Fatal overdoses linked to the highly potent synthetic opioid fentanyl dipped in the first three months of 2019 in Maryland, leading to a decline in the total number of drug and alcohol deaths for the first time in years.
The overall drop was just under 15 percent to 577 total deaths, with fewer overdoses logged in 15 counties and Baltimore City, which has been the epicenter of the opioid scourge in the state, according to data from the state Department of Health and the Opioid Operational Command Center.
“We have never witnessed so many counties reporting declines in the number of opioid-related fatalities,” said Steve Schuh, executive director of the opioid center, in a statement. “But the heroin and opioid crisis in Maryland is by no means over. More than 500 of our friends, family members, and neighbors lost their lives to opioid use disorder during the first quarter of 2019.”
That’s more than six people dying of an overdose every day, on average.
Officials locally and across the country have been allocating extra resources to combat the epidemic since the overdoses were declared a public health emergency in the last two years, but it’s not clear what led to the decline in Maryland — or whether it will continue.
But if the pace of fatal overdoses continues through the year, it would mean that Maryland logs slightly fewer deaths this year than last year when 2,385 people died. That would be the state’s first annual decline since 2010, when opioids began tightening their grip on users nationwide.
The past decade’s spike in deaths has been attributed to the cheaper and more dangerous fentanyl, which law enforcement says has been imported from illicit labs in China. Many users initially didn’t know what they were getting because it was mixed with heroin by dealers looking for an edge by offering more potent drugs.
Public health and law enforcement officials now believe fentanyl has mostly replaced heroin in the street supply, leading to the sharp increase in deaths in recent years among people who couldn’t tolerate the more powerful drug.
Overdoses from heroin and prescription opioids had been on the decline, at least partially due to a decline in availability.
The new data raises questions for experts including Dr. Micheal Fingerhood, who treats substance use disorders at Johns Hopkins Bayview Medical Center and is an associate professor of medicine and public health at Johns Hopkins University.
“I would like to know data about nonfatal overdoses and whether more naloxone is being used,” said Fingerhood, referring to the opioid overdose remedy that public health officials have been aggressively distributing to people who use the drugs as well as their friends and family. “Also, I don’t remember whether there are seasonal trends, meaning more in warmer weather.”
Fingerhood said he participated in a community walk in East Baltimore last week with health workers, stopping to talk to people on their stoops and in corner stores — and witnessing some drug deals.
“People on the street know it’s fentanyl and many said they preferred it, sadly,” he said of users seeking a more potent high.
Combating the epidemic remains a challenge, said Dr. Yngvild Olsen, medical director for the Institute for Behavior Resources, a treatment center in Baltimore, and the vice president of the American Society of Addiction Medicine. She also wasn’t sure what contributed to the decline in deaths, so the push needs to continue on all fronts.
She cited work in the past few years including public awareness of addiction as a disease; broad access and use of naloxone; hospital and emergency department efforts to screen and identify users and start them in treatment; outreach and harm-reduction activities; better access to effective medications for opioid use disorder; and enhanced recovery support services.
“While this decrease is certainly welcomed,” Olsen said, “there are still too many people dying unnecessarily. We can’t claim mission done.”
Fentanyl continues to be a dominant killer in 2019, though the total deaths dropped about 8 percent in the first three months of the year compared with the same period a year ago. Fatal overdoses related to fentanyl continued to increase in about half of the counties and Baltimore City, where 215 people died in January, February and March, four more than a year ago.
Cocaine-related deaths, which had been making a comeback, also declined in the first quarter of the year by 21 percent. Most of those deaths involved a mix of cocaine and opioids, usually fentanyl.
Dr. Letitia Dzirasa, Baltimore City health commissioner, said opioid overdoses remain a public health crisis that the health department will continue addressing.
“My sincere condolences to anyone who has lost a loved one to substance use disorder,” she said. “Every life is valued. With that in mind, the Baltimore City Health Department supports a three-pronged strategy for combating the opioid crisis: administering naloxone in an effort to prevent fatal overdoses, increasing access to on-demand and evidence-based treatment, and fighting stigma around opioid use disorder with education.”
Those who need help can call a 24-hour crisis hotline at 410-433-5175. More information can be found at dontdie.org.
Maryland Health Secretary Robert R. Neall said in a statement the state also will continue its efforts.
“We’ve seen a decrease in deaths during this first quarter and continue to work diligently to combat this epidemic,” Neall said. “Treatment and prevention options are available 24/7 for those who want it.”