A modest but sustained overdose decline started six months ago

Ohio’s “Narcan blitz” may have played role in reduced death

By Dennis Cauchon
President, Harm Reduction Ohio

Ohio overdose deaths appear to be declining from the historic pace that started in the spring of 2020 when Covid first appeared and the presence of fentanyl soared in Ohio’s drug supply.

Based on analysis of preliminary state mortality data, Harm Reduction found that overdose deaths started to decline from record highs last November and appear to have continued to fall at least through April. The decline in overdose death appears modest but sustained over six six months

Preliminary state mortality data show that confirmed and reported overdose deaths declined 6.5% from November 1, 2021 through today (May 21, 2022) compared to the same period a year earlier.

Overdose deaths declined in five of six months between November and April vs. the same time a year earlier. (Too few reports have arrived for May to assess this month.)

The largest drop occurred in December: 57 fewer overdose deaths reported and confirmed in December 2021 versus December 2020. That’s a 13.2% decline. February 2022 is the only recent month since that has recorded an increase in overdose deaths compared to a year earlier. As of today (May 21), the mortality data report  23 more deaths in February 2022 than in February 2021. That’s an 8.3% increase.

Pace of overdose death falls after two years of record death 

Harm Reduction Ohio analysis analyzed preliminary mortality data found in the Ohio Department of Health’s mortality database. Coroners have six months to file death certificates that report causes of deaths; sometimes investigations and reporting take even longer. So data is incomplete, especially for March and April.

The final overdose death count for 2021 will be reported infall of this year. The final overdose death count for this year will be reported in late 2023.

To get comparable data, Harm Reduction Ohio compares the number of overdose deaths reported and confirmed as of specific date versus what had been reported on the same date in previous years. This has proven a highly reliable way to track overdose death trends quickly.

Confirmed overdose deaths in Ohio set a record (5,017 deaths) in 2020 and broke that record in 2021. The state has already confirmed 5,107 overdose deaths. Another dozen or so will be added before the death count is final.

In March, Harm Reduction Ohio estimated the 2021 overdose death count would be about 5,250. However, because of the sharp decline in deaths in the last month of 2021, it appears overdose deaths will be slightly less than 5,150.

Even with the decline, overdose death continues at a horrific pace, higher than at any time other than the record years of 2020 and 2021. Last year, Ohio suffered an average of about 426 overdose deaths per month. The pace so far in 2022 appears to be just under 400 deaths per month and about the same as 2017 when carfentanil caused death to soar.

Ohio’s Narcan blitz appears to have limited overdoses

Harm Reduction Ohio’s staff worked long hours to ship mammoth amounts of Narcan to zip codes with high overdose death rates.

Why are overdose deaths declining? The answer is not clear.

However. one factor may be that the state’s historic push in distributing the overdose-reversing drug naloxone (Narcan) last August and September. The state spent about $7 million, funded by the federal State Opioid Response grant, to expand Narcan distribution in an effort tied to Overdose Awareness Day in August and Recovery Month in September.

Given the time it takes to distribute Narcan to community members and when it may be needed to reverse an overdose, the lag between when the state conducted its “naloxone blitz” and when overdose deaths declined seems to closely match.

It’s a complicated world, though, and, as social scientists say, correlation is not necessarily causation. Still, it’s a hopeful sign that the state’s Project DAWN (Deaths Avoid With Naloxone) program, of which Harm Reduction Ohio is one of more than 100 members, is making a difference.

Lori Criss, director, OMHAS, oversaw Narcan drive

Last year’s “naloxone blitz” was an intense effort to distribute 70,000+ Narcan kits, especially in zip codes that have high overdose death rates. It was a joint effort by the Ohio Department of Mental Health and Addiction Services (OMHAS) and the Ohio Department of Health. (Harm Reduction Ohio, the state’s largest naloxone distributor, distributed 6,000 of these Narcan kits.)

The role of fentanyl

The level of fentanyl in Ohio’s drug supply remained largely unchanged in late 2021 when overdose deaths started to decline. In fact, fentanyl’s presence increased slightly.

A Harm Reduction Ohio analysis found that 27.0% of drugs tested  in state crime labs during the fourth quarter of 2021 contained fentanyl. That was higher than the 26.4% of drugs found to contain fentanyl in the previous quarter and 25.7% found in the fourth quarter of 2020. The fentanyl level was below the record of 29.0% of confiscated drugs in Ohio containing fentanyl in the second quarter of 2020 when overdose death soared to record numbers at the start of the covid pandemic.

The evidence shows that the closing of the borders, limiting the flow of bulky drugs such as heroin and cocaine, caused a surge in the use of compact fentanyl and its analogs. The increase in fentanyl in the drug supply was the primary cause of record overdose death, although increased use and other factors may have played lesser roles.

Before the pandemic, about 21% of Ohio drugs contained fentanyl or a fentanyl analog. Since then, fentanyl has consistently been found in 25% to 30% of Ohio drugs. This means that high levels of overdose death are likely to continue.

An effort to crack down on fentanyl and other drugs would likely increase the death toll by substituting fentanyl with even more dangerous drugs, just as the crackdown on heroin led to fentanyl and the crackdown on prescription pills led to heroin.

When a crackdown on one drug occurs, drug markets respond with alternatives that are more compact, easier to smuggle and more potent (and dangerous). The drug war is the cause of Ohio’s and the nation’s overdose epidemic. It’s an example of how bad regulations, however well-intentioned, can have bad, even catastrophic, consequences.

A little good news: What does it mean?

In an important piece of good news, carfentanil, the most potent and deadly fentanyl analog, has been almost non-existent in Ohio since the pandemic started. From 2016 through 2020, Ohio had more carfentanil and carfentanil-related deaths than any other state in the country. In fact, all increases and decreases in overdose death in Ohio between 2016-2019 had been closely tied to increases and decreases in carfentanil’s presence in Ohio’s drug supply.

That pattern ended in 2020. Fentanyl and analogs (some a little more potent, some a little less) accounted entirely for the expansion of fentanyl in the drug supply. (A few synthetic nitrazenes, another synthetic opioid, also are appearing in Ohio’s drug supply but not at significant levels and have not had a noticeable effect on total overdose death.)

A consistently high, even increasing, level of fentanyl in the drug supply supports the idea that last year’s massive Narcan distribution effort may have made a measurable difference in total overdose death.

Serious and sophisticated research would be needed to untangle coincidence from true connection. But it’s a hopeful sign. And as horrific and unacceptable as 395 overdose deaths per month is, at least it’s better than 426 deaths per month. At least the curve appears to have bent a little, if ever so slightly, in a positive way. That’s a good thing after two years of non-stop darkness.


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