“He liked being outdoors, he liked nature … he loved his kids,” recalled Deanna Gramling of her son Zac Reeves, a father of two who passed away at age 30 from an opioid overdose on April 16. “The people where he was working told us that they called him ‘Smiley’ and that he didn’t seem to meet a stranger. It was funny; he was quiet and kind of shy but he smiled and laughed a lot. But he did struggle with a lot of things people didn’t know on the inside.”
Reeves’s death occurred amid a spike in fatal overdoses being reported across the country as the nation endures months of shelter-in-place orders and business closures because of the spread of coronavirus. The New Jersey Health Department, for example, recently reported that drug-related deaths increased over last year by 17.7 percent, 15.3 percent, and 24.6 percent in March, April, and May, respectively. In Cook County, Illinois, which includes Chicago, suspected or confirmed fatal overdose deaths doubled in the first five months of this year: There were 924 this year, and 461 during the same time period last year.
Shelby County, Tennessee, which includes Memphis, issued 45 overdose spike alerts across a 34-day period ending on May 30. Between April 27 and May 27, there were 439 suspected overdoses reported; 68 were fatal. The Overdose Detection Mapping Application Program, a federally funded project aimed at compiling suspected overdose data to improve law enforcement and treatment approaches to drug use, issued a report in May showing significant increases in overdoses in participating counties after states began issuing stay-at-home orders.
“Our coroner reported … that, compared with this time last year, we have seen a 40 percent increase in fatal overdoses,” said Chris Schaffner, program director of JOLT Harm Reduction in Peoria, Illinois. “Through our own testing, we are finding a lot of stimulants laced with fentanyl. You’re seeing methamphetamine in some parts being positive for fentanyl, and people using methamphetamine are typically opioid naïve, so they are overdosing.”
“Our concern this year has not been, in fact, more overdoses; the concern has been the proportion of lethality,” said Cheryll Moore, director of the Erie County Department of Health Opioid Program. Erie County, New York, which includes Buffalo, had 19 suspected fatal overdoses in January and February, combined, 29 in March, and 22 in April; in contrast, there were 48 fatal overdoses in the first four months of 2019, combined. “People are isolated, they are not in public places, so they are being found in places where someone is not available to resuscitate them.”
Although the numbers being reported are preliminary, and it will be some time before a comprehensive nationwide count is released, they represent a notable setback from 2018, when the country celebrated a national decline in overdose fatalities. That decline was lauded as a small but significant milestone after the country struggled for several years against an onslaught of drug-related fatalities that were exacerbated by an influx of illegally manufactured fentanyl, an extremely potent, relatively cheap synthetic opioid that has been added to or completely replaced heroin supplies in many parts of the country.
Experts caution that questions remain about the exact correlation between these deaths and the coronavirus pandemic.
“Given that we don’t have a robust data set on historical nonfatal data, it’s still difficult to say what seasonality looks like for overdose trends—what if it could be seasonal?” said Aliese Alter, ODMAP program manager at the Washington/Baltimore High Intensity Drug Trafficking Area. She also noted that, because more naloxone is being distributed to non-medical personnel who don’t necessarily report every time they reverse an overdose, it can be difficult to get a clear picture on the number of nonfatal overdoses.
Still, members of directly impacted populations and those working closely with them say it’s impossible to ignore the impact of the pandemic on the way people use drugs. Nicole Reynolds, a freelance street-based harm reduction outreach specialist in Raleigh, North Carolina, said that she has observed a rise in illicit drug prices while quality has lowered. “Because the quality is less, they’re doing more and more, and with fentanyl, you just don’t know what you’re getting,” Reynolds said. “It’s never blended evenly … you might have a chunk of fentanyl in this half of the brick but only a little in the other half.”
Gramling said that, to her knowledge, her son stopped using drugs after being arrested in May 2019 and forcibly detoxed in jail. After being released in December, he entered a faith-based rehab, then switched in February to secular residential inpatient treatment facility, and was, she described, “doing really well. He had a job … [and] he had been [sober] since May of 2019.” But family and community support was a big part of his recovery, she said, including weekend visits and in-person peer support meetings.
“When COVID happened … nobody could come visit on weekends. It felt weird and it was alien,” Gramling said. “It felt unusual to not be able to go see him. When they’re in rehab, they’re not allowed cell phones, so they just don’t have any way of communicating with family.” They were also not able to attend in-person meetings outside of the facility.
Followers of the show “Intervention”—which has been criticized by some as exploitative and misleading, but still garnered 2.9 million viewers at its peak—might remember Zac Reeves as the quiet musician featured in the “Heroin Triangle” season that focused on several people struggling with opioid addiction in the Atlanta area. His 2017 public stint in detox was one of many tries at sobriety, a common pattern for people addicted to opioids who don’t utilize the assistance of long-term methadone or buprenorphine, two evidence-based treatments for opioid addiction that have the highest success rates.
More recently, Reeves relapsed on an opioid while out on an Easter day pass. Although he had only been away one day, and could not therefore have developed an opioid dependency in that time, Gramling says his treatment center took him to a local detox center and told him he could only return after completing a few days there. The detox center, however, was not taking new admissions. Gramling says she doesn’t know exactly where Zac was or what he did in the three days between leaving the treatment facility and overdosing, and that she hadn’t even known the details of her son’s expulsion from the center until the Thursday after Easter, April 16.
“By Thursday, it was too late. We realized that we were chasing a ghost at that point,” she said. The last time she saw her son was during a brief stop by his work about 10 days before his overdose. Because of COVID-19, she was afraid to touch him, and gave him an air hug from several feet away.
Some are concerned that this uptick in deaths could be just the beginning. A predictive analysis conducted by Well Being Trust and the Robert Graham Center found that, following the current pandemic response in the United States, there may be 75,000 more “deaths of despair”—meaning deaths related to suicide, alcohol, and drug use—than seen in a typical year.
“COVID-19 really highlights the risk factors [for deaths of despair] that we know are most prevalent: unemployment, social isolation, disconnection. Those are huge risk factors. Whether or not there’s a direct causal relationship, that’s a whole other issue,” said Benjamin Miller, chief strategy officer with Well Being Trust.
“People have to be really careful when looking at COVID-19 because nobody has ever studied social isolation and disconnection like we are experiencing right now,” he added. “This to me is unprecedented in the times—stuff you and I will remember for the rest of our lives.”