The Current - Opioid deaths dropped this year. Experts hope it’s not ‘a blip’

Episode Date: October 17, 2024

New figures show a sharp drop in overdose deaths in the U.S., offering a rare glimmer of hope in the opioid crisis. Guest host Rebecca Zandbergen digs into what could be driving that decrease, whether it’s a blip — and what it all means for saving lives here in Canada.

In 2017, it felt like drugs were everywhere in the news, so I started a podcast called On Drugs. We covered a lot of ground over two seasons, but there are still so many more stories to tell. I'm Jeff Turner, and I'm back with Season 3 of On Drugs. And this time, it's going to get personal. I don't know who Sober Jeff is. I don't even know if I like that guy.

On Drugs is available now wherever you get your podcasts. This is a CBC Podcast. Hello, I'm Matt Galloway, and this is The Current Podcast. It's not often you hear a glimmer of hope when it comes to the opioid crisis, but according to the U.S. Centers for Disease Control and Prevention, there was a sharp decline in overdose deaths between April of last year and April of this year. The numbers show an unprecedented 10.6 percent drop in deaths across the U.S. And in some states, deaths are down by as much as 20 to 30 percent.

We'll look at how this is playing out in Canada in a moment. But first, I'm down by as much as 20 to 30 percent. We'll look at how this is playing out in Canada in a moment, but first I'm joined by Nabaran Dasgupta. He is an epidemiologist whose research contributed to the CDC's findings. He's also a street drug scientist at the University of North Carolina Injury Prevention Research Centre. Good morning. Good morning. Thanks for having me. Nabaran, when did you first start to see a drop in opioid deaths? Well, we heard it first from our partners on the ground, frontline public health programs, starting in mid to late 2023. We're saying that maybe things have chilled out a little bit. And then we started looking at the data in the third quarter of last year,

and things started to look like they were going down, but we were still hesitant and skeptical because we've had blips before where things have gone up and down. So we were waiting until more data had accrued. So this is not a blip though, as far as you can tell? This does not feel like a blip. We've been there before with blips. This feels like a actual trend that is moving in the good direction. And why? Why is this happening? I think there's a number of factors. It's a very sudden drop, and it's also something that seems to move from East Coast to West Coast. There's a lot that's been done from the medical and public health side over the last four or five years to increase access to the antidote, to increase

access to drug treatment. Those are definitely part of it. But there's also something fundamentally shifting in the drug supply that we think is also contributing to the declines. Okay, we'll get to that in just a moment. But I do just want to touch on something you mentioned, I think naloxone, and that's the drug that's able to reverse overdoses. Do we think that's a factor in the drop then? We think it should be. There was a concerted effort led by the federal government and then implemented by the states in 2023 to get to a point where we were no longer at a scarcity mentality with the antidote, but really saturating the communities of people who use drugs and making sure that they had plenty of the reversal agent.

So that was a shift from the way things had been done for the decade before that. You also just said, though, that there might be something inherently different about the drug supply that's contributing to these dropping numbers that we're seeing. It's good news, but what might be another reason we're seeing this drop? When we look at the drug supply, it's very simple to kind of think about it in two frames. One is the potency and the amount of substance like fentanyl, and the other is how many things are in there. What we're seeing is the potency or like the amount of active ingredient in fentanyl is moving around a bit, but not hugely. What we do see is that there's additional things that are

being put into the drug supply more frequently now than before, and some of those substances might actually lead people to use less fentanyl. So, that's the direction we think the data are most consistent with. Is that accidental or is that purposeful? system with. Is that accidental or is that purposeful? It's very hard to infer intent from molecules and from these complex hidden behaviors, right? So, it could be a matter of the market self-correcting a bit because we often hear, you know, the question of why would a seller want to sell a product that is killing their customers, right? So, that's one kind of dimension. The other is that the fentanyl has been around in the places where we're seeing the greatest declines for long enough that people are kind of tired of it. Fentanyl is not like

the top choice for most people who are experienced with opioids. And so, what we hear in our field studies is that people are not wanting to get high from fentanyl as much anymore, but rather don't want to go through withdrawal and don't want to get sick. And so, there's a new kind of customer demand from people who are using fentanyl where they're ready to move on from it, but need something new to help them kind of reduce their use. And some of these additives that we see in the drug supply kind of help with that. You know, here in Canada, much of this debate around overdoses and how we get a hold of this problem of opioids is around supervised consumption sites and harm reduction versus treatment. What is the conversation like in the U.S. and where you are

in North Carolina about harm reduction? I think in North Carolina, we've taken a very pragmatic approach to addressing the overdose problems we have and the substance use problems more broadly. There's been extensive efforts to expand treatment as well as harm reduction services, and it doesn't seem like a binary for us here in the South as much as it may in other parts of the United States. We've had strong bipartisan support, and if anything, we've had more support from Republicans than Democrats. And when I go into like rural mountain areas in North Carolina and talk about these life-saving interventions, they often tell me that they already know about them because they've been practicing harm reduction for generations. Because many of these are like moonshine areas where

there's been substance use at the margins of the law going on literally for generations. And people know you can't just lock up all your sons for providing for their families. And so how much have we seen overdoses drop by in North Carolina in the last year? It looks like it's around 30% on the mortality level, which is unprecedented. I've been studying overdose mortality data for over 20 years, and I don't think I've felt hopeful like this in decades. So, if you're hopeful, what are you grasping onto to ensure it still moves in this trajectory? What do we take away from what we've learned in the last year then, if we can't really pinpoint why

it's happening? from what we've learned in the last year then, if we can't really pinpoint why it's happening. It's a tough feeling where you feel like you're not able to pinpoint the exact cause. The things that we have been doing seem to have shifted things, and we should keep doing them. I think now is the time to look at who's getting left behind. The declines that we're seeing in overdose mortality are not uniformly felt across different racial groups, urbanicity, rural areas. So and that is different from state to state. So I think now that we have a general sense that we're headed in maybe the right direction, now is the time to get into the nuanced detail at a local level about who's getting left behind. Okay, Nabaran, thank you so much for speaking with us this morning.

My pleasure. Nabaran Dasgupta is an epidemiologist whose research contributed to the CDC's findings. He is a street drug scientist at the University of North Carolina Injury Prevention Research Center. Now, Brad Feingood has been seeing the number of overdoses decrease in Seattle and throughout Washington state from ground level. He leads the Overdose Prevention and Response Unit with Public Health for Seattle and King County. Good morning. Good morning. Thank you for having me.

Of course, Brad, what have you seen in Seattle with the number of reductions in overdose deaths? Yeah, much like Dr. Knabb, we've seen a significant decline in overdose deaths also in the West Coast and in the Northwest, started in Seattle. Really starting in the third quarter of last year, we started to see a pretty steady, slow decline that continues to decline month over month here. We've seen about a 22% decline when you look at third quarter last year versus third quarter this year, a 22% decline in fatal overdose deaths. We've also seen a decline in non-fatal overdoses that EMS has responded to. So that's a really, really good thing. And like Dr. Nab, I think that gives us a lot of hope. What was it like before this year? Talk to us about the last decade. What have you been seeing?

We saw a fairly protective drug market here from fentanyl for years. And part of that is due to the type of drugs that we've gotten in the East Coast. They saw a lot of drugs contaminated with fentanyl. We really did not see fentanyl here until about 2018, 2019. And then once COVID hit, we saw this perfect convergence of COVID and lockdown and people becoming disconnected from each other and social distancing with a huge increase in the fentanyl market here. And that overlapped with, you know, people having trouble getting information and getting access to treatment. And so right about the time of COVID, we really started to see a really significant increase in overdoses in Seattle. I understand all of this is personal for you that you lost your brother.

Yeah, that's correct. Coming up on New Year's this year, we have a significant anniversary. It'll be 20 years that my brother has died. And so even though it's been quite a long time since my brother has passed away of a drug overdose, so many of those lessons that we take from 20 years ago still remain true today, you know, around carrying naloxone, around understanding what an overdose looks like, and really around reducing the stigma of drug use so that people can get the access to the help and the treatment that they need. We heard Namroon talk about people who use fentanyl are getting tired of using fentanyl, tired of the way it affects them,

and tired of being worried about an overdose. I mean, have you seen that for yourself? Yeah, I mean, I think we're starting to see that, and we're starting to see that, you know, really what's happening is our treatment system is starting to come in line with what people need. We have some great research from our syringe service program survey out here where we're asking people what is it that they want. And we know the vast majority of people out there using fentanyl and also using methamphetamine want help. They want service. It's just sometimes the historic treatment system that we've had hasn't really came along. So we're really working to lower

barriers for people to get access to treatment. And then there's, you know, new interventions. Our crisis system is coming along. So we're so people can get in the front door earlier. Our access to medications like methadone and buprenorphine are really starting to have lower barriers. Having mobile methadone clinics out in the community, have lower barriers, having mobile methadone clinics out in the community, having access to buprenorphine in new forms, like buprenorphine shots that can last between a week and a month. So it gives somebody a running chance. And Brad, do you think the interventions, the low barrier interventions that you've just talked about, are these the reasons why at a local level, you're seeing fewer people overdose?

You know, like Dr. Descupta said, you know, there's a lot of things that we just don't know, but I will tell you that we know that providing access to evidence-based services work. We know that here in Seattle and King County, we're distributing, you know, three times the amount of naloxone that we sent out three, even three years ago, you know, we sent out like 30,000 naloxone kits a quarter. We have 12,000 people on medications for opiate use disorder every year. So we know providing access to medications in new and low barrier way, you know, can reduce overdose, especially with medications up to 50% or more, they reduce overdose. You said you're hopeful. Are you hopeful

policymakers see the change and make further strides in ensuring that we pursue the trajectory that we're on? Absolutely. And we see it not only with policymakers, but with the community and the public. In King County, we just passed a local sales tax and levy last year to provide access to what's called crisis care centers. So five different crisis centers across the community that have behavioral health walk-in centers. So people can just walk in. It used to be that people had to agree to detox in order to get into treatment in the front door. Now people can just walk into basically a behavioral health urgent care and get the help that they need right on demand

without jumping through hoops. So I have a lot of hope, as you said, and really looking at the future, providing a great opportunity for people to reduce the risk of overdose and get the access to health and services. Brad Feingood, thank you for this conversation. Thank you so much.

