Despite being the smallest state in the United States, Rhode Island has some of the biggest drug problems in the nation. The Ocean State ranks first for the number of people using illicit drugs, the Brown Daily Herald publishes. More than a third of the population filled prescriptions for controlled substances in 2013, and more than 90 million doses of narcotics, sedatives, stimulants, and tranquilizers were prescribed across the state, according to the Providence Journal. Rhode Island came in third in the United States for the number of residents misusing prescription drugs in 2009.
Drug overdose rates are increasing as well. In 2015, they reached an all-time high as nearly 300 people died from an accidental overdose, the State of Rhode Island Department of Health reports. It is no surprise that Providence, the capital and most populated city in the state of Rhode Island, is also home to high drug abuse, addiction, and overdose rates.
Drug Abuse Trends
Per capita, residents of Rhode Island abuse drugs like marijuana and illicit drugs at rates that are almost 50 percent higher than the United States as a whole, the Providence Journal publishes. Rhode Island rates high for abuse of the following drugs in 2013:
- 1st in the US for marijuana abuse
- 3rd for binge drinking and alcohol poisoning
- 4th for cocaine use
- 4th for benzodiazepine misuse
- 4th for prescription painkiller abuse
In Providence, between 2014 and 2016, there were 229 drug overdose deaths, the highest rate in the entire state, Prevent Overdose RI publishes.
Heroin is readily accessible, easy to snort or inject, and cheaper in Providence than in Boston, WPRI reports, making it the drug of choice in the city. Heroin dealers are lacing the illegal opiate with a more powerful synthetic opioid, fentanyl, which in part is driving the rise in overdose fatalities; they spiked more than 70 percent between 2009 and 2014.
Fentanyl is 50-100 times more potent than morphine, the National Institute on Drug Abuse (NIDA) warns. It is often used to “cut” heroin and make a batch bigger. Fentanyl is both an illicit opioid and a prescription narcotic. It is prescribed to treat acute and severe pain, but it is also manufactured in clandestine laboratories and sold on the street. It is often passed off as heroin or added to heroin (or even cocaine) without the buyer’s knowledge.
Overdoses from fentanyl are rising fast all over the United States and especially in Rhode Island. In April, May, and June of 2016, around 60-70 percent of all overdose deaths in the state were attributed to fentanyl, the Newport Buzz publishes.
Overdoses on prescription drugs have leveled out some in recent years in Rhode Island; however, deaths from illicit drug overdoses are rising. This may be due to the fact that individuals who struggle with addiction to prescription narcotics are switching to heroin as a cheaper opiate (which may or may not be laced with fentanyl).
Marijuana is legal for medicinal use in the state of Rhode Island, and for the third year, lawmakers are pushing to legalize the drug for recreational use as nearby Massachusetts (and seven other states) has done, the Brown Daily Herald publishes. Rhode Islanders use marijuana at rates almost triple the national average. The Providence Journal reports that 2013 national survey results show that 20 percent of adults over the age of 12 in Rhode Island report past-month marijuana use, while the national average is just over 7 percent for monthly use.
Legalizing recreational use of the drug may increase access, and therefore potentially use, in Rhode Island. Close proximity to states like Massachusetts where marijuana is legal already makes the drug fairly accessible.
Local Treatment Options
Addiction is a serious brain disease with far-reaching ramifications for individuals, families, and society in general. The National Survey on Drug Use and Health (NSDUH) reports that over 21 million Americans battled addiction in 2014. Addiction is a highly treatable disease with many different types of treatment programs, tools, and options to choose from. Treatment options generally take the following forms:
- Detox and medical detox: Detox programs provide supervision and assistance as drugs process out of the body safely. In the case of opioids, alcohol, and benzodiazepines, drug withdrawal can be significant and even potentially dangerous; therefore, medical detox programs are generally considered optimal. A medical detox program may use medications to manage withdrawal symptoms, while closely monitoring vital signs and emotional health as well. These programs usually last a couple days, and medical detox programs are typically inpatient, meaning that the individual stays on site while the drugs process out of the body.
