First responders work on a victim of an apparent overdose in Albuquerque, N.M., in August. Despite an encouraging national decrease in overdoses, deaths are still rising in many Western states. (Tim Henderson/Stateline)
Despite an encouraging national dip in the past year, overdose deaths are still on the rise in many Western states as the epicenter of the nation's continuing crisis shifts toward the Pacific Coast, where deadly fentanyl and also methamphetamine are finding more victims.
Overdose deaths remain sharply higher since 2019. Many states are working on "harm reduction" strategies that stress cooperation with people who use drugs; in some cases, states are getting tougher on prosecutions, with murder charges for dealers.
Alaska, Nevada, Washington and Oregon have moved into the top 10 for rate of overdose deaths since 2019, according to a Stateline analysis of 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 spread of fentanyl, a synthetic opioid that can cause overdose and death even in tiny amounts, explains much of the east-to-west movement in the number of deaths, said Daliah Heller, vice president of overdose prevention program at Vital Strategies, an international advocacy group that works on strengthening public health.
"Fentanyl really came in through the traditional drug markets in the Northeast, but you can see this steady movement westward," Heller said. "So now we're seeing overdoses going up on the West Coast while they're going down dramatically on the East Coast."
The provisional CDC data estimates drug overdose deaths in the year ending with April 2024, and nationally they decreased by 10%, with more than 11,000 fewer deaths than the year before. But they're 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 climbed by almost 1,300 in those states and others 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's some kind of improvement spreading from east to west and we don't know exactly what it is yet. Everybody sees their little piece of the elephant," said Nabarun Dasgupta, a scientist specializing in opioid disorder and overdose at the University of North Carolina's Injury Prevention Research Center.
In North Carolina and other states with recent improvements, "it feels like we finally got a lid on the pot, but the pot is still boiling over. Things aren't really cooling down," Dasgupta said.
It could be a result of better acceptance of harm reduction policies to help those who use drugs, including no-questions-asked testing of street drugs and providing naloxone to counteract overdoses. Or users may simply be getting more wary of fentanyl and its dangers and unpleasant side effects, Dasgupta said.
"Fentanyl is very potent, but potency isn't the only thing. Otherwise we'd all be drinking the highest proof IPAs (India pale ales)," Dasgupta said.
Alaska now has the nation's second-highest rate of drug overdose deaths, about 53 per 100,000 population, behind only West Virginia (73 per 100,000). Other Western states that are 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 had the largest increase from 2023 -- up 42%, to 390 deaths. Republican Gov. Mike Dunleavy in August 2023 proposed legislation making fentanyl dealers subject to murder charges in overdose death cases, writing: "Drugs and drug overdoses have had a devastating effect on our state." The legislation was signed into law this year.
In May, the state kicked off "One Pill Can Kill," a national awareness campaign warning about the dangers of fentanyl.
Fentanyl, mostly in the form of counterfeit 30 mg oxycodone pills, has become tremendously profitable for smugglers in Alaska who make use of airline passengers and air shipments of other products to get drugs into the state, said state Department of Public Safety spokesperson Austin McDaniel. Pills that sell for less than $1 near the U.S. southern border with Mexico can fetch $20 in Alaska, McDaniel said.
"We want to make the dealers think twice about targeting Alaska," said Alaska state Rep. Craig Johnson, an Anchorage Republican, who supported the bill signed into law July 12.
Johnson's 23-year-old nephew died of a fentanyl overdose two years ago. "This is personal. I don't want other Alaska families to go through what we went through. I hope we never have to use it, because that will mean nobody else died."
Other state and federal authorities are also trying a more punitive approach to the fentanyl crisis: Under a state program in Wisconsin meant to ferret out suppliers, three people were arrested in September and charged with first-degree reckless homicide in the fentanyl overdose death of a 27-year-old man. In Michigan, two men pleaded guilty this month to federal charges in a mass fentanyl poisoning that led to at least six deaths.
Such punitive approaches can backfire, experts say, if they drive people toward more dangerous solitary drug use -- where no one can see an overdose and try to help -- and away from programs such as free testing to unearth fentanyl hidden in other drugs.
"It's sort of nonsensical, like saying you can beat something out of people. People are still going to use 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 issue."
In Nevada, health authorities in the Las Vegas area are stressing more cooperation with residents who use drugs, increasing naloxone distribution and encouraging people to submit their drug purchases for testing so they're not surprised by counterfeit heroin, methamphetamine or other drugs that are increasingly cut with cheaper fentanyl, said Jessica Johnson, health education supervisor for the Southern Nevada Health District.
A state office coordinates goals for county naloxone distribution based on factors such as hospital reports of overdoses. More overdoses trigger more naloxone distribution to community centers, clinics, entertainment venues and even vending machines.
One puzzle in Nevada and in other states is that increasingly, overdoses involve a combination of opioids, such as fentanyl, along with stimulants such as methamphetamine. Almost a third of overdoses in Nevada are caused by both being used together, according to a state report based on 2022 data.
It feels like we finally got a lid on the pot, but the pot is still boiling over. Things aren't really cooling down.
- Nabarun Dasgupta, University of North Carolina Injury Prevention Research Center
It could be that some people seek the "roller coaster of effects using a stimulant like methamphetamine and a depressant like fentanyl or heroin," Jessica Johnson said, but mostly she hears that unsuspecting users get cocaine or methamphetamine that's been cut with cheaper fentanyl.
"We get people saying, 'Oh I don't need naloxone because I don't use fentanyl,' and our team is able to say, 'Well, our surveillance data actually suggests there might be fentanyl in your methamphetamine' or whatever it is."
Nationally, both drugs are increasingly a factor in fatal overdoses: Synthetic opioids such as fentanyl contributed to 68% of overdose deaths in this year's CDC data, up from 48% in 2019. Stimulants such as methamphetamine were factors in 35% of deaths, up from 20% in 2019.
Heroin and other partly natural opioids, such as oxycodone, have diminished as factors, together accounting for 13% of deaths in the latest data compared with 40% in 2019.
Some experts theorize that the high potency of fentanyl makes those who use drugs want to tweak or balance the effect with methamphetamine. Fentanyl itself is often cut with xylazine, a non-opioid animal tranquilizer -- often known as "tranq" -- that can cause unpleasant side effects, including extreme sedation and skin lesions, Dasgupta said.
"During the pandemic, there were a lot of reasons why people were using substances more. Now that things are different, people are tired of the adulteration, the sedation, the skin wounds," Dasgupta said. "People may take lower doses, and that in itself can help lower overdoses."
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. Contact Editor Scott S. Greenberger for questions: [email protected]. Follow Stateline on Facebook and X.