Overdose deaths saw a sharp drop in the U.S. Experts hope it's not 'a blip'
Health Canada says 'too early' to say if deaths in Canada will follow trend in U.S.
New figures from the U.S. Centres for Disease Control show a sharp drop in overdose deaths, offering a rare glimmer of hope in the fight to curb the opioid crisis.
"I've been studying overdose mortality data for over 20 years, and I don't think I've felt hopeful like this in decades," said Naburan Dasgupta, an epidemiologist and a street drug scientist at the University of North Carolina Injury Prevention Research Center.
Dasgupta's research contributed to the CDC's findings, published in September. The data showed a 10.6 per cent drop in drug overdose mortality across the U.S. from April 2023 to April 2024. Some states showed even higher decreases of up to 30 per cent.
In an update this week, the CDC predicted the drop in fatalities for May 2023 to May 2024 would be even bigger, at 12.7 per cent. That drop includes overdoses from both stimulants like cocaine, and opioids like heroin and fentanyl.
The CDC has described the decline as "the first annual decrease in drug overdose deaths since 2018."
Dasgupta said front-line workers started to report a downward shift in mid-to-late 2023, but he remained cautious because he's seen mortality rates rise and fall in the past.
Now that more data has accrued, he said that "this does not feel like a blip.… This feels like an actual trend that is moving in the good direction."
In Canada, the latest figures from Health Canada show a total of 1,906 opioid-related deaths in the first three months of 2024, an eight per cent drop compared to the same period in 2023.
But in a statement emailed to The Current, Health Canada said fluctuations between quarters are normal, and it's too early to determine if that three-month drop will turn into a trend.
"Multiple factors could be contributing to any decrease observed, which could include actions and investments being made in jurisdictions, fluctuations in the illegal drug supply or changes in substance use patterns," the statement said.
Despite the decrease on both sides of the border, the number of deaths remains at crisis levels. There were 81,083 opioid-related deaths reported in the U.S. in 2023, and 8,049 opioid-related deaths in Canada for the same year, equivalent to 22 deaths a day.
Dasgupta noted that the decline in mortality is not being seen uniformly among different racial groups and between urban and rural settings, and said it's time to start thinking about "who's getting left behind."
Stephen Murray, the harm reduction program manager at Boston Medical Center, said he's still seeing those devastating outcomes first hand.
"Before August, I had gone almost a full year without losing somebody that I intimately knew to overdose," said Murray, who is also the director of the Safe Spot Overdose Hotline, a drugs crisis line available in both the U.S. and Canada.
"And now I've had six die in just two and a half months."
What could be driving down deaths?
Dasgupta said it's hard to pinpoint what's driving the U.S. decrease, but it's likely linked to a number of factors.
One is the illicit drug supply itself, which he said may be shifting to become less deadly.
"We often hear the question of: Why would a seller want to sell a product that is killing their customers, right?" he said.
He also pointed to federal and state governments' efforts last year to increase the availability of naloxone, a drug that temporarily reverses an overdose to allow time for lifesaving medical treatment.
He said that work involved not only making sure there was plenty of the reversal agent available, but also making sure people who use drugs knew they could access it, potentially meaning the difference between life and death.
Brad Finegood has also seen a "steady, slow decline" in overdose deaths in Washington state.
"We're really working to lower barriers for people to get access to treatment," said Finegood, who leads the overdose prevention and response unit with Public Health for Seattle and King County.
Finegood said that includes having mobile clinics offering greater access to drugs and treatments for opioid dependence. It also means removing conditions, such as requiring patients to agree to a detox program before getting access to treatment, he said.
"Now people can just walk into basically behavioural health urgent care and get the help that they need, right on demand, without jumping through hoops," he said.
Finegood's work has a personal factor: his brother died from an overdose 20 years ago.
"Even though it's been quite a long time since my brother has passed away … so many of those lessons that we take from 20 years ago still remain true today," he said.
"[That includes] carrying naloxone around, understanding what an overdose looks like and really reducing the stigma of drug use so that people can get the access to the help and the treatment that they need," he said.
Could Canada see similar trend?
In Canada, different provinces have taken different approaches to tackling the opioid crisis — ranging from limited decriminalization of illicit drugs, to harm reduction efforts such as safe consumption sites, to a focus on treatment and abstinence.
But epidemiologist Dan Werb said there is a "bizarre discourse" that pits harm reduction services against a focus on treatment, when many experