Last week, the Centers for Disease Control and Prevention released its analysis of overdose deaths from 2019. The new projections indicate that the United States has failed to maintain the marginal progress represented by 2018’s slight fall in fatalities. The nation is projected to have seen a 4.8 percent increase in deaths in 2019.
Tragically, 70,980 people are recorded as having lost their lives last year. Fentanyl and other synthetic opioids were involved in over half of these deaths, with cocaine and methamphetamine involvement rising. CDC officials are pointing to the introduction of fentanyl to other drug supplies, like meth and cocaine, as a major factor.
With the 2020 presidential election looming, the new data could become a political hot button, potentially inspiring calls for more repressive law enforcement tactics. The White House took credit for the drop in fatal overdoses from 2017 to 2018, and Trump personally campaigned on the issue in 2016.
Diving into the new data on a regional level, a more complex story emerges than the overall worsening situation. Most states did indeed experience at least a small rate of increase. However, most of the nine states in the Northeastern region managed to reduce their rates of overdose deaths significantly from 2018 to 2019. Other states that saw significant drops include Georgia, Maryland, Michigan, Utah and Nevada.
A preliminary conclusion might be that Northeastern investment in harm reduction is paying off. Historically speaking, the hubs of harm reduction have been the most liberal and urban cities, such as San Francisco, Chicago and New York City. Over the last decade, harm reduction organizations have become visible in a greater diversity of locales. But it is perhaps the Northeast, one of the regions hit hard by the continuing opioid-involved crisis, that has seen the greatest degree of institutional absorption of harm reduction techniques and philosophies.
In New Jersey, for example, the Department of Health has created “Harm Reduction Centers” throughout the state, which include government-operated syringe exchanges and wrap-around services. In Burlington, Vermont, former Police Chief Brandon del Pozo ordered his officers to no longer arrest people for unprescribed buprenorphine, contributing to fatalities decreasing by more than 50 percent. In Philadelphia, District Attorney Larry Krasner followed suit, vowing to no longer charge people for buprenorphine possession.
Meanwhile, the South, as defined by the US Census standard, is faring better than the Midwest. Out of the 12 Midwestern states, all of them saw increases in overdose deaths except Michigan and Missouri, which each had rates of decrease below 10 percent.
The Midwest suffered the nation’s starkest rate increases. South Dakota experienced a 54.4 percent rate increase in overdose deaths, the most severe in the US, while North Dakota’s rate increase came in second place at 31 percent. Efforts there to stem harms that can result from drug use still largely consist of law enforcement interdiction, exclusionary, traditional rehab services, and tone-deaf ad campaigns, like the widely mocked “Meth. We’re On It” billboards.
In comparison, four out of 16 Southern states saw decreases in their overdose death rate from 2018 to 2019: Georgia, Maryland, Arkansas and Oklahoma. In the latter two, the rate decreases were in the double digits, with Arkansas seeing a significant 16.6 percent decrease. Only Vermont saw a greater drop in its overdose death rate, at 18.1 percent.
A 2019 story from Stateline, the state policy newswire from Pew Charitable Trusts, explains how policymakers and law enforcement in the Southern states have been slower to adapt to harm reduction than their counterparts in the Northeast, but are still making progress in recent years.
As Georgia State Rep. Houston Gaines, a Republican, told Stateline, naloxone and needle distribution have become politically palpable as partial solutions to the overdose crisis. But this does not mean Georgia Republicans have become harm reductionists, either. “Georgia isn’t trying to be California,” said Rep. Gains of safe consumption sites. “I’m not in favor of them. I’ve not seen enough research that it’s making an impact, and the trade-off is increased crime rates.” Even though the lawmaker’s latter claim is completely unsubstantiated, the political import is clear.
While California is the favored liberal bastion for Southern conservatives to slate, its own embrace of harm reduction is uneven. The state’s response is complicated by the fact that meth is involved in a significant amount of overdose-related deaths there, while many harm reduction efforts continue to focus on opioids.California’s overdose rate increased by 15.5 percent from 2018 to 2019, which some experts credited to the comparatively recent introduction of fentanyl into the heroin supply. All of this added up to 5,494 preventable deaths in 2018 and 6,345 preventable deaths in 2019.
Sadly, there are grounds for further pessimism at a national level. Many observers are noting overdose increases due to pandemic-related factors, and expect death rates for 2020 to be higher still.
“While the increase in overdose deaths in the US in 2019 is devastating, it is not at all surprising,” said Dr. Sheila Vakharia,* deputy director of the Drug Policy Alliance’s Department of Research and Academic Engagement, in a DPA press release. “There is reason to believe that these deaths will continue to climb in 2020 as a result of the COVID-19 pandemic, which has increased isolation, disrupted the drug supply and reduced access to harm reduction and treatment supports.”
At the same time, pandemic-related fiscal squeezes threaten funding cuts for many harm reduction organizations.
* Dr. Vakharia is a member of the board of directors of The Influence Foundation, which operates Filter. DPA has previously supplied a restricted grant to The Influence Foundation, to support a Drug War Journalism Diversity Fellowship.