State public health officials and addiction treatment providers held a joint briefing on Wednesday to offer updates on their response to Delaware’s escalating overdose crisis.
Their presentations included somber news: Delaware likely set a record for overdose deaths in 2022, surpassing the previous record of 515 deaths set in 2021.
Division of Forensic Sciences Director Dr. John Evans says his agency can’t provide a final figure for 2022 until it finishes more than 100 remaining toxicology reports on suspected overdose deaths.
“I can confirm that there were 406 overdose deaths confirmed in the first three quarters of 2022," he said, "with approximately 124 suspected overdose deaths still pending in the fourth quarter of 2022.”
Delaware saw 374 overdose deaths during the first three quarters of 2021. Fentanyl remains the primary driver of overdose deaths statewide, with New Castle County seeing more than half of the fatalities.
Primary care and substance use treatment providers also discussed the impacts of xylazine: a veterinary tranquilizer used as an additive in other substances, especially in fentanyl, that is increasingly ubiquitous in Delaware's drug supply.
Brandywine Counseling and Community Services CEO Lynn Morrison notes while xylazine is not an opioid, patients unintentionally using it in combination with other drugs develop a dependency.
“We know that people are experiencing withdrawal, so it’s physically addicting," she said. "We need to address both addictions – to opioids, and now to the tranquilizer.”
Philadelphia's public health department issued guidance for treatment providers trying to treat xylazine withdrawal last year. With limited research on the drug's effects on humans and no FDA-approved medication for treating xylazine withdrawal, the Philadelphia Department of Public Health suggested pain relievers like ketamine, some insomnia medications and anti-anxiety medications like Valium.
Delaware providers have not yet determined how they will treat patients experiencing xylazine withdrawal — patients who, generally speaking, would also need treatment for opioid withdrawal.
Morrison adds that so far, xylazine use is typically unintentional, though she worries that its addictive qualities could lead some users to seek it out specifically. "We haven't seen that yet, but it's certainly a trend we all need to be looking out for," she said.
But some providers have expanded their wound care offerings as a growing number of patients develop deep ulcers on their limbs associated with xylazine use. Brandywine, for instance, recently launched a wound care clinic that it plans to offer as a mobile service in the near future.
Brandywine Prevention Program Manager Holly Rybinski says she initially began distributing basic wound care kits, including gauze and water-based antibiotics, through drop-in centers and mobile needle exchanges more than three months ago.
Division of Public Health Chief Physician Gregory Wanner noted that in some cases, substance use treatment providers may not be equipped to work with patients who have serious xylazine-related wounds, creating an additional barrier for those looking to begin the recovery process.
Because xylazine is not an opioid, it does not respond to overdose reversal drugs like naloxone. Wanner and others urged users and other members of the public to continue carrying naloxone to reverse opioid overdoses, but if naloxone alone doesn't revive a person experiencing an overdose — if they don't begin breathing at a normal rate, for instance — public health officials advised that additional CPR may be needed to address a possible xylazine overdose.
Delaware's Division of Forensic Science did not offer data on the role of xylazine in last year's overdose deaths. Dr. Evans says that his lab is currently only able to test for xylazine in drug samples collected by police departments around the state, though preparations are underway to begin testing post-mortem samples — those taken from people who die of suspected overdoses — within the next several months. "Bringing in a new testing method isn't like turning on a light switch," he said.
Public health officials did point to several bright spots in Delaware's response to the overdose crisis, including the launch of an overdose response center equipped to dispatch outreach teams after localized spikes in overdoses.
Division of Substance Abuse and Mental Health Director Joanna Champney also noted the growing availability of in- and out-patient substance use disorder treatment across Delaware over the past year. In 2022, the number of publicly funded beds in detox facilities open to patients with limited or no insurance grew by 43 percent, while outpatient treatment capacity increased by 36 percent statewide.
