Colorado’s overdose rates stabilized in 2022, despite fentanyl’s growing dominance

Fatal overdoses declined slightly in Colorado in 2022, newly finalized state data shows, after two years of surging deaths. But public health officials and addiction experts drew little comfort from last year’s totals, which remain near record highs amid fentanyl’s growing dominance of the illicit drug supply.

“(Overdoses) evened themselves out a little bit. We have a new normal, which is terrible,” said Dr. Josh Blum, an addiction medicine physician at Denver Health. “Now we have a stable, unacceptably high death rate.”

In 2022, 1,799 people fatally overdosed in Colorado, a 4% drop from 2021’s total of 1,881, according to data from the state Department of Public Health and Environment. The figures represent a bittersweet stabilization: A slight, one-year decline is still a reprieve after rates nearly doubled in recent years. The number of fentanyl-related deaths — which quadrupled between 2019 and 2021 — plateaued, and methamphetamine fatalities dipped.

Yet 2022’s rate is still higher than any other pre-pandemic year, and fentanyl and methamphetamine continue to fuel and dominate the crisis. Fentanyl, a potent synthetic opioid, was present in more than half of all fatal overdoses here last year. More Coloradans died after ingesting the drug in 2022 than overdosed on all drugs in 2016.

“It’s this idea that while we might be able to find some encouragement if the numbers stay the same or if we do see somewhat of an increase — but the numbers are unacceptably high to begin with,” said Natalee Salcedo, the community health promotion manager for the Adams County Health Department. The county has one of the highest overdose death tolls in the state, and Salcedo said recent increases have been most significant among Black residents.

It’s unclear what exactly prompted the flattening of deaths, six addiction and public health officials said, and they cautioned against drawing any conclusions of broader trends based off of one year. Sterling McLaren, Denver’s chief medical officer, said the state may have reached a natural plateau of overdoses, as opposed to some sort of turning point.

She and other experts also noted the increased availability of harm reduction and some treatment services. The state has begun to embrace harm reduction services, intended to help keep drug users alive and healthy until they’re ready or able to seek treatment. But Blum and Salcedo both called on legislators to go further and to allow for safe drug-use sites, in which users can consume illicit drugs under the supervision of health providers. A bill that would’ve allowed a facility to open in Denver passed the House earlier this year, only to die in a Senate committee in late April.

Legislators have more thoroughly embraced more common harm reduction tools: Colorado has spent millions to distribute naloxone, which is used to reverse opioid overdoses, and lawmakers passed a bill last year to dole out free doses to a broader group of entities, including schools.

The state distributed more than 258,000 naloxone doses between July and March, said Sam Bourdon, the harm reduction grant program manager for the state health department. That’s more than double what was distributed in the year prior. Denver also distributes naloxone for free to city residents.

Lawmakers also set aside several hundred thousand dollars to buy fentanyl test strips, and they expanded treatment in jail settings. Thirty-one of the state’s 64 counties have also agreed to distribute fentanyl test strips, and the state has ordered more than 80,000, Bourdon said.

The pandemic’s end and the broader return to normalcy may also have contributed to the state’s numbers stabilizing. Though it increased isolation and temporarily limited traditional treatment options, the COVID-19 crisis also shepherded in positive changes to drug treatment elsewhere, Blum said: Methadone, a key medication used to treat opioid dependence, has become more available under enduring pandemic-era rules. Telehealth has expanded, and federal regulators in December also made it easier for physicians to give patients another opioid treatment medication.

Nationally, overdoses increased slightly in 2021, according to data from the Centers for Disease Control and Prevention. Like in Colorado, drug deaths surged across America during the pandemic, and 2022 represented a relative plateau after those peaks. In a statement to the New York Times, the Biden administration’s drug czar attributed that stabilization to expanded treatment, improved naloxone distribution and law enforcement efforts to limit fentanyl trafficking.

Policymakers in Colorado have similarly sought to crackdown on the drug. In the same law that increased funding for naloxone and test strips, lawmakers also tightened penalties for drug users caught with the equivalent of roughly 10 fentanyl pills and for dealers whose fentanyl caused a fatal overdose.

But state data show that fentanyl continues to monopolize the drug supply, a grim if unsurprising warning that overdose rates are likely to remain high. Though it has legitimate medical uses, fentanyl has become the opioid of choice for drug manufacturers in recent years, given how cheap and easy it is to produce relative to heroin. It’s flooded the broader drug supply, often contaminating other substances without users’ knowledge. In 2022, for instance, more than half of methamphetamine and cocaine deaths also involved fentanyl.

Heroin, meanwhile, has been largely replaced in the illicit market. Black tar heroin used to be the dominant opioid in Colorado, and 220 people overdosed from the drug in 2020. But that total plummeted to 62 deaths in 2022, state data shows, as cartels have prioritized fentanyl.

The shift has been years in the making, data and experts say. While heroin requires a climate-dependent cultivation process, fentanyl can be made year-round in labs. Fentanyl is also 50 times more potent than heroin and represents a far more lucrative product for the cartels that dominate the illicit opioid trade. It’s cheaper for users, too: A fentanyl pill can cost as little as $2 to $3 apiece.

Thus far, Colorado hasn’t grappled with the new synthetic substances, like the animal tranquilizer xylazine, that are flooding parts of the East Coast. Xylazine, which isn’t an opioid, is often mixed in with fentanyl and is particularly damaging to users who inject it. Kirk Bol of the state health department said there were four deaths involving xylazine here in 2022.

It’s unclear if 2022’s stabilization will hold. Denver, which accounts for the largest share of the state’s overdoses, began this year “hot,” with more drug deaths than the first few months of 2022, said Ethan Jamison, a forensic epidemiologist with the city’s Office of the Medical Examiner.

He said 2023 would provide insight into what Coloradans should expect going forward. But fentanyl’s enduring presence suggests the high rates will endure, and public health officials urged state leaders to continue embracing harm reduction approaches.

“It’s just going to make the next couple of years (expletive),” Blum said. “It’s going to be really challenging for the next few years because in many cases, people who have just been introduced to opioids die before they even get a chance to get into treatment because the drug supply is so potent.”

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