3 Questions

According to the state health department’s most recent overdose prevention quarterly measures report, New Mexico has seen a slight decline in the number of opioid prescriptions being written, and a little bump in those for opioid-addiction treatment drugs. Unfortunately, overdose deaths in the state remain consistently among the highest in the US, with the synthetic opioid fentanyl driving overdoses since 2019 here and across the country. Fortunately, health professionals in the field continue to work helping addicts, demystifying drug use and preventing deaths through advocacy, naloxone training and more. Bernie Lieving is one such person. The principal of The Lieving Group LLC, Lieving has worked as a consultant and statewide overdose prevention coordinator with the New Mexico Human Services Department for the last eight years, providing community outreach and training sessions, among other services. This interview has been edited for clarity and concision.

We frequently hear that New Mexico is in an opioid crisis—can you explain what that looks like?

So we see that when there are supply-side interventions—which means drug busts and the disruption of street-drug operations—that overdose deaths go up as the supply becomes unstable. We saw that happen here in New Mexico in late summer, early fall of 2019, and it was in December 2019 that we started seeing heroin disappear and those little blue pills take over; those counterfeit [oxycodone pills] that are really fentanyl. When the disruption created a vacuum, it was quickly filled with a non-predictable and short-acting opioid that can be more lethal because we have a population that isn’t used to it. And because it’s an unregulated market, you never know what you’re getting on the street.

My colleagues around the country had been seeing fentanyl in their markets for at least five, maybe even seven years, and it had wreaked havoc in Appalachia, the Northeast, the Southwest, the West Coast, New York, San Francisco, Los Angeles, Boston. But we hadn’t seen that here until then. Between 2019, 2020 and 2021, our overdose deaths increased by at least 200 a year. That also coincided with the perfect storm of the COVID-19 pandemic; with people being alone and using more drugs and alcohol…to deal with anxiety and stress and catastrophic life changes like the deaths of loved ones or the loss of a job.

Recent Department of Health data indicates a slight decline in opioid prescriptions and slight increase for synthetic-opioid addiction treatment drugs like Suboxone. Does that indicate any improvement?

I would not say that. I did see some lines going down in preliminary data, though I haven’t studied that. I’d agree with the increase in subscribers…the [Drug Enforcement Administration] no longer requires [special training] in order to prescribe those drugs—now general physicians and nurse practitioners can prescribe it. What I’ve been advocating for whenever I speak to federal partners is for people who have their pharmD to prescribe it so people can get Suboxone prescribed to them at a pharmacy.

I’m not an epidemiologist, but I know what I see. If we are increasing the number of prescribers, that’s great. I don’t see us doing structural and social change that slows the pipeline of people who are self-medicating because their lives are horrific from not having a place to live, mental health issues, etc., etc., etc. I’m always looking for the parallel line that shows we are addressing the antecedents in the first place, and I don’t see it.

What are some of the ways New Mexico is combating the opioid situation? Have fentanyl testing strips, for example, become widely available yet, and can everyday people otherwise help?

Yeah. I just left 25 fentanyl testing strips at a middle school where I did training with 50 or 60 kids. And the Department of Health is distributing to community-based organizations. Corresponding with that is we now have a drug checker through the Department of Health’s Harm Reduction Program—Phillip Fiuty. He does sophisticated spectrography of illicit drugs looking for adulterates that could cause problems in the street drugs.

Another thing I think is huge is that we’ve seen statistical increases into the number of deaths among African American men in our state, but I now have a subcontract with a group called Women in Leadership, an African American woman-led organization that provides overdose prevention, recognition and response trainings all over the state within African American communities. Overdose deaths are significant among Indigenous people in our state, too, and with the support of HSD and our Pueblo Tribal partners, we now have bilingual training in Diné and Keres, which is pretty badass if you ask me—and it’s because we partnered with those communities so the work is being done with community members and not outsiders.

You can go to doseofreality.com, through the New Mexico DOH Harm Reduction Program. You can get Narcan without a prescription, over the counter. If you have Medicaid, you can get Narcan at a pharmacy without a prescription and with no co-pay.