Oftentimes, medications like methadone or buprenorphine are used to replace drugs like heroin or other short-acting opioids during detox and opioid addiction treatment. They are longer-acting and do not have as significant agonist features as many other opioids, meaning that a person is less likely to feel “high” when taking them. These medications are often useful in helping to manage withdrawal, minimize cravings, and reduce relapse. Replacement opioid medications can be given in lower doses less often and then tapered off slowly over a set period of time.
- Outpatient treatment programs: Outpatient treatment programs may offer a variety of services like therapy, counseling, medications, and support. The nature of an outpatient program means that the person receiving services can attend meetings and sessions around their existing life obligations and schedules. Outpatient programs are highly flexible.
- Residential, or inpatient, treatment programs: Residential treatment programs are more comprehensive and often provide the highest level of care. An individual’s needs are attended to on a 24-hour basis and their days are highly structured to foster lasting recovery.
- Peer support programs: Support groups that provide individuals with ongoing encouragement throughout recovery are often hosted by community-based programs and agencies, many of which contract with the Rhode Island Department of Health(RIDOH). Examples of local peer support programs include Alcoholics Anonymous in Rhode Island (Rhode Island AA), the Greater Providence Area of Narcotics Anonymous (GPNA), and Rhode Island Marijuana Anonymous (MA), to name a few. These groups are national or even international organizations that host local meetings and groups.
Prevent Overdose RI hosts a helpline that is staffed 24/7 to help individuals and families who are battling drug abuse and/or addiction. The Prevent Overdose RI website is an initiate of Governor Raimondo’s Overdose Prevention and Intervention Task Force, which is also a collaboration with the Rhode Island Department of Behavioral Healthcare, Developmental Disabilities, and Hospitals (BHDDH), RIDOH, and the Brown University School of Public Health. It provides a map (and list) of local addiction treatment options offered within the Ocean State. The Substance Abuse and Mental Health Services Administration (SAMHSA) also provides a behavioral health treatment services locator tool that people can use to find local treatment options that fit their specific needs. Primary care providers can be great resources for finding local treatment options as well.
State and City Actions and Resources
Officials in the state of Rhode Island are tackling drug abuse and overdose issues head on. Governor Raimondo’s Overdose Prevention and Intervention Action Plan promises to reduce overdose deaths in the state by a third in three years via the following four complementary strategies:
- Prevention: Monitor opioid use and prescriptions closely through the Prescription Drug Monitoring Program (PDMP) and use community-based programs to provide local education and information to the public on the drug abuse epidemic.
- Rescue: Ensure access to the opioid overdose reversal drug naloxone.
- Treatment: Expand treatment and offer more options and programs across the state.
- Recovery: Improve access to medication therapies and peer-based recovery services.
As of the most recent National Survey on Substance Abuse Treatment Services (NSSATS) in 2013, there were 62 total addiction treatment programs in Rhode Island that were accredited and recognized: 47 private nonprofits, 13 private for-profits, and two federal government programs. Rhode Island does not currently have any state-run programs. BHDDH provides resources on local agencies licensed to provide substance abuse services in Rhode Island. The Substance Use and Mental Health Leadership Council (SUMHLC) of RI also hosts resources for addiction and mental health services in the area.
Ideally, addiction treatment programs should offer a range of options that help to address the physical, emotional, social, and behavioral aspects of the disease of addiction. NIDA recommends that individuals spend no less than 90 days in an addiction treatment program, be it outpatient or residential. A client may begin treatment with medical detox and then move on into either an inpatient or residential program. This care should then be followed with ongoing recovery and aftercare services that often include peer support and 12-Step programs.
Recovery is personal; therefore, no two treatment plans will look exactly alike. High-quality care should be tailored to meet the needs of the unique individual.