Brad Feingood leads the Overdose Prevention and Response Unit with Public Health for Seattle and King County. In 2017, it felt like drugs were everywhere in the news. So I started a podcast called On Drugs. We covered a lot of ground over two seasons, but there are still so many more stories to tell. I'm Jeff Turner, and I'm back with Season 3 of On Drugs. And this time, it's going to get personal. I don't know who Sober Jeff is. I don't even know if I like that guy.

On Drugs is available now wherever you get your podcasts. Now here in Canada, there is some evidence suggesting a downward trend in deaths by overdose as well. Statistics published by the federal government show that in the first three months of this year, opioid deaths are down by 8% compared to the first three months of 2023. To talk about what all of these numbers may mean to Canada's response to the opioid crisis, I'm joined by Dan Werb, an epidemiologist and associate professor at the University of Toronto, also director of the Centre on Drug Policy Evaluation at St. Michael's Hospital in Toronto. Good morning. Good morning. When you hear about the decline that they're seeing in the U.S., some declines we just heard as high as 30 percent in some states. What do you think? I mean, my first thought is thank God. I mean,

you know, we're talking about thousands and thousands of people who might otherwise be dead who are alive. And whatever the reason for that, I just think it's something to celebrate. There are so few wins. There have been so few wins over the past 10 or so years of this crisis, both in Canada and the United States. So, I mean, it's really life-affirming, and it makes me really happy. Do you think we will see numbers closer to the U.S.? I mean, are we going to fall a lockstep with that decline? Look, I hope so.

going to follow lockstep with that decline? Look, I hope so. And we've also seen some drops in Canada in the regions in which the overdose crisis is most intense in British Columbia, in Alberta, and in Ontario. Unfortunately, in other parts of the country, in the Maritimes and in Quebec, we're seeing an acceleration of overdose mortality. But at least in the three epicenters here in Canada, we're seeing some declines. And again, I mean, regardless of the cause, I think it's great news. Hopefully, it's not just short-term good news and that we can build on these declines. My hope is that these declines spur some efforts to leverage and try to advance towards the end of the epidemic. How do you think Canada needs to move forward if we want to continue this trend? So I think one of the best ways to move forward is to recognize that the

political conversation around how to end the overdose crisis and respond to people who are at risk of dying is totally different than the clinical and scientific conversation about how to end it. So in Canada, we have this really bizarre discourse that seems to be pitting public health-oriented services like harm reduction, naloxone distribution, the provision of sterile syringes, supervised consumption sites, against a focus on treatment and a robust, comprehensive approach to helping people manage their substance use long-term. These two sectors are not at odds. And in fact, they are a part of a comprehensive approach to responding to the needs of people who use drugs and who are at risk of overdose. And really, unless we invest in

both of these sectors, we're not going to be able to build on the gains that we've already seen. One thing I wanted to ask you about was we heard Nabran Dasgupta mention that there's been a change in the drug supply, something inherently different to it that's causing people to use less fentanyl, for instance. Is that something that we might be seeing in Canada as well? Quite possibly, yeah. We see these three different provinces, all of which have taken different tacks towards ending the overdose crisis. And we're seeing declines across all of them. And as Nab said, you know, there's declines across a number of different regions in North America. And so that suggests that it's something external to the policies or the

resources that have been put into place in each of these individual places. I'll also say that we saw something of the reverse right before COVID. In the middle of 2019, in the summer, there was a sudden spike in overdose mortality that lasted about four months. And it was seen across multiple regions in Canada and multiple regions in the U.S. And as the numbers were released and people started looking back, that spike was the result of the introduction of carfentanil, a synthetic opioid, you know, 100 times more powerful than fentanyl even, into the drug supply. It was this sudden spike, this surge related to a drug market shift that is totally outside of the control of governments. And then that carfentanil was effectively removed by drug trafficking organizations from the market.

And then we saw a rapid decline. So I think it's likely that part of at least what we're seeing is related to changes in the drug market. It's certainly one of the key factors that is going to drive overdose mortality either up or down. Dan, one final question. Are you more hopeful today than you were a year ago? I am cautiously optimistic. I am hopeful that governments look at these gains and think, you know, this is a political winner for me, and that they look to build on the minor reductions that we've seen here in Canada to fund comprehensive approaches to this crisis, which in BC, Alberta, and Ontario have claimed more lives than COVID. Dan Werb, thank you for this. Thank you. Dan Werb is an epidemiologist and the

director of the Centre on Drug Policy Evaluation at St. Michael's Hospital in Toronto. Now, as we mentioned, the federal government reported an 8% decline in opioid-related deaths in the first three months of this year compared to 2023. We asked Health Canada to comment on that drop. And in a statement, it said, quote, that drop. And in a statement, it said, quote, it is too early to interpret these decreases in deaths as a real trend. Fluctuations in opioid-related deaths between quarters is normal, and more time is needed to determine if a potential trend is sustained.