How the pandemic has worsened Colorado's part in America's overdose death epidemic
Last November, the US Centers for Disease Control and Prevention indicated that for the first time, drug overdose deaths topped 100,000 annually. According to the CDC, more than 102,000 Americans die of diabetes each year, and more 134,000 die from Alzheimer’s Disease.
A large portion of these overdose deaths are attributed to opioids. The CDC estimates approximately 75,000 of the deaths in that 12-month period were caused by opioids. In Colorado, the situation mirrors what public health experts are seeing across the country. According to state data, deaths due to fentanyl doubled in the first year of the pandemic to 452, from 214 the year prior. In 2020, 1,477 Coloradans died from drug overdose.
To understand local and statewide efforts to prevent overdoses, reduce harm and address underlying causes, we speak with Sam Bourdon, the harm reduction grant coordinator with the Colorado Department of Public Health and Environment. We also speak with Georgia Babatsikos, harm reduction manager with the Works Program in Boulder County, which for decades has provided services to reduce the risk of disease and overdose death.
These highlights have been lightly edited for length and clarity.
Erin O’Toole: Sam, I’d like to begin with you. As we mentioned, nearly 1,500 Coloradans died in 2020 due to drug overdoses. You work with the state’s health department, can you give us an overview of the situation in Colorado right now? How would you characterize this moment?
Sam Boudon: Exactly like you first said in your introduction, we are seeing the same sort of increase in fentanyl in every substance in the U.S. and in Colorado. We're seeing it in Xanax and benzodiazepines. We're seeing it in methamphetamine and stimulants and we're seeing it (in) opiates where that original kind of cross-contamination started to happen. And this is happening in the illicit market.
Really, it has been exacerbated by the pandemic. The pandemic interrupted the supply chain of both the licit economic markets and of the illicit drug supply. And so we started seeing more of this prevalence of fentanyl. And fentanyl is a legitimate medical drug, and some people do seek it out illicitly. They may have a higher tolerance. However, it is now contaminating other substances without people's knowledge. And so people who are opiate naive take these substances and may experience a very swift overdose that could be fatal. And so with that contamination of fentanyl, we're seeing this huge uptick in overdose across our state. We lost, like you said, about 1,500 individuals to overdose of all substances in the last reportable year - 2020 - and we're seeing that uptick every single year since 2000.
You work specifically with harm reduction grants. I want to talk more about funding for drug overdose prevention in the state. But first, let me ask about harm reduction. Can you give us a quick explanation of what that means for people who aren't familiar and what harm reduction looks like in practice?
Bourdon: So harm reduction is not a new philosophy, but it can be controversial when it comes to substance use. It actually became popularized during the HIV/AIDS epidemic and was started by people who were most affected by HIV and AIDS. And it's really been informed by the people most affected by the harms of substance use, sexual activity, communicable diseases throughout our history. We know that being a human being and interacting in our world can be inherently dangerous. And so we utilize all sorts of tools to keep ourselves safe. Helmets, life jackets, masks, condoms, seatbelts. Really, we're trying to help people have the autonomy to make their own choices and also live to see another day.
So with harm reduction, really, it's an evidence-based realistic approach to drug use. We recognize that substance use has always been a part of human history. Everybody has a relationship with substances, whether it's positive or negative. And really, we can do a lot of different things to try and reduce harm and reduce death due to drug use. We know that every overdose death is a preventable death. And so the work that we're doing in the state, and the work our partners are doing is really critical in stemming this spate of fatalities that we've been seeing for quite some time.
You mentioned that harm reduction can be a controversial topic for some. Is there any evidence that offering harm reduction options for substance users increases the likelihood that people will use?
Bourdon: No, the evidence is actually quite opposite of that. It's been shown to reduce crime and certainly not increase it. It's been shown to reduce syringe or other drug use litter. It's been shown to increase uptake into treatment services for people who use drugs, re-engagement with health care services and other important referrals. And also, to combat the stigma that really comes with using substances or having a substance use disorder. It can be a tremendously isolating experience, and anyone who's lived know the last few decades can see how many narratives are related to drug use and how some of those can be really harmful when it comes to people accessing the care that they need in the community that they need.
Georgia, let's bring you in because you're also well-versed in this as the harm reduction manager with the Works Program in Boulder County, which has been around for decades. Tell us about the program and the work that you do as the harm reduction manager.
Georgia Babatsikos: So we are the third oldest program in the country. We started around 44 years ago, one year after the federal ban on federal syringe programs came into effect. And so basically, as Sam mentioned, our goal is to reduce HIV and hepatitis C infections and reduce deaths to overdoses. So what it looks like in practice is that we provide free HIV and hepatitis C testing. We provide harm reduction equipment, including syringes and other supplies. We do overdose prevention and education, and we provide Narcan and fentanyl systems. We also refund recovery services as well as treatment services in the jail.
We just heard from Sam about the statewide picture. I'm wondering what the situation is like in Boulder County. What have you seen and observed through the course of the pandemic?
Babatsikos: So we have had to continue to deliver our services outside of buildings because there was still a demand for services. We had about the same number of people using the program, but the actual supplies that we were giving out was 50-100% more. So the stress of COVID really took its toll on our program participant. And we also similarly saw an increase in the overdoses in the last two to three years. So definitely, we're seeing that fentanyl is having a huge impact in the community, both for people seeking fentanyl and people looking at other substances and finding that fentanyl is in there. So it's being manufactured and incorporated into the substances. We're hearing a lot from participants about how scary that is for them, for people who don't want it and for people who are choosing it because it's so unregulated, they can't tell how much of the substance is there and how to self-regulate. So a lot of people are overdosing either way.
I'm wondering how common are programs like yours. I know there are programs in places like Denver where people can get naloxone and fentanyl test strips, for example. But I can't imagine there are many with the history and the support that the works program has.
Babatsikos: There’s a national network that organizes all of the different syringe access programs in terms of mapping. And so there are about 488 around the country. 12 of them are in Colorado. Most of them along the I-25 corridor. So that makes it difficult for people in rural areas to access programs. So we are looking at supporting a lot of new programs out because we've been around a long time with mentoring other programs in the rural areas. But also, if you look around the states around us, there are almost no programs. So if you look at this map, you know, anywhere, but this Midwest area, there aren't many programs, so there is a need to do more. And a lot of the conservative, local governments don't agree with it or don't understand or support it. So that's the challenge that we have even within our state working with these other programs, working with the police, they can't believe that we work so well with the police. So that's a huge part of it, is working with those local counties to get these up and running and overcome those barriers with law enforcement.
OK, Sam, let me turn back to you. What does access to safe use and harm reduction services look like across our state or even just outside the Front Range? I would imagine many of these issues look a little bit different in rural Colorado, for example.
Bourdon: Yeah, absolutely. Georgia is correct, we are a little bit of an oasis in some ways. So there's some gratitude there for Colorado’s more progressive harm reduction legislation and some recent moves that have been made to kind of reduce barriers to starting a syringe access program in the state. However, we do have a high concentration in metro areas and along the I-25 corridor. We do have some syringe access programs on the Western Slope, and in the southeast corner of the state. These different organizations need additional support. We have about 25 counties that don't have a localized harm reduction program, and that is a huge gap, especially looking at how many lives are being lost just to overdose, not even to mention the other harms that are associated with drug use. And that number is likely an underestimate as well because of our inability to really get that full picture through toxicology reporting, autopsy. So we know that there's gaps that exist, and our hope at the state level is to continue advocating for harm reduction as an evidence-based practice, really building up support for additional programs to open and operate in these areas that that need that service. And we're grateful to the existing syringe access and harm reduction programs for sharing their expertise and being willing to really advance this work across the state.
Well, Sam, I'm wondering what you think people should take away from what we've been talking about here, whether that's how to access available resources or maybe even how to think about some of these issues?
Bourdon: I think one of the fundamental pieces is that, like we've mentioned, substance use can affect anyone, and every single death from overdose is preventable and it's preventable by friends, family members and strangers. I encourage everyone to carry naloxone. It's very easy to administer. You should be able to access it at your local harm reduction organization or the pharmacy, and you never know when you're going to be able to save a life. I also encourage folks to really confront their own stigma that might exist. It's hard to exist through generations without kind of absorbing some of the messaging that we've had in the past that doesn't really take into account the bio-psycho-social influences of drug use and why it happens. And so really extending that compassion and extending that compassion to all populations. No one is more worthy than another person for services and for the ability to see another day. And so this is a Coloradan issue. We all have a role to play in this in stemming the overdose epidemic and also keeping each other healthy.
And Georgia, what would you like people to know about what we've been covering here? Or maybe how can people in Boulder County access your services?
Babatsikos: I think the big picture takeaway, and this comes from the National Alliance of State & Territorial AIDS Directors: “The opioid overdose epidemic is the most visible indicator of a much broader set of intersecting health and social issues related to drug use. Health care access, mental health, criminalization, racism and poverty.” So I think understanding the issues that lead to the opioid epidemic and I would add trauma into there as well. Then in terms of specifics, our program, we have program services in Longmont, Lafayette and in Boulder. And so we have offices available, some of them 24 hours. They are all free and we would encourage people to get on our website if they want more information on the Works Program. We do a lot of training of community organizations as well on Narcan and harm addiction. So we're available at community level as well.