When Kevin Sharp began his career as the Tioga County coroner in the 1990s, opioid-related overdose deaths were rare. More than 20 years later, about 25% of all deaths investigated in Cortland County are related to opioids.
In the late 2000s through 2010s, states in the Northeast, such as New York and Massachusetts, saw a rapid acceleration in opioid-related overdose deaths, reports Cortland Area Communities That Care. The group engages the community to promote a healthy culture for positive youth development, according to its website.
Between 2010 and 2017, New York state saw those deaths triple from 5 to 16.2 deaths per 100,000 people.
During that time period, Cortland County saw 69 fatal drug overdoses. “The biggest change we’ve seen is the increase in opioid deaths,” said Sharp, who retired as the Cortland County coroner on April 6. “They’ve always existed but as of late, they’re more and more frequent.”
Of the dozen cases Sharp worked on before he retired this year, about a third of them came back pending toxicology, he said. Until the toxicology report comes back, they are deemed suspected overdoses.
National heroin-related fatalities decreased by 200% between 2010 and 2017, driven by a more than 100% increase in deaths caused by fentanyl, a synthetic opioid, reports Cortland Area Communities That Care. Counties in Western New York, Central New York and Hudson Valley have disproportionately higher opioid overdose rates when compared to other regions.
Opioid-related fatalities continued to fluctuate in Cortland County between 2017 and 2020 but fatal and non-fatal overdoses have been on the rise since 2017, reports Cortland Area Communities That Care. The appearance of heroin in fatal overdose toxicology reports has decreased and plateaued since 2017 but the appearance of fentanyl has risen sharply.
“Most recently, these overdoses are being driven by the presence of fentanyl in toxicology reports as well as on-scene investigations,” said Travis Young, data coordinator for Cortland Area Communities That Care. “The number of 21 overdose fatalities comes from law enforcement agencies — if these numbers come back and they’re related specifically to opioid use, it’ll be the highest number we’ve seen in over a decade in Cortland County and significantly higher than our low point in 2018.”
When looking at opioid-related deaths, Young noticed a general increase between 2014 and 2017 and a significant decrease in 2018 that was followed by a rise in overdoses in 2020, he said.
“Typically, if we investigate and there is no clear cause of death, we would order an autopsy,” Sharp said. “Depending on the findings, the cause would come back pending toxicology reports.”
Still, there is a clear indication that total overdoses have increased in the county, and across the country, through the last year, Young said.
Sharp speculates the increase in overdose fatalities can be contributed to two factors — preexisting addictions from prescribed pain killers and cheap street prices for heroin.
In the last year, national and state data showed a relationship between increases in overdoses and increases in social distancing, Young said. But Cortland Area Communities That Care doesn’t know if the increase in overdoses is specifically related to the COVID-19 pandemic.
To prevent opioid-related overdose deaths, Cortland Area Communities That Care is working with the Cortland County Health Department and Family Counseling Services of Cortland County to fund and host programs to teach people how to administer naloxone, said Sara Watrous, project director for Cortland Area Communities That Care.
The training is simple; in five to 10 minutes, people are shown how to administer naloxone, a drug used to stop the progress of an opioid overdose, by pushing the pink release button between the finger holds and spraying naloxone up the person’s nose. Afterward, trainees are given an overdose rescue kit containing two doses of naloxone.
“There are no negative side effects,” said Jacqueline Allen during a training session in February. Allen is an AmeriCorps volunteer with Cortland Area Communities That Care. “This is why we are trying to get Narcan out into the community – you will save the person’s life 99% of the time, if you get to them in time.”
Because of the Good Samaritan Law that New York enacted in 1984, the person calling 911 and the person overdosing are protected from prosecution if drugs or drug paraphernalia are on the scene of an overdose, Allen said.
“We want to prevent death,” Watrous said. “We need access to naloxone to make sure people don’t die but also want to make sure community members have access to harm reduction services, treatment and any other services.”
The Cortland County Health Department distributed 237 kits in 2020, with 41% of those kits going directly to law enforcement, reports Cortland Area Communities That Care. In addition, Family and Children’s Counseling Services has distributed 200 kits since October through its clinic, community pop-up events and virtual training.
Still, most communal administration of naloxone goes unreported, according to Cortland Area Communities That Care. In 2019, about 70 doses of naloxone were reportedly distributed by law enforcement and community members as opposed to the estimated 45 in 2018.
Cortland police responded to 55 opioid overdoses in 2020, more than twice what they responded to in 2017, said Jesse Abbott, the Cortland city police department’s community policing officer. But this doesn’t account for the remainder of the county whose data has not been collected.
“Almost all of our officers have had to use it,” Abbott said. “Most of us have had to use it several times.”
Since Jan. 1, the Cortland Police Department has responded to 25 overdose calls, 14 of which required naloxone distribution and three of which resulted in death, according to data from the police department. Of those 14 distributions, seven were from patrol officers, five were from civilians on scene, one was from the Cortland Fire Department and one was self-administered.
The most recent overdose call the department received was a week ago today for a man who overdosed on heroin and naloxone was administered by a civilian, the data shows.
Between Jan. 1, 2020 and April 17, 2020, the department responded to 17 overdose calls, said Lt. David Guerrera. That’s eight less than the start of this year.
“A citizen usually has already administered Narcan by the time we’ve arrived,” said Cortland Police Officer Melissa Eccleston.
This past year, civilian distribution has become more common, observed Eccleston. Years prior, it was unheard of.
When Eccleston responded to her first overdose call, she found a woman, alone and unresponsive, in a cold bath tub on Homer Avenue, she said. It took three to four 2mg doses of naloxone to revive her. Since then, she’s seen the same people overdosing and being transported to hospitals where they are released within an hour and found overdosing again within 24 hours or less.
Cortland Area Communities That Care and Healing Cortland have partnered with the Cortland County Health Department and Family Counseling Service of Cortland County to work toward communal naloxone access and training, Watrous said.
But the easy access of naloxone within communities has made opioid users more comfortable, speculates Cortland Police Officer Ryan Gross. He’s observed several drug dealers carrying naloxone at the same time, as if anticipating naloxone use, and drug use, in higher quantities.
The data collected through Cortland Area Communities That Care in partnership with local agencies and organizations can be used to better understand opioid-related treatment and prevention in the community to better target communities and develop strategies for people accessing treatment and prevention services, Young said. It can also help when educating children, teens and young adults.
“A lot of our youth prevention initiatives are focused on the common substances that youth are actually using like alcohol, marijuana, tobacco and vaping,” said Cortland Area Communities That Care director Matt Whitman. “The younger someone starts using a substance, the higher the risk is of using a substance later in life.”
The goal in educating youths is to delay onset of potential substance use in the future, Whitman said. Some programs, like Too Good for Drugs, target kids in fifth, sixth and eighth grade to give them the skills to prevent substance use.
“We know that if someone starts drinking at 13, they’re going to be at an increased risk for developing more problematic drinking behavior or a substance abuse problem than someone who starts drinking when they are 21,” Whitman said.
Since Cortland Area Communities That Care began researching youth substance use 20 years ago, drinking rates among 12th graders have decreased from 58% to 36%, Whitman said. The survey has shown similar declines in almost every substance.
“The declines have mirrored what we’ve seen in Cortland,” Whitman said. “All of the work we are doing now with fifth-, sixth-, seventh-, eighth-graders is going to create healthy adults from our community.”
Fifteen to 20 years from now, Whitman wants to see a decline from the current numbers.