As fentanyl deaths soar, providers push new treatments, harm reduction

The potent blue pills fentanyl is so often mixed into have become ubiquitous: thousands of the counterfeit pills have been seized locally this year. They're also often found at the scenes of fatal overdoses like that of 19-year-old Elisabeth Duncan, who overdosed on a counterfeit fentanyl pill in June.

Those fighting the local opioid epidemic from the front lines say the region has made huge strides in moving toward a holistic and evidence-based approach to addiction treatment in recent years. But as overdose deaths continue to surge, the question remains: what more can be done?

Addiction treatment in Evansville

Some of the most well-studied and effective treatment methods are available locally in Evansville, such as “medication assisted treatment,” or MAT. And grassroots organizations such as the Evansville Recovery Alliance distribute Narcan and fentanyl testing strips to addicts free of charge.

Doctors, health officials and addiction experts increasingly view MAT as the new gold standard for treating opioid use disorder. But according to federal data, the number of doctors licensed to practice MAT in Evansville lags far behind the number of doctors licensed to prescribe opioid painkillers.

This isn’t ‘a drug for a drug’

James Evans is the area manager for CleanSlate Centers, a medication assisted treatment provider that operates 18 facilities in Indiana, including one in Evansville off Washington Avenue. 

CleanSlate’s outpatient facility provides therapy, mental health treatment and MAT to hundreds of Southern Indiana residents who struggle with substance use disorders. 

“Medication assisted treatment is kind of the gold standard when it comes to opioid recovery,” Evans said. “While every path does have a success rate, and we do utilize multiple paths, our initial focus is on the harm reduction aspect.”

The medication CleanSlate prescribes is buprenorphine (pronounced byoo-pra-nor-feen), which is an opioid itself. Using an opioid to treat opioid addiction may sound like a contradiction, but Evans said that's a feature of buprenorphine rather than a bug. 

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Buprenorphine binds so tightly to opioid receptors in the brain that it blocks drugs such as heroin, oxycodone and fentanyl from producing a high – or an overdose. It’s also a mild opioid not known for producing much in the way of euphoria, but it still has the power to reduce the cravings that so often lead people to relapse.

“Instead of affecting the entire brain, it’s only affecting a small portion of it,” Evans said. “Because it is only a partial agonist, it (the effect) comes up and then it plateaus. It doesn’t matter how much you take. You’re never coming above a certain level.” 

These unique properties are what have propelled buprenorphine from its origins as a seldom-prescribed pain medication to a blockbuster, multi-billion dollar drug.

Prior to the year 2000, most doctors were barred from prescribing opioids such as buprenorphine to treat opioid addiction. But, the Drug Addiction Treatment Act of 2000 changed that, and allowed the drug Suboxone – a combination of buprenorphine and the opioid blocker naloxone – to be prescribed for opioid addiction. 

In the years since, the U.S. Drug Enforcement Administration eased restrictions for doctors wishing to prescribe the drug. 

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Buprenorphine can be employed short term to treat the acute symptoms of opioid withdrawal or long term to reduce cravings, relapses and overdoses. 

It’s even being studied as an option for people with treatment resistant depression. 

CleanSlate sees patients from a diverse background, Evans said. Some clients were referred to CleanSlate after a recent arrest or years of homelessness. Others have masters-level degrees. Some are old, some are young.

The road to recovery

One of Evans' patients made it to her 70s without suffering from any form of addiction. Then she fractured a bone and was prescribed heavy doses of opioid pain medications. 

“For many years she was highly medicated, and then she was cut loose cold turkey,” Evans said. “Now she realizes she has a substance use disorder. She went through and sold everything she had. She sold her house, all of her property, to fulfill that need.”

She then sought professional addiction treatment and was eventually prescribed buprenorphine to treat opioid use disorder. 

“Now she’s on the road to recovery,” Evans said. “She’s been free and clear of anything for the last two years.”

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But MAT has its detractors, and many patients face stigma. 

“We’ve had patients who have left and gone to a pharmacy while they’re in treatment, and the pharmacist will yell at them, call them ‘druggies,’ ‘addicts,’ ‘thieves,’” Evans said. “This isn’t just a ‘drug for a drug.’ We’re not enabling this. What we’re doing is preventing withdrawals. We’re preventing overdoses.”

And while buprenorphine regulations have been eased in recent years, barriers to treatment remain. According to the U.S. Substance Abuse and Mental Health Services Administration, just 19 doctors within 50 miles of Evansville are licensed to prescribe buprenorphine to addicts.

'Our number one category of death'

So far in 2022, the powerful synthetic opioid fentanyl has caused more fatal overdoses in Vanderburgh County than any other drug, according to data from the coroner’s office. 

Fourteen people have died from fentanyl alone, the data shows, while an additional 16 victims tested positive for fentanyl in addition to other drugs, such as methamphetamine. 

Vanderburgh County Coroner Steve Lockyear has spoken to dozens of local families who have lost someone to opioid addiction. He fears more local families will face the same tragedy in the years to come if the region can’t improve addiction treatment outcomes. 

