Paula Silha on the Health Goals of Overdose Fatality Reviews

Frederica Freyberg:
In health news, good news. The Centers for Disease Control and Prevention reports a more than 10% decline in drug deaths this year for the first time after decades of steep increases. Wisconsin mirrors the downward trend. There certainly has been an all-out push to save lives from law enforcement interdiction efforts to harm reduction efforts like Narcan. On the ground locally, the Medical College of Wisconsin also helps communities conduct overdose fatality reviews to look holistically at the victims, to help others stay alive until they can get treatment. La Crosse County has been conducting such reviews since 2018. Paula Silha is from the county health department. She joins us now. And Paula, thanks a lot for being here.

Paula Silha:
Thank you so much. It’s an honor to have this discussion.

Frederica Freyberg:
So has La Crosse County also seen a reduction in overdose deaths as has been the case nationally and statewide?

Paula Silha:
Well, our rate in 2023 was the highest that it’s ever been. So, you know that was end of 2023. When we’re looking at 2024, we’re behind the numbers that we saw last year at this time. So we’re hopeful that the total numbers will be less than, you know, 2023. But we don’t know that yet. We’ve still got a few months of ’24 to get through.

Frederica Freyberg:
When you’re conducting an overdose fatality review, what are you looking at in that person’s life?

Paula Silha:
We’re looking at early substance use. We’re also looking at trauma that they may have experienced. You know, were they a party to a home where other substance use was going on? Did they have particularly difficult schooling? Did they move a lot? You know, were they a part of a broken family? People may have heard of the term ACES, which is adverse childhood experiences. And we know that those — there’s like ten different experiences and we know those experiences make children’s lives that much more difficult. So we look for that. We aren’t calling them ACES, but we look at the growing up history of the person. If we have access to that, we also look at how much they moved. There might have been medical problems that people have had. We’ve had several people who have had head injuries, and we know that — a concussion. We know that also impacts thinking and coping abilities that young people have. And then we look at involvement with treatment, law enforcement, if they’ve been incarcerated at all. We’re looking at all of those kinds of things to look at opportunities where prevention couldn’t be implemented to save someone from walking down that same path in the future.

Frederica Freyberg:
Give us a sense of who makes up the team.

Paula Silha:
So the team is a combination of — there’s probably 12 to 15 professionals and community members that are a part of the group. So law enforcement, we have someone from the judicial system. We have some treatment — people who are involved in treatment. When we have people from a school setting, whether it’s K-12 or post-secondary education, we have someone from that educational setting as well. We have a pharmacist who we can consult with whenever we need to. Our medical examiner and then fire department staff, who are often the first responders or respond when an overdose/911 call is called in within the city of La Crosse.

Frederica Freyberg:
So you spoke to some kinds of changes that have been affected coming out of these reviews. What’s an example of one of those tangible changes?

Paula Silha:
One of the changes is a jail release kit that’s provided to all people who have been discharged from the county jail. We were noticing in doing and conducting reviews that within the first couple of months after getting out of jail, if the individual returned to their former lifestyle, they were at a great risk of overdose. And so a jail release kit was something that was put together by some of the groups that or agencies that are represented on the team. And so it includes Narcan. It includes a rescue mask so for providing rescue breathing. That’s one example. Another example is, acknowledging that we might have a particularly, particularly, contaminated supply of drugs in our community because the thought now is that there’s no pure substance. Even substances like meth, are often laced with fentanyl or xylazine in the community.

Frederica Freyberg:
So your most recent report describes reducing the stigma of drug addiction as an important prong. Why?

Paula Silha:
I think it’s important to talk about it in the community and not have people look down on folks who are using substances. And in order to do that, we need to talk about it openly in the community. People sometimes have bad feelings about harm reduction. Well, why would you prevent people from overdosing? Because it’s about saving their lives until they’re ready to take that next step towards treatment. I also think that we need to acknowledge that many people, not all, but many people who are attracted to substance use are attracted because they’re struggling with some other condition. Something else that has a lot of stigma in our community and probably state and nationwide is mental health. I also think that we need to talk about people who overdose in our community aren’t just unsheltered people. They are people who have jobs, who have homes, might have college educations. They just are caught in that cycle, that addictive cycle of substance use and that drive, that addiction is really, really strong. And so they might want to quit. But it’s one more, one more experience with a substance. And that might be the experience that has the fentanyl in it. That then leads to them having an unintentional overdose.

Frederica Freyberg:
Paula Silha, we leave it there. Thanks very much. Thanks for your work.

Paula Silha:
Yeah. Thank you.