After several years of slow-but-steady increases and two years of sharp climbs, drug overdose deaths in Southwestern Pennsylvania declined by more than 40 percent last year.
Preliminary reports from the Centers for Disease Control and Prevention for the first quarter of 2018 suggest it is a trend that has spread across Pennsylvania, West Virginia and Ohio — all of which saw overdose deaths spike dramatically in 2016 and 2017 as the opioid epidemic expanded to include lethal synthetic opioids such as fentanyl and carfentanyl.
It remains unclear whether the numbers simply signal a move to different, less lethal drugs, the widespread use of Narcan to revive overdose victims or real progress in the battle against addiction.
Dr. Donald Burke, dean of the University of Pittsburgh Graduate School of Public Health, has his doubts that the region has turned any corners.
“At this point, I’m not confident it is a permanent change for the good or if we’re just returning to the expected curve,” Burke said. “In our paper in Science a few months ago, we showed overdoses from all drugs, not just opioids, have been growing exponentially for 40 years. Occasionally it speed ups and slows down, but the growth curve always snapped back.”
Burke suspects much of the dramatic spike in overdose deaths in 2016-17 resulted from the emergence of fentanyl.
In Westmoreland County, preliminary reports show overdose deaths declined from 193 in 2017 to 122 last year. District Attorney John Peck also cited the impact of fentanyl and the fear it sparked among intravenous drug users who saw friends die.
“I think people are aware that taking these drugs, heroin laced with fentanyl, is suicide,” Peck said. He added that detectives are seeing a resurgence of cocaine and methamphetamine as drug users increasingly shy away from heroin.
Carfentanyl, a large-animal tranquilizer even more potent than fentanyl, was a factor in 30 overdose deaths in Westmoreland County in 2017 but none last year, said Tim Phillips, director of the Westmoreland County Drug Overdose Task Force.
“People on the streets are becoming more educated about what they are taking,” he said. “We’ve seen some people using fentanyl testing strips to test their drugs.”
Experts are scrutinizing the data closely, said Dr. Karen Hacker, director of the Allegheny County Health Department. Preliminary figures show overdose deaths in Allegheny County declined from 737 in 2017 to 379 last year, with 91 cases still pending toxicology results.
She said there may be a number of factors at work.
Like Phillips, she believes drug users have become wary of fentanyl. But she also pointed to massive training and education efforts to promote the use of Narcan to counter overdoses.
The overdose antidote, known generically as naloxone, was widely provided to police and other first responders two years ago and now is available to everyone at most pharmacies.
EMS calls for Narcan are way down this year, but that could be in part because drug users themselves are keeping it close, Hacker said.
“Our ability to monitor how many people have been saved by naloxone is limited,” she said. “But the (drug)-using population learns over time. They’re not trying to die.”
Washington County District Attorney Eugene Vittone, a former paramedic, said it may be a combination of things at work.
“One of the things is Narcan. It helps; it keeps them alive immediately, like an AED. But you’ve got to have more,” he said. “Now we have a treatment infrastructure. We’re diverting people from jail to treatment. We’re starting program where EMS is circling back to people and getting them into treatment and therapy and trying to reduce mortality and morbidity.”
Both Vittone and Hacker cautioned against reducing efforts to battle addiction.
Experts say additional harm reduction measures merit consideration, such as making medical treatment available in all jails, making fentanyl test strips available in drug stores and changing the law to provide clean needle exchanges in areas outside of Pittsburgh and Philadelphia.
“Whenever people see improvement, it’s easy to turn away and say something else is the problem. As a public health officer, I think that would be a mistake,” Hacker said.
Vittone agreed. He said continued enforcement coupled with treatment is needed.
“At this time last year, we had 17 overdose deaths in Washington County. This year we’ve had one. That’s a really significant drop, but one batch of drugs could change everything,” Vittone said. “This is not a war on drugs. We’re fighting a war against addiction.”