The Mercury News

Drug overdose deaths drop in US for first time since 1990

- By Abby Goodnough, Margot Sanger-Katz and Josh Katz

After three decades of ever-escalating drug overdose deaths, the tide of fatalities may have started to turn. Total drug overdose deaths in America declined by around 5% last year, the first drop since 1990, according to preliminar­y government data made public Wednesday.

The reversal was slight enough that experts could not be sure whether it was the start of a trend or simply a blip.

And even with the shift, the number of deaths in 2018 — more than 68,000 — exceeded the nation’s peak yearly historical deaths from car accidents, AIDS or guns.

“It looks like there’s light at the end of the tunnel,” said Dr. Andrew Kolodny, co-director of opioid policy research at Brandeis University. But, he added, “there’s nothing to celebrate, because the death toll is still very high.”

A decline in prescripti­ons for opioid painkiller­s was the major factor for the overall drop in overdoses. Fatal overdoses involving other drugs, particular­ly the deadly synthetic opioid fentanyl as well as methamphet­amine, which has come roaring back the past few years, continued to rise.

Many in the addiction and law enforcemen­t fields say the overall drop may be a result of more drug users having access to treatment, and to naloxone, the overdose-reversing drug that has brought back thousands from the brink of death. There also has been growing awareness about the immense danger of fentanyl.

More cautious prescribin­g of opioid painkiller­s, a result of numerous limits instituted in many states in recent years, may also have had a role. Prescripti­on painkiller­s were the main cause of overdose deaths until heroin, and then fentanyl, surpassed them over the past decade. The fading presence in some regions of carfentani­l — an analogue of fentanyl that the Centers for Disease Control and Prevention describes as 10,000 times more powerful than morphine — also could be a factor.

“We are all cautiously optimistic and grateful to see this drop,” said Patrick Trainor, a spokesman for the Drug Enforcemen­t Administra­tion in Philadelph­ia, which has been particular­ly hard hit by fentanyl deaths. “But no one can point to any one thing.”

After President Donald Trump made the opioid crisis one of his health care priorities in his 2016 campaign message, some in the addiction field now fear his focus will shift as he heads into the 2020 campaign. Already, he is talking much more frequently about other health care issues, such as high medical bills and prescripti­on drug prices.

Alex Azar, Trump’s Health and Human Services secretary, said in a statement that the new data showed “that America’s united efforts to curb opioid use disorder and addiction are working.”

“Lives are being saved, and we’re beginning to win the fight against this crisis,” he said. “While the declining trend of overdose deaths is an encouragin­g sign, by no means have we declared victory against the epidemic or addiction in general. This crisis developed over two decades, and it will not be solved overnight. We also face other emerging threats, like concerning trends in cocaine and methamphet­amine overdoses. President Trump and HHS will continue to provide the resources and support communitie­s, families and individual­s in our collective efforts to prevent and treat addiction.”

Trump and Congress have provided $3.3 billion in grants to states since 2017 for treatment, prevention and recovery services, but the money will run out next year. And Trump and other Republican­s are fighting in court to overturn the Affordable Care Act, which has allowed 36 states to expand Medicaid and provide free addiction treatment to low-income adults.

Sen. Rob Portman, ROhio, said that in his state, “probably half our Medicaid expansion dollars are now used for mental health or substance-use disorder treatment.”

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