3/4/2021 Provider alert anniversary of the COVID-19 pandemic and increase of fentanyl overdose

| March 5, 2021

Actions Requested

  • Support clients and patients who are experiencing despair or hopelessness, apathy or anger, and grief and loss. See the Supporting Clients and Patients section and resources for providers for more information.
  • Share information and resources with clients, patients, and their families on building resilience, support strategies, mental and emotional well-being, and crisis support. See resources for clients, patients, and families for more information.

Background

Consistent with previous literature on disaster response and recovery cycles, the one-year anniversary after the initial impact of a disaster is typically a significant event for many in the affected population.1 As the one-year anniversary of the initial social and economic impacts from the COVID-19 pandemic approaches for Washington residents in mid-March 2021, behavioral health related responses to this significant period will be widespread and varied.

Areas of concern include:

  • Despair or hopelessness that the pandemic has continued this long and that we are still in it.
  • Apathy or anger about ongoing restrictions and following public health guidelines a year (or more) after the initial outbreak/impact.
  • Significant bereavement, grief, and loss reactions about what has been lost or changed (e.g., economically, socially, and personally).

Expressions of distress during this time will vary dramatically and may range from being very intense to almost nonexistent. Consistent with other types of disasters or critical incidents, the one-year anniversary of the impact of an event can go unnoticed by some and is a main focus of attention or distress for others.

Supporting Clients and Patients

For clients and patients who are experiencing despair or hopelessness:

  • Normalize their reaction and validate that a year is a long time to be struggling through something this significant.
  • Try to facilitate a space for them to process their experiences. Use active listening when possible.
  • Reflect with them about a light at the end of the tunnel. Ask them to identify small improvements they have made in the last several months.
  • Try to help them make the shift, mentally and emotionally, from seeing the pandemic as a threat to seeing it as a Challenges have pieces that can be overcome and can generate growth and resilience.

For clients and patients who are experiencing apathy or anger:

  • Help them try to direct their attention and motivation towards something bigger than themselves. For example, sometimes it’s easier to make healthy and safe choices when people are committed to helping others.
  • Help them identify positive ways that they can contribute to the experience of others, if possible. For example, they could lend a hand or offer support to those around them who may have fewer resources.

For clients and patients who are experiencing grief and loss:

  • Recognize that there are significant cultural, familial, and past experiences that affect how each of us experience loss and how we show grief.
  • Stay focused on validating and listening to the griever.
  • Validate conflicting emotions. It’s okay to feel terrible loss and also relief at the same time.
  • Facilitate problem solving and decision making to prevent impulsive or risky decisions (e.g., decisions related to precautionary health measures, burial of loved ones).
  • Modify coping plans if traditional strategies aren’t possible (e.g., gathering with family to grieve using a virtual meeting platform).
  • Help them identify places of belonging, safe and positive relationships, and activities that are uplifting. This helps the person feel some control.
  • Provide psychoeducation about the grief and loss process, especially around the warning symptoms of complicated grief and trauma, such as symptoms consistent with post-traumatic stress disorder or major depressive disorder.

Resources

For Providers:

For Clients, Patients, and Families:

“The COVID-19 pandemic has affected all of us,” said Bob Lutz, state medical advisor for the COVID-19 response. “Those Washingtonians with substance use disorder may have found themselves using more frequently, and unfortunately, the data suggest they are also overdosing more often.”  Maki, Kristen. “Overdose deaths show alarming trend in 2020; fentanyl partly to blame.” Washington State Department of Health, 19 Feb. 2021, News Release

Actions Requested in regards to the risk of overdose

  • Alert patients to changes in the drug supply and the resulting risk of overdose due to fentanyl.
  • Educate caregivers and communities about the signs of an overdose.
  • Educate patients, caregivers, and communities about naloxone.

Background

Preliminary data from the Washington State Department of Health indicate there were more overdose deaths in Washington in 2020 than in 2019. The number of overdose deaths due to fentanyl is particularly concerning. Preliminary data show:

  • 828 overdose deaths in Washington in the first half of 2020, compared to 607 overdose deaths in first half of 2019.
  • Of those overdose deaths, 305 were attributed to fentanyl in the first half of 2020, while 137 were attributed to fentanyl in the first half of 2019.

A convergence of factors may be leading to an increased risk of drug overdose in Washington. Illicit fentanyl has been found in counterfeit pills made to look like prescription opioids, as well as in powders and other illicit drugs. The extended disillusionment phase of disaster for the COVID-19 pandemic may be an additional factor, since it is typically the disaster phase with the greatest behavioral health impacts.

Action Steps

  • Educate patients about changes in the drug supply and the risks for overdose due to fentanyl.
  • Make sure patients and their caregivers have access to and knowledge of naloxone.
    • Prescribe naloxone to anyone who uses illicit drugs.
    • Prescribe or distribute naloxone to people who use opioids and have recently been incarcerated or have had a break in use.
    • Co-prescribe naloxone with an opioid prescription.
    • Provide resources for patients, their friends, and their family about how to use naloxone.
    • Counsel patients about how to create a safety plan with their friends, family, and caregivers in case of an overdose.
    • Inform patients and caregivers on Washington’s standing order to dispense naloxone.
  • Talk to patients who are in recovery from opioid use disorder (OUD) about the risk for recurrence of use and the benefits of effective treatment medications and naloxone.

Resources

For Providers

For Caregivers and Communities