Last year, the U.S. Centers for Disease Control and Prevention (CDC) reported a 3% decline in drug overdose deaths, the largest decline in five years. Officials called the numbers “encouraging” but did not say the decline was a sign of a larger trend.
But now, with drug overdose deaths continuing to decline through the first five months of 2024, public health officials may have reason to believe that the 2023 decline is more than just an anomaly.
Preliminary estimates of drug overdose deaths decreased by 12.7% from May 2023 to May 2024, from a record high of 111,029 in 2022 to 98,820.
“It’s natural to be optimistic,” said Leif Fenno, MD, president of the American Psychiatric Association’s Council on Addiction Psychiatry. Medscape Medical News. “This should be a little bit of inspiration to everyone who is working at all levels to try to do something about this really bad overdose crisis that we’ve been in for the last five years.”
Despite the decline, nearly 100,000 deaths each year is a “very high” loss, said Dr. Navaln Dasgupta, a senior scientist at the University of North Carolina Injury Prevention Research Center in Chapel Hill, North Carolina. , MPH said. Medscape Medical News.
“It feels like the lid is off, but it’s still at the boiling point,” said Dasgupta, who works at the Opioid Data Lab, an academic collaboration.
And the latest numbers represent a patchwork of progress. Opioid overdose deaths have fallen by as much as 30% over the past 12 months in some states, while others have seen an increase of up to 36%.
Additionally, researchers still don’t understand the reasons behind the spike in overdoses or the recent decline.
“It’s clear that there are more forces at work here than we traditionally think about in public health and public health interventions, but we don’t understand them, and we don’t know what to do in the direction of overdose. We are not in control,” Dasgupta said.
Why did it decrease?
Fenno, who is also an assistant professor of neuroscience and psychiatry at the Dell School of Medicine at the University of Texas at Austin, said a number of factors are likely contributing to the decline.
“There is nothing major that has happened that could explain the sudden reversal,” he said.
Daniel Ciccarone, MD, MPH, professor of family and community medicine at the University of California, San Francisco, said one reason for the decline may be that “the susceptible population is no longer growing.” Medscape Medical News.
Since 2015, the main cause of deaths has been the presence of fentanyl in the drug supply. Although fentanyl remains deadly, the number of new users is decreasing. Ciccarone suspects this is because new young users are being warned not to use the drug. He believes fewer users will lead to fewer deaths.
This decrease may also be due to the synergistic effect of increased availability of naloxone and an increase in the number of clinicians prescribing buprenorphine following the lifting of restrictions in late 2022. However, “there is still no data to support that the repeal of the buprenorphine exemption has had an impact,” he said.
Ciccarone said the government’s seizures of fentanyl likely haven’t made a difference. He said the drug remains cheap and readily available, suggesting supply has not been affected.
Dasgupta said based on recent data on fentanyl use, he hasn’t seen a decline in new users. “There are still a lot of 20-year-olds using fentanyl for the first time,” Dasgupta said.
He has seen a shift in the drug supply in the East, where fentanyl is primarily taken to prevent withdrawal. Dasgupta said people are taking less fentanyl and adding other drugs, especially the animal tranquilizer xylazine, to get the sedative effects of fentanyl.
He said xylazine is cheap, xylazine and fentanyl overdoses are less severe than fentanyl alone, and users may add cocaine or methamphetamine to counteract the sedation. All of this added up could lead to less fentanyl use and fewer overdoses.
Effects of naloxone?
Dasgupta said naloxone’s widespread distribution may explain the decline in overdoses in some geographic regions. In mid-2023, the U.S. Substance Abuse and Mental Health Services Administration provided grants to states to increase access to naloxone in their communities.
For example, Dasgupta said this may have helped curb an overdose in St. Louis. The CDC reported that overdose deaths in Missouri decreased by more than 20% in the year ending in May 2024. Using its own data, the University of Missouri-St. Louis reported that the number of deaths statewide is expected to drop by 30% in the first half of 2024.
The university reported that its data shows an 11% decline statewide in 2023 and a 14% decline in the St. Louis metropolitan area. The report identified St. Louis as Missouri’s death epicenter, and university experts said increased distribution of naloxone likely made the difference.
Overdose deaths in Texas decreased by about 2% through May 2024, according to the CDC. Fenno said Texas is doing some things right, including naloxone vending machines and an emergency medical technician-led program that provides buprenorphine on the spot to those who request it within 24 hours of an overdose. said.
Needle exchange programs and fentanyl test strips are illegal in Texas. Still, “there is a growing debate at the state level around implementing public health strategies to reduce access to illicit opioids and the harms they cause,” Fenno said.
Fentanyl isn’t going away in Texas. In his opioid treatment program, most patients reported that the first opioid they used was fentanyl. “People are starting to use fentanyl,” Fenno said, adding that younger users aren’t shying away from it either.
“Green Shoot of Progress”
Deaths are declining in states that have weathered the worst of the opioid epidemic. For example, in the CDC’s latest report, West Virginia saw a 15% decline, while Ohio saw a 22% decline, numbers that Ciccarone called “impressive.”
Dr. Ashwin Vasan, who just resigned as commissioner of the New York City Department of Health and Mental Hygiene, said that after doubling the number of deaths between 2019 and 2022, New York City will see a 1% increase in overdose deaths in 2023. He said it had decreased. At an October press conference hosted by the Metropolitan Health Coalition, Vasan said the decline “represents the beginning and green shoots of progress.”
Vasan praised the city’s efforts, including supervised consumption facilities (operated by contractors and called overdose prevention centers), syringe services, naloxone distribution and programs to connect people to medication-assisted treatment. He said the $154 million the city received in settlements with opioid manufacturers is “starting to make a difference.”
Western states did not fare as well. Deaths increased by 36% in Alaska, 22% in Oregon, 18% in Nevada, 7% in Utah and 11% in Washington state.
Dasgupta and Ciccarone said this is one reason the fentanyl epidemic is spreading from east to west.
But Brad Finegood, who oversees overdose prevention efforts in Seattle and King County, Washington, as a strategic advisor, said real-time data shows a 22% decline in deaths in the first nine months of 2024. He said it shows.
“We are seeing a significant increase in people using opioids, including naloxone,” Finegood said on the Metropolitan Health Coalition call. Approximately 85% of drug users report having naloxone in their possession.
The county has seen increased use of methadone, buprenorphine and naltrexone, with an estimated 12,000 Medicaid recipients currently taking one of these drugs, he added. A new 24/7 hotline launched in January will help people obtain buprenorphine. The service has served approximately 400 clients to date.
In addition to fixed-site methadone clinics, King County also has multiple mobile methadone vans where health care providers offer long-acting injectable medications for opioid use disorder.
African Americans and Native Americans remain at risk
In King County, Finegood said there are still disparities in overdose deaths, especially among older adults of color, Alaska Natives and American Indians.
Older black men are disproportionately dying in New York, Vasan said. These people are suffering from “the cumulative effects of long-term physical and health neglect, long-term social and economic needs and marginalization,” “the effects of racism,” and even “changes in drug supplies.” vulnerabilities in the face of Vasan noted that fentanyl is 40 times more potent than heroin.
“We are still seeing deaths,” Dasgupta said, adding that “mortality rates are going up for African Americans and Native Americans.”
But, he added, “we are at a critical inflection point where significant new funding is being poured into opioid solutions.” There are many things we can do. ”
Mr. Ciccarone reported that he is the voluntary medical director of Remedy Alliance/For the People, a major wholesale distributor of naloxone and other pharmaceutical products. Mr. Dasgupta reported that he is an uncompensated director of Remedy Alliance/For the People and a contractor to the U.S. Food and Drug Administration on the issue of opioid overdose measurement. Fenno and Vasan did not report disclosures.
Alicia Ault is a freelance journalist based in St. Petersburg, Florida, whose work has appeared in publications such as JAMA and Smithsonian.com. You can find her at X: @aliciault.