“Twenty years ago when I was at the sheriff’s office, we were not seeing many fentanyl deaths,” Lockyear said. “We were looking at 20 overdose deaths a year in Vanderburgh County. Last year, we were at 106.”

Overdoses have increased so dramatically that organ donations spiked in recent years since many overdose victims are donors, according to Lockyear. 

“I’ve known a lot of people that are wrapped up in drugs during my career at the sheriff’s office and here, and I’ve asked them, ‘If you were told this substance or pill had fentanyl in it, would you still take it?’” Lockyear said. “And most of them said, ‘Most likely, yes.’ Your body is screaming for it. And it screams very loudly.”

Overdoses in Henderson

Overdose deaths have spiked in Henderson, Kentucky, too, according to federal and local law enforcement officials working to prosecute fentanyl dealers in connection with specific deaths.

In February, a federal grand jury indicted three people for distributing fentanyl that prosecutors said killed 19-year-old Henderson resident Trestin Fox in October 2021. The fentanyl also reportedly caused a non-fatal overdose inside the Henderson County jail.

And in October, federal prosecutors charged 19-year-old Elijah Lovell, of Henderson, with two counts of distribution of fentanyl resulting in death. The fatal overdoses occurred between December 2021 and January 2022, according to the indictment.

The problem has gotten so bad that the Henderson Police Department said they will not press charges against addicts who dispose of fentanyl at the police station and seek help from Kentucky State Police's Angel Initiative.

The program, which got its start in 2016, connects those suffering from addiction with treatment resources, "no questions asked."

Lockyear also believes in a multi-pronged approach to combating the surge in overdoses: law enforcement interdicts the drug supply while treatment centers, nonprofits and first responders offer help to addicts. 

That help is already here in ways that it wasn't just a decade ago. For every fatal overdose in Vanderburgh County there are dozens of people who survived an overdose thanks to first responders injecting them with Narcan, Lockyear said. 

“Without it, I can’t imagine what the numbers would be,” Lockyear said. “Literally hundreds of doses are administered by the fire department alone.”

'We have to save their life'

The Indiana Recovery Alliance advocates for expanded access to MAT and other innovative methods to reduce the harm caused by addiction. Evansville’s chapter has installed “opioid rescue kits” that include Narcan at nine locations across the city.

Karen Warpenburg, who helps run the Evansville Recovery Alliance, is a strong believer in MAT. The effectiveness of drugs like buprenorphine and methadone, another opioid used to treat addiction, have been born out through decades of research, she said. 

For the skeptics, she points to the tight government regulations and strict accrediting agencies that hold MAT providers to protocols. 

“It’s evidence-based, it’s been proven over time, and we fully support it,” Warpenburg said.

The organization's main focus is harm reduction, which means reducing the harm experienced by those people who are still in active addiction as well as the harms posed to society as a whole by drug use.

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As part of that effort, the ERA has freely distributed more than 3,800 doses of Narcan over the past four years, according to Warpenburg. The organization recently started providing fentanyl testing strips free of charge to people who would like to ensure their drugs are not contaminated. 

“This is something we’ve had to start pushing,” Warpenburg said. “It’s really important now that fentanyl is everywhere. … And these strips can be used to test any drug, so it’s a really important aspect (of harm reduction).”

But the drug testing kits for people who still actively use drugs frequently receive backlash from those who believe it condones, or supports, illicit drug use. Warpenburg doesn’t see it that way.

"We have to save their life to get them to a point where they’re able to stop using, you know?" Warpenburg said. "If we can’t save their life, we’re not going to get them to a point where they can stop using.

“So once we get (detractors) past that conversation, we usually have ‘em. But, we do get a lot of pushback, initially.”

Warpenburg wants to do more, and she wants local officials to do more, too. As an example, she points to an Indiana Recovery Alliance-backed syringe program in Bloomington.

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Monroe County has partnered with the IRA to operate the Monroe County Syringe Service Program. It's open seven days a week with the goal of reducing overdose deaths and the spread of infectious diseases.

"We'd really like to see that here, but we would definitely get a lot of pushback on that," Warpenburg said. "We know. We've brought it up."

Some Indiana towns have opposed MAT providers setting up shop locally, too, according to Evans. But acceptance is growing.

"We didn't see that (opposition) in Vanderburgh County, and I was pretty excited for that," Evans said. "The health department is very understanding."

The U.S. Substance Abuse and Mental Health Services Administration hosts an online tool that helps those suffering from opioid use disorder and their family members locate a MAT provider in their area.

Where to get an opioid rescue kit

The ERA's opioid rescue kits can currently be accessed 24 hours per day, seven days per week at these five addresses:

• ECHO Housing — 401 John St.
• ECHO Housing — 315 Mulberry St.
• ECHO Housing — 25 W. Division St.
• Ivy Tech — 3501 N. First Ave.
• Community — 30 E. Virginia St.

Warpenburg said the ERA is "always looking for more locations" willing to host a 24/7 opioid rescue kit.

"We're having a meeting next week," she said. "And so I think there's going to be sixth one."