Despite an encouraging nationwide decline over the past year, overdose deaths are still rising in many Western states as the epicenter of the country’s ongoing crisis shifts toward the Pacific Coast, where deadly fentanyl and also methamphetamine are finding more victims.
The number of overdose deaths has continued to rise sharply since 2019. Many states are working on “harm reduction” strategies that emphasize working with people who utilize drugs. In some cases, states are stepping up enforcement and bringing murder charges against dealers.
Alaska, Nevada, Washington and Oregon have moved into the top 10 for overdose deaths since 2019, according to a Stateline analysis from the federal Centers for Disease Control and Prevention Data. Meanwhile, the biggest one-year improvements were in Nebraska (down 30%), North Carolina (down 23%), and Vermont, Ohio and Pennsylvania (all down 19%).
The proliferation of fentanyl, a synthetic opioid that can cause overdoses and death even in tiny amounts, explains much of the east-west shift in the number of deaths, Daliah Heller, vice president of the overdose prevention program at Vital Strategies, told International Advocacy group working to strengthen public health.
“Fentanyl actually came into the market through the traditional drug markets in the Northeast, but you can see this steady movement westward,” Heller said. “So now we’re seeing overdoses go up on the West Coast while they’re going down dramatically on the East Coast.”
The preliminary CDC data estimates drug overdose deaths in the year ending April 2024 fell 10% nationally, with more than 11,000 fewer deaths than the year before. However, they are still rising in 10 states and the District of Columbia, including 42% in Alaska, 22% in Oregon, 18% in Nevada and 14% in Washington state. Deaths rose by nearly 1,300 in those states and in other states with more modest increases: Colorado, Utah and Hawaii.
Experts are still debating why some eastern states hit early in the overdose crisis are seeing improvements.
“There is some type of improvement that is spreading from east to west and we don’t yet know exactly what type it is. “Everyone sees their little piece of the elephant,” said Nabarun Dasgupta, a scientist specializing in opioid disorders and overdoses at the University of North Carolina’s Injury Prevention Research Center.
In North Carolina and other states with recent improvements, “it feels like we’ve finally put a lid on the pot, but the pot is still boiling over. Things aren’t really cooling down,” Dasgupta said.
This could be due to greater uptake of harm reduction measures to support drug users, including non-mandatory street drug testing and the provision of naloxone to combat overdoses. Or users are simply becoming more wary of fentanyl and its dangers and unpleasant side effects, Dasgupta said.
“Fentanyl is very effective, but effectiveness is not the only thing. Otherwise we would all be drinking the highest proof IPAs (India Pale Ales),” said Dasgupta.
Meanwhile, Alaska has the second-highest rate of drug overdose deaths in the country, at about 53 per 100,000 residents, behind only West Virginia (73 per 100,000). Other Western states now in the top 10: Nevada (47 per 100,000), Washington State (46 per 100,000) and Oregon (45 per 100,000).
The CDC data shows Alaska saw the largest increase since 2023 – a 42% increase to 390 deaths. Republican Gov. Mike Dunleavy proposed legislation in August 2023 that would subject fentanyl dealers to murder charges in overdose death cases. Write: “Drugs and drug overdoses have a devastating impact on our state.” The law was signed into law this year.
In May, the state launched the national “One Pill Can Kill” initiative. Awareness campaign Warning about the dangers of fentanyl.
Fentanyl, mostly in the form of counterfeit 30 mg oxycodone pills, has become hugely profitable for smugglers in Alaska, who utilize airline passengers and air shipments of other products to smuggle drugs into the state, said Austin McDaniel, spokesman for the Department of Public Safety US state. Pills that sell for less than $1 near the U.S.’s southern border with Mexico can fetch $20 in Alaska, McDaniel said.
“We want to make traders think twice about targeting Alaska,” said Alaska state Rep. Craig Johnson, an Anchorage Republican who sponsored the bill signed July 12.
Johnson’s 23-year-old nephew died of a fentanyl overdose two years ago. “This is personal. I don’t want other families in Alaska to go through what we went through. I hope we never have to use it because that means no one died anymore.”
Other state and federal agencies are also trying to take a tougher approach to the fentanyl crisis: Three people were affected as part of a state program in Wisconsin aimed at tracking down suppliers arrested charged in September with first-degree manslaughter in connection with the fentanyl overdose death of a 27-year-old man. Two men in Michigan pleaded guilty this month on federal charges stemming from a mass fentanyl poisoning that resulted in at least six deaths.
Such punitive approaches can backfire, experts say, if they lead people to utilize more unsafe individual drugs – where no one can detect an overdose and try to support – and turn them away from programs such as free testing to screen for fentanyl, which is used in others Drugs hidden is to be uncovered.
“It’s kind of nonsensical, like saying you can beat something out of people. “People are still going to do drugs,” said Heller of Vital Strategies. “This should be a call to action to wake up and really invest in a response to drug use as a health problem.”
In Nevada, health officials in the Las Vegas area are emphasizing greater collaboration with residents who utilize drugs, increasing distribution of naloxone and encouraging people to test their drug purchases so they do not come from counterfeit heroin, methamphetamine or other drugs Surprised drugs that are increasingly in circulation with cheaper fentanyl, said Jessica Johnson, director of health education for the Southern Nevada Health District.
A State office coordinates naloxone distribution goals in the county based on factors such as hospital reports of overdoses. More overdoses are leading to greater distribution of naloxone in community centers, clinics, entertainment venues and even vending machines.
One conundrum in Nevada and other states is that overdoses are increasingly involving a combination of opioids like fentanyl and stimulants like methamphetamine. According to one state, nearly a third of overdoses in Nevada are caused by the simultaneous utilize of both substances report based on 2022 data.
It could be that some people seek the “roller coaster of effects with a stimulant like methamphetamine and a depressant like fentanyl or heroin,” Jessica Johnson said, but more often than not she hears unsuspecting users take cocaine or methamphetamine tempered with cheaper fentanyl .
“We get people saying, ‘Oh, I don’t need naloxone because I don’t use fentanyl,’ and our team can say, ‘Well, our surveillance data actually suggests that there might be fentanyl in your methamphetamine,’ or what whatever it is.”
Nationally, both drugs are increasingly playing a role in fatal overdoses: Synthetic opioids like fentanyl contributed to 68% of overdose deaths in this year’s CDC data, up from 48% in 2019. Stimulants like methamphetamine were factors in 35% of deaths , an increase of 20% in 2019.
Heroin and other partially natural opioids such as oxycodone have declined as contributing factors, together accounting for 13% of deaths in the latest data, compared to 40% in 2019.
It feels like we finally have a lid on the pot, but the pot is still boiling over. It doesn’t really frigid down.
– Nabarun Dasgupta, University of North Carolina Injury Prevention Research Center
Some experts believe that fentanyl’s high potency makes drug users want to optimize or counterbalance the effects with methamphetamine. Fentanyl itself is often laced with xylazine, a non-opioid animal tranquilizer — often known as “Tranq” — that can cause unpleasant side effects such as extreme sedation and skin lesions, Dasgupta said.
“During the pandemic, there were many reasons why people used more substances. Now that things are different, people are fed up with the adulteration, the appeasement, the skin wounds,” Dasgupta said. “People may take lower doses, and that alone may help reduce overdoses.”
