'Unprecedented' decline in US drug overdose deaths gives experts hope | Opioid crisis

Experts welcome news of a reported decline in overdose deaths in the United States, saying they are cautiously optimistic about the downward trend but needing more efforts to maintain progress. and warns that additional resources will be required.

Overdose deaths in the United States have fallen by about 10%, the largest decline in decades. As of April 2024, the estimated annual death toll has fallen to 101,168, according to an analysis of state-level data.

Overdose emergency department visits decreased by 24%, and overdose 911 calls decreased by 16.7%. While eastern states have seen big changes, some western states are still struggling with rising tax rates.

Overdoses rose sharply during the first three years of the pandemic, reaching a peak of 111,029 deaths in 2022. 5 times more In the past 25 years, much of that has been caused by opioids, especially the powerful drug fentanyl.

1 in 3 Americans know A person who died from a drug overdose.

According to the U.S. Centers for Disease Control and Prevention (CDC), it will decline by 3% in 2023, marking the first decline in five years. said In May.

The reasons for the decline are not immediately clear, but researchers and those on the front lines believe changes in drug supply and improved access to treatments and harm reduction programs are to blame.

“Looking back over the past quarter century, no intervention has reduced overdose deaths on this scale,” said Navalun Dasgupta, a senior scientist at the University of North Carolina and one of the authors of the book. say. analysis. “It's unprecedented.”

“The recent decline in estimated overdose deaths is unprecedented and appears to reflect real-world trends,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse (NIDA) at the National Institutes of Health. said in an emailed statement. “These data give us hope that we may finally be able to make significant progress in reducing the devastating loss of life due to the overdose crisis.”

But she also highlighted that the death toll from the overdose crisis continues and is becoming increasingly unequal when it comes to who is most affected in society.

“It's also important to recognize that progress is not equal for all groups,” she says. “Unfortunately, mortality rates for the most affected groups – Native Americans and Black men – are not decreasing and are at their highest levels on record.”

Leo Beretsky, a professor of law and health sciences at Northeastern University, said the U.S. death toll of 12,000, now more than 100,000, was considered “absolutely catastrophic” at the time. I remember being there. He feels “cautiously optimistic” about this decline and urges policymakers to continue this momentum by expanding prevention programs.

“We're seeing a reversal of a trend that's been going on for a very long time. We're still at historically high levels,” Beretsky said. “We need to try to build on what works and move away from what doesn’t.”

About 18 months ago, Eric Mokewich decided to get clean after spending years in recovery. He is undergoing treatment and currently receives monthly buprenorphine injections. This prevents withdrawal symptoms and helps manage opioid use disorder.

Access to naloxone, the drug that reverses opioid overdoses, “definitely helps,” Mockwaiche said, as do housing, food, child care and other social services, along with accessible and affordable treatment options. said.

“Anything that lasts long enough for people to decide to do something else is definitely a good thing,” he says.

In 2021, the Biden administration announced: plan Preventing overdoses by expanding treatment and distributing naloxone.

after naloxone price rose sharply For some harm reduction groups, much more affordable. Narcan, a naloxone nasal spray, was approved for over-the-counter sale in 2023, making it more widely available.

Beretsky said the administration also relaxed “very outdated” rules regarding drugs such as buprenorphine and methadone. Due to previous restrictions, only a third of people who need these drugs have access to them, but access is gradually expanding, he said.

“Distributing naloxone, providing people with substance use treatment, providing people with clear information about drug supplies, all of these efforts are working,” Beretsky said. “We know they are saving lives.”

Many of the resources provided during the pandemic, such as Medicaid expansion and financial assistance, also helped, but those programs have now expired.

Another major factor leading to a reduction in overdoses may be behavioral changes.

Xylazine, a tranquilizer, has become a common adulterant in street drugs in recent years. Like fentanyl a few years ago, it emerged in the east and is moving west. This is the same pattern as the reduction in overdose.

People who use drugs containing xylazine often need to use them less frequently than drugs containing fentanyl because xylazine binds to receptors longer. Reducing the frequency of use means “less rolls of the dice” that can lead to overdose, Dasgupta said.

However, injecting xylazine can cause extensive scarring. “That's pretty cruel,” Mokewich said. “When I was being treated, a lot of people showed up. There was a girl who had just lost her arm to an amputation.”

Because of these risks, people who use xylazine tend to smoke or snort it rather than inject it, and such routes of administration may have a lower risk of overdose than injections.

“The market is also maturing. People are getting a little tired of Fendt,” Dasgupta said. Dependence on xylazine may represent a desire for something else, especially among people who use xylazine to prevent dope intoxication.

Dasgupta said, “This is something that will probably help us open up a little bit of a path and now we need to rush forward with all the resources that we have developed over the last 10 years.” “We should dump a lot of material.” [funding for] The development and scale-up of drugs to treat opioid disorders is providing people with better options. ”

This is especially true for communities that have not seen declines, such as African Americans and Native Americans in some states, he said.

Beretsky said options should include not only harm reduction services and substance use treatment, but also “broader structural responses” such as access to medical care, pain management and mental health care. “All of these things have an impact on drug use and overdose.”

Taking action also means ending harmful practices and policies that are known to increase the risk of overdose, such as incarceration, which increases the risk of overdose by 120% once people re-enter society. Yes, Beletsky said.

Drug criminalization only deepens stigma and makes it more difficult to prevent overdoses, he said.

“Law enforcement never stopped me,” Mokewich said. “Everything is still going on.”

dasgupta is worried move Classifies xylazine as a Schedule III drug in the United States. “If we suddenly cut off the supply of xylazine now, I have no doubt that we would see a spike in overdose deaths,” he says.

Experts agreed that drug seizures at the border do not seem to have an impact on overdose rates and may even worsen the crisis. Authorities are seizing far more meth and marijuana at the border than fentanyl. Due to low availability of meth, drug dealers tend to cut it with fentanyl, increasing overdoses. Dasgupta said authorities should instead focus on making the supply of medicines safer.

Mokewich currently works at a treatment facility and plans to become a peer recovery specialist. This is a “bridge” career between recovery and a full-fledged counseling degree for people who want to use their experience to help others recover. he said.

“This will allow people to get into the field and allow people to be exposed to services,” Mokewich said. “A lot of the treatment was based on abstinence and telling people how they should live. In peer networks, we're just meeting people where they are.”

He said such efforts are important because overdoses “remain a huge problem,” with more than 100,000 people dying and more people being hospitalized each year.

“The number is still too high,” Dasgupta said. “We may have put a lid on the top, but we're still at the boil.”