Dominion Diagnostics Advisory Board Member and Educator Lisa Marzilli, PharmD leads discussion on opioid abuse in RI with Drug Prevention Coalition

The North Kingstown Prevention Coalition held a meeting last week to discuss the opioid crisis from both a national and statewide perspective. Along with members of the coalition, North Kingstown Police Officers and Firefighters, Dr. Lisa Marzilli, a pharmacist and expert in pharmacokinetic research, was also on hand to give a presentation and answer questions about the opioid crisis. 

Opioids make up a class of drug that includes heroin, synthetic opioids like fentanyl and pain relievers available legally by prescription, such as oxycodone, hydrocodone, codeine, morphine and others.

According to the National Institute of Drug Abuse (NIDA), Rhode Island is among the top ten states with the highest rates of opioid-related overdose deaths. In 2016, NIDA’s website reads, there were 279 opioid-related overdose deaths--- in Rhode Island—a rate of 26.7 deaths per- 100,000 persons and more than twice the national rate of 13.3 deaths per 100,000. 

In 2015, more than 33,000 Americans died as a result of an opioid overdose, which included overdoses on prescription opioids, heroin and illicitly manufactured fentanyl.

And though opioid prescriptions have steadily decreased since 2013, as a way to stem the overdose rate, Marzilli pointed out during her presentation that the decline led people already addicted to prescription drugs to seek illegal opioids, such as heroin and fentanyl. 

“The drive to get drugs is a primitive survival kind of craving and memory. And they’re chasing a high, chasing a high and the truth of the matter is they don’t even get high anymore,” Marzilli said. “The truth of the matter is, the dopamine receptors in the brain do what’s called down regulate, and they can’t feel good. You don’t feel any pleasure, zero pleasure. What manifests as a symptom is lying, cheating, stealing–chasing down the drug.”

“To a diseased brain, not having a pill is not going to stop the intense seeking of a drug,” she added. 

During her presentation, Marzilli focused heavily on the use of fentanyl, both purposeful and accidental, calling it a “poisoning epidemic.” 

Fentanyl is a powerful synthetic opioid analgesic that is similar to morphine but is 50 to 100 times more potent.  It is a schedule II prescription drug, and it is typically used to treat patients with severe pain or to manage pain after surgery. It is also sometimes used to treat patients with chronic pain who are physically tolerant to other opioids.

However, with fentanyl being mixed with illicit opioids such as heroin, there has been an additional spike in opioid-related overdoses. 

“It’s a poisoning epidemic, not an overdose epidemic,” Marzilli said, adding that nobody knows how much fentanyl is mixed with opioids. 

“Two milligrams of fentanyl would kill everyone in this room. It may actually supplant the heroin market,” she continued. “In 2017, 55 percent of overdose deaths were from fentanyl itself.” 

As the presentation went on, Marzilli also touched on means of prevention, such as additional funding and raising awareness of opioid abuse, emphasizing the education of children and young adults. 

“What’s going to be the thing that turns it around?” she said. “Approaching it like public health forensics might be one idea. Or a public health emergency or crisis.”

“When children are five or six,” she added, “parents teach their kids ‘don’t light a match you’re going to burn down the house.’ If you know something that’s this serious, really getting it on people’s radar, it’s going to take us a lot of years to get there. It’s funding from the top down, for sure. All levels. Government, pharma–the whole program.” 

Though she didn’t shy away from the direness of the situation, Marzilli pointed to the treatment and sharp declines in the rates of HIV and Zika virus as examples of how a public health crisis can be managed. 

“The amount of information that came out, the rapidity that it came out, is how it was funded,” she said. 

And as a means of preventing overdoses, Marzilli also pointed to the possible use of supervised injection facilities (SIFs), which, though she said sounded “insane,” resulted in a “huge decrease in overdose, hospitalization and infection.” 

Though SIFs–medically supervised settings where people can inject previously obtained drugs–do not currently exist in the US, states like Massachusetts are considering the use of the facilities as a means to reduce potential harm. 

Kathy Sullivan, a coalition member, also brought up Project Lazarus, a community-based overdose prevention program in Wilkes County and western North Carolina, as a possible way forward. The program focuses on increased access to naloxone, a medication used to block the effects of opioids, especially in overdoses.

“It’s community prevention. It’s a combination of education in the community with events like this, drug take back events, reducing access, working with local prescribers […] and oversight,” Sullivan said. 

Marzilli also said she was a proponent of increased access to naloxone, considering it a preventative measure in slowing the overdose rate. She also said the increased abuse and overdose rate was the result of ignoring the root cause at the heart of the epidemic–mental illness. 

“90 percent of people with a drug addiction have mental illness. And we don’t fund mental illness properly,” Marzilli said. “The things we’re trying to tackle are so thick and so engrained. It’s going to take a long time. It’s going to take a really long time, because it isn’t viewed as a chronic disease.”

“Perhaps this is a symptom of a much larger social problem,” she added.  

The prevention coalition will meet again on Nov. 15 at the Davisville Academy in North Kingstown from 3:00 to 4:30 p.m.