The number of fatal drug overdoses nationwide has fallen for six consecutive months, fueling hopes that the downturn marks not just a reprieve but a long-lasting shift in the tide of the addiction crisis.

Annual U.S. drug overdoses have been tracking upward for nearly four decades, and the rate of growth increased sharply in the last few years with the onset of the opioid epidemic.

But in the 12-month period ending in March 2018 — the most recent span for which data are available — the Centers for Disease Control and Prevention reported a decline of 2.8 percent in the number of overdose deaths, to an estimated 71,073 people, compared with the 12 months ending in September 2017.

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Public health experts warned against drawing firm conclusions based on a half-year’s worth of data.

“After 40 years of this predictable growth pattern, we can hope that the curve is finally bending downward for good,” Dr. Donald Burke, the dean of University of Pittsburgh’s Graduate School of Public Health, wrote in an email. “But history tells us to interpret these wobbles cautiously.”

While opioids overall continue to drive the bulk of deaths, killing an estimated 48,400 people from April 2017 to March 2018, the number of fatal opioid overdoses fell by 2.3 percent compared with the year ending in September 2017. The decline was caused by a drop in the number of overdose deaths from both heroin and “natural and semi-synthetic opioids,” a category that includes most prescription opioids.

CDC Overdose deaths march 2018
CDC

Still, ominous signs lurk in the CDC data. The ongoing addiction crisis is not limited to opioids, and cocaine and stimulants — a group that includes methamphetamine — are each now killing more than 10,000 people a year, a threshold they only crossed in the past few years.

“Whether we’re looking at cocaine or methamphetamine, we are seeing a crisis in the United States,” said Ray Barishansky, a deputy secretary at the Pennsylvania Department of Health.

Experts have predicted that any lasting downturn in overdose deaths would start with a gradual flattening and then cresting of the curve that measures fatal overdoses over time, and the data fit that pattern.

The CDC data remain a provisional count of overdose deaths, so the numbers could be adjusted as authorities continue to investigate deaths around the country.

“Three months ago I wasn’t sure the provisional deaths curve was really going down,” Dr. Daniel Ciccarone of the University of California, San Francisco, wrote in an email. “But the trend seems robust.”

Experts are not sure yet what exactly is driving the decrease, which was first noted by the Opioid Watch website, a project of the nonprofit Opioid Research Institute. But they said they are hopeful that policy initiatives at the local, state, and federal level are starting to pay off.

“There are 2 major takeaways,” said Leo Beletsky, a drug policy expert at Northeastern University. “One is that we are not out of the woods yet, since these rates are still sky high. [And] we need to be doing much more of what works to get the rates down further.”

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A number of states have issued emergency declarations to free up resources for addiction responses, and President Trump last year declared the opioid crisis a public health emergency.

Among other steps, advocates and health officials have pushed to expand the use of the overdose reversal medication naloxone, providing it to more law enforcement officers and people who use drugs. Having naloxone on hand can turn what would be a fatal overdose into a nonfatal incident.

And as part of a broader medical innovation law signed by President Obama in 2016, Congress approved $1 billion in spending to fight opioid addiction, funding that helped states expand treatment options, housing services, and education and workforce campaigns. Trump this week is expected to sign another addiction measure that will fight drug trafficking and expand options for accessing medication-assisted treatment for opioid use disorders.

Some clinicians are also being more cautious in their prescribing patterns, which means that fewer people are being exposed to opioid painkillers in the first place.

“It’s encouraging,” CDC Director Robert Redfield said in an interview with STAT Executive Editor Rick Berke on Tuesday, while noting that the data are preliminary.

The CDC tracks fatal overdose numbers by state, and researchers said the differences among states suggest local initiatives are having an impact as well. Many public health experts point to campaigns in Rhode Island, Vermont, and Massachusetts as models for addressing addiction, and all three states reported decreases in overdose deaths from March 2017 to March 2018 — declines that many of their neighbors did not see.

“The states that have been comprehensive and have gone after evidence-based methods are seeing the declines,” said Brandon Marshall, a Brown University epidemiologist.

CDC Overdose deaths march 2018
CDC

Overall, Montana and Wyoming reported the biggest percentage drops in overdose deaths, though they had fewer initial overdose cases than many other states.

Beyond the policy efforts, Ciccarone, who studies drug supplies, said people who use drugs may have made “behavioral adaptations” that have led to safer drug use. Many overdoses occur when the powerful opioid fentanyl and its analogues are illicitly mixed into heroin or other drugs. Ciccarone said he and his research colleagues have found that some people are sampling their drugs before using the full amount or are speaking with others about how potent a particular supply may be before using.

Indeed, while deaths tied to synthetic opioids — the classification that includes fentanyl — continue to rise in the CDC’s tracking, their growth rate has slowed in recent months.

Epidemiologists said they look to CDC’s provisional data each month to determine if the bend in the curve will hold and to see which state responses should be studied further. But as promising as the latest slowdown might be, with each fewer fatal overdose representing a life saved, experts have seen “flattening periods” in the past that did not change the overall trajectory of overdose deaths.

Burke, of the University of Pittsburgh, was the senior author on a paper published last month in Science, in which researchers outlined how “the U.S. drug overdose epidemic has been inexorably tracking along an exponential growth curve since at least 1979.” They described an epidemic that is made up of many different drug “subepidemics.”

The “current opioid epidemic may be a more recent manifestation of an ongoing longer-term process,” the study said.

This story has been updated with a quote from the director of the CDC. 

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  • Yep. Doing everything possible for the addicts. While doing NOTHING for the Chronic Pain Patients. Aside from withholding the medications that give some semblance of life. But they dont want to discuss that. Or the thousands that have taken their own lives due to Intractable Pain and having the meds, some have been taken for decades, taken away. Cold Turkey. Even Cancer patients are being TORTURED at the hands of the CDC, DEA, and a bunch of OverZealous politicians trying to appease the voter in an election year. Hey Andrew, how about reporting our side of this Made Up Crisis!!

    • I absolutely agree. I went through two different episodes where the medical industry refused to deal with the cause of the pain issue. In one, I suffered a couple years, until a tumor that was causing the pain was removed. The other was also almost two years. I was disabled and in pain. When the docs got around to corrective surgery, I had seriously considered ending my life. Had they acted sooner, the residual effects would have been significantly less. In both cases when the cause was removed, recovery was speedy.

      It is difficult to have confidence in an industry that is absolutely wrong so often.

  • It would be profoundly helpful if you stopped using the catch-all phrase, “opioids” for everything from Tylenol 3 to heroin and street Fentanyl. This confuses the issues. When people die from IV street drugs, it’s very unfair to chronic pain patients who take meds as prescribed to put them in the same grouping as hardcore drug addicts and abusers of street opioids.

    Pain patients are not the same as drug abusers. Drug abusers and addicts take a ton of drugs, looking for a high, and often end up nodding off or in a stupor, or overdosing and dying. Pain patients take their meds in measured doses and are only after some pain relief and the chance to be a part of the world around them, as opposed to escaping reality as drug addicts do.

    In the future, please make an effort to distinguish between pain patients and street addicts. As a pain patient, I feel a lot of sympathy for addicts, but I am not an addict and resent being viewed in the same light as drug abusers and addicts. Thank you.

  • This looks like the Narcan push into the street is working. Perhaps the test strips for illegal fentanyl analogs tainting heroin too are making a positive difference.

    There appears to be no lag in the manufacture or smuggling of illegal Chinese fentanyl analogs or carfentanil, or stopping that smuggling across the border from Mexico into the US or through the USPS in any meaningful way.
    For every car that is celebrated after being confiscated, full of methamphetamine or illegal Chinese fentanyl analogs, how many made it through unhindered? Hopefully the legislation forthcoming will death with this in a definitive manner.

    In regards to methamphetamine overdoses, the numbers are stark.

    They have doubled in two years. From just over 5000 in 2015 to over 10,000 in 2017.

    The Narcan push onto the streets is helping the heroin/illegal fentanyl analog ODs, and that is encouraging. Anything positive should be looked at as a small step forward.

    However, the government needs to take a less narrow view of addiction. Methamphetamine overdoses trail prescribed opioid overdoses by only +-4000 deaths in 2017. Prescribed opioid deaths (14,957) dropped 16% from 2016, while meth deaths rose. The money Congress is putting toward the opioid crisis should instead be placed more comprehensively.
    Meth addiction is particularly grim, with successful long term recovery for those suffering methamphetamine addiction in single digits.
    We need more funding on all fronts, not just opioids, especially seeing the gap between opioid abuse and meth abuse closing so quickly. Illegal fentanyl analogs are opioids, yes, but they are mainly agents in polypharmacy deaths- where the dramatic spike we see on the CDC chart of overdoses lies are overdose deaths with 3+ drugs involved, and many with 5+ drugs, the illegal fentanyl analog a lacing agent.
    Are those truly attributable to the “opioid crisis”? Or would it be fairer to say SUD?

    When Congress realizes (as the recently released 2017 SAMHSA annual report of substance abuse treatment in the US shows) that SUD has been steady throughout the “opioid crisis” with ODs only being a novelty due to the illegal fentanyl analogs, perhaps we will be able to address SUD honestly in the USA, and not just one type- the type that can be monetized.

  • I think the publicity given to Narcan as the miracle drug that brings people back from certain death has done more than anything to reduce the number of overdose deaths. Communities have demanded that their firefighters and law enforcement officers be equipped with it to provide a fast response. Though many politicians were against it at first, they forced by popular demand to approve it. I don’t think there are fewer overdoses at all, just better response times and fewer deaths. Our city seems to have at least a couple of overdoses daily. But, the cops can give the injection and save lives.

  • This is interesting. Could the drop in fatal overdoses have something to do with the wider availability of Narcan?

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