The medical and public health communities are on our back feet when it comes to combatting the current and evolving drug overdose crisis. Without immediate action, communities will continue to be devastated at an increasing rate. As a first responder in New York City, I know this all too well.
The rise of polysubstance overdose – when an individual takes a mixture of drugs, sometimes unknowingly – has led to an overdose epidemic that’s grown more dangerous and complex than ever before. It’s also laid bare how unequipped those on the front lines are to fight back against this menace, let alone keep people alive.
In the Emergency Department, when I have an unresponsive patient in front of me, and I don’t know what they’re on and have just minutes to respond, the current tools at my disposal just aren’t enough.
I’m not looking to point fingers or dissect how we got here. I want to be honest about what’s staring me and many other first responders in the face in hopes that somebody listens.
A record-high 109,000 people in the United States lost their lives to a drug overdose in 2022. While the overdose crisis has reached historic levels in New York City, it is obviously not contained to just one area. Nor is this crisis contained to one demographic; it impacts everyone – young people, veterans, and individuals from across the entire socioeconomic spectrum.
Polysubstance drug overdoses have risen at a dangerously fast rate in recent years, contributing to the uptick in this crisis. In fact, between 1999 and 2018, deaths caused by deadly cocktails of drugs increased by a startling 760% among young people. By 2019, almost 50% of drug overdose deaths involved multiple substances, such as benzodiazepines (e.g., Xanax and Valium) and alcohol. Now, in recent years, a non-opioid tranquilizer called xylazine, sometimes called “tranq,” has become popular to combine with cocaine and opioids to form lethal combinations. Appropriately, the White House Office of National Drug Control Policy recently declared xylazine an emerging threat to the United States.
Current overdose treatment options have been critical tools in combatting the opioid crisis, but their effectiveness can be limited as we see more drugs laced with potent synthetic opioids and non-opioid substances.
Ultimately, overdose deaths occur because of respiratory failure or cardiac failure due to inadequate breathing. And currently, I essentially have only two tools to save people’s lives: naloxone and a ventilator. Although a powerful tool in our public health toolbox, naloxone works by binding to opioid receptor sites. In other words, it only works – and gets people breathing – if we know only opioids are involved.
As we triage in the Emergency Department and see someone who isn’t breathing, we administer naloxone – we have nothing else. Next, we’d put them on a ventilator, which requires multiple steps, such as sedation and intubation, to get patients in a place where it’s safe for them to even be put on a ventilator. In already-overburdened emergency rooms where we’re often dealing with many patients at the same time, every second counts.
There are currently no FDA-approved treatment options that are widely available to reverse polysubstance drug overdose. Overall, innovation in emergency overdose treatment has not kept pace with the ever-changing drug landscape. Naloxone first received FDA approval more than 50 years ago and has since been repurposed as the standard treatment for emergency opioid reversals. And while the FDA’s recent approval of Opvee – a nasal spray version of an older opioid antagonist similar to naloxone – is a small step forward, we’re still behind the curve with new, innovative treatments and addressing the broader risks of polysubstance overdose.
Federal and state governments have mobilized a broad base of stakeholders to fight the growing crisis. And it is, indeed, a crisis that demands holistic and urgent action.
But from my perspective on the ground, one of the clearest actions we can take is prioritizing the development of promising treatments and getting them into the hands of those in need. Fortunately, there are promising drug candidates in the pipeline that get people breathing, regardless of the underlying substances causing the overdoses, giving first responders the chance to save a life. In the same way the government, private sector, and communities rallied around the development of innovations to help first responders during the pandemic, I hope we can do the same here.
Something must be done, and now. The cost of inaction is too great. To catch up, we must foster innovation, encourage regulators to collaborate with drug developers to treat this crisis with the urgency it deserves, and equip clinicians and first responders with the modern treatment tools they need.
Eugene Vortsman, DO, is a practicing emergency medicine specialist with experience treating substance abuse and COVID-19 patients at the largest provider of healthcare in NY State, Northwell Health. He serves as the Medicine Lead for both the Opiate Task Force and Sepsis Task Force and on the Scientific Advisory Board for Enalare Therapeutics.
