Overdose deaths have fallen nationally but have risen in many Western states. • Minnesota Reformer

Despite an encouraging national dip over the past year, overdose deaths are still rising in many Western states as the epicenter of the country’s ongoing crisis shifts to the Pacific coast, where deadly fentanyl and also methamphetamine are killing more and more find.

Overdose deaths remain significantly higher since 2019. Many states are working on harm reduction strategies that emphasize working with people who use drugs; in some cases, states are becoming stricter in their prosecution, with murder charges against dealers.

Alaska, Nevada, Washington and Oregon have entered the top 10 in overdose deaths since 2023, according to a Stateline analysis of data from the federal Centers for Disease Control and Prevention. Meanwhile, the biggest single-year improvements were seen in Nebraska (down 30%), North Carolina (down 23%), and Vermont, Ohio and Pennsylvania (all down 19%).

The spread of fentanyl, a synthetic opioid that can cause overdose and death even in small doses, explains much of the east-west movement in deaths, said Daliah Heller, vice president of the overdose prevention program at Vital Strategies, a international interest group that works to strengthen public health.

“Fentanyl really came in through the traditional drug markets in the Northeast, but you can see a steady movement west,” Heller said. “So now we’re seeing overdoses on the West Coast rising, while on the East Coast they’re dropping dramatically.”

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. But they are still rising in ten 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, with others showing 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 kind of improvement spreading from east to west and we don’t know exactly what it is yet. 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 Injury Prevention Research Center.

In North Carolina and other states with recent improvements, “it feels like we finally put a lid on the pot, but the pot is still boiling over. It’s not really cooling down,” Dasgupta said.

This could be the result of greater uptake of harm reduction policies to help drug users, including no-questions-asked street drug use and the provision of naloxone to reduce overdoses. Or users may simply become more wary of fentanyl and its dangers and unpleasant side effects, Dasgupta said.

“Fentanyl is very powerful, but potency is not the only thing. Otherwise, we would all be drinking the highest proof IPAs (India pale ales),” Dasgupta said.

Alaska now has the second-highest rate of drug overdose deaths, 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 that Alaska had the largest increase from 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, writing, “Drugs and overdoses have had a devastating effect on our state.” The legislation was signed into law this year.

In May, the state launched “One Pill Can Kill,” a national awareness campaign warning of the dangers of fentanyl.

Fentanyl, usually in the form of counterfeit 30 mg oxycodone pills, has become hugely profitable for smugglers in Alaska who use airline passengers and air shipments of other products to bring drugs into the state, said Austin McDaniel, spokesman for the Department of Public Safety. Pills that sell for less than $1 at the U.S. southern border with Mexico can fetch $20 in Alaska, McDaniel said.

“We want to make the dealers think twice about attacking Alaska,” said Craig Johnson, a Republican from Anchorage, who supported the bill that was signed into law on 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 else dies.”

Other state and federal authorities are also trying a more punitive approach to the fentanyl crisis: Under a Wisconsin state program designed to track down suppliers, three people were arrested in September and charged with first-degree reckless homicide in the death of a fentanyl overdose 27 year old man. In Michigan, two men pleaded guilty this month to federal charges in a massive fentanyl poisoning that led to at least six deaths.

Such punitive approaches can backfire, experts say, if they push people toward more dangerous solitary drug use — where no one can see an overdose and try to help — and stay away from programs like free testing to detect fentanyl hidden in other drugs.

“It’s a bit nonsensical, like saying you can beat something out of people. People are still going to use drugs,” says 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 authorities in the Las Vegas area are emphasizing more cooperation with residents who use drugs, increasing the distribution of naloxone and encouraging people to submit their drug purchases for testing so they aren’t surprised by counterfeit heroin, methamphetamine or other drugs that are being used more and more often. cutting with cheaper fentanyl, said Jessica Johnson, health education supervisor 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 lead to more distribution of naloxone to community centers, clinics, entertainment venues and even vending machines.

One conundrum in Nevada and other states is that overdoses increasingly involve a combination of opioids, such as fentanyl, along with stimulants such as methamphetamine. Nearly a third of overdoses in Nevada are caused by both drugs being used together, according to a state report based on 2022 data.

Some people may seek the “rollercoaster of effects using a stimulant like methamphetamine and a sedative like fentanyl or heroin,” Jessica Johnson said, but most often she hears of unsuspecting users getting cocaine or methamphetamine cut with cheaper fentanyl.

“We get people who say, ‘Oh, I don’t need naloxone because I don’t use fentanyl,’ and our team can say, ‘Well, our surveillance data actually suggests there might be fentanyl in your methamphetamine,’ or whatever. is.”

Nationally, both drugs are increasingly playing a role in fatal overdoses: Synthetic opioids like fentanyl contributed to 68% of overdose deaths according to this year’s CDC data, up from 48% in 2019. Stimulants like methamphetamine were factors in 35% of deaths, up from 20% in 2019.

Heroin and other partly natural opioids, such as oxycodone, have declined as factors and are jointly responsible for 13% of deaths, according to the latest data, compared to 40% in 2019.

Some experts theorize that fentanyl’s high potency makes those who use the drug want to modify or offset the effect with methamphetamine. Fentanyl itself is often cut with xylazine, a non-opioid animal tranquilizer — also known as “tranq” — that can cause unpleasant side effects, including 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 tired of adulteration, anesthesia and skin wounds,” Dasgupta said. “People can take lower doses, and that in itself can help reduce overdoses.”

Like the Minnesota reformer, Stateline is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Stateline maintains editorial independence. If you have any questions, please contact editor Scott S. Greenberger: (email protected). Follow Stateline on Facebook and X.