observe track marks, abscess scars, heart murmurs from valves damaged by bacteria that entered the bloodstream as needles pierced flesh, and hear stories of lives blown off course. "It started with Percocet prescribed when I had my wisdom teeth out, if I'd known … I'd never have taken them." When I'd tell my addicted patients the dangers of combining opioids with other depressants, such as Valium-type drugs (benzodiazepines), a light would go on. "Oh, that's what killed Sheila." Everyone knew someone who died from an overdose. It's an epidemic, as data from the state's medical examiner shows. It's happening in most every Connecticut town, from three and four dead in Coventry and North Canaan to 31 reported overdose deaths last year in Waterbury.

The numbers keep rising — from 260 statewide in 2009 to 487 last year. Connecticut's five-year total is just under 2,000. As Deaths Increase, Heroin Continues To Be Scourge Of State, Nation As Deaths Increase, Heroin Continues To Be Scourge Of State, Nation After so many death reviews, I've grown numb — that is, until a mother of a child with a bad addiction sidelines me at a workshop or social event. Desperate, she'll ask me what can be done, and tell me of failed treatments, of bank accounts drained and insurance that won't pay. At the end of the conversation, where I try to give a message of hope and potential referrals, I'm left with a pit in my gut … this won't end well.

The autopsies tell the story of the end. Opioids are ingested, snorted or injected, often combined with another sedating substance. The person nods off and stops breathing, their lungs fill with fluid and they die. It's that simple. Portraits Of Addiction Portraits Of Addiction What has surprised me is that the toxicology reports don't show high levels of a single substance. It's the combination that kills. That explains some of the mess we're in. These drugs are cheap, available and it doesn't take a lot to kill someone. Our opioid problem is also resistant to various logical fixes.

The death toll rises, despite policy changes to alter prescribing patterns and get overdose reversal kits (Narcan) into the hands of those who need them. Nationwide, we've seen a decrease in the number of prescriptions written. As those come down, however, inexpensive heroin from Central America floods our streets. To reverse the current trend requires a multi-pronged approach. Law enforcement has to be empowered to break the supply lines. Dope doesn't magically appear on the streets of Torrington. It comes up Route 8 from Waterbury, and the Waterbury dope comes from New York or Hartford.

And that comes from … At the same time, people who engage in criminal behavior to feed their drug habits should be diverted from prisons and into long-term treatment, which is not readily available. Rapid detoxification does not work. Treatment needs to involve opioid replacement therapies, such as buprenorphine and methadone, or detoxification followed by careful strategies to get the person through the subsequent year when urges to relapse are high and the risk of death is great. Mental health problems must also be addressed, or the addicts are back where they started, with their painful emotions forever tied to the memory of relief inside a glassine bag of heroin.

Swallow down a couple Valium, Klonopin or Xanax, and I'm reading another autopsy.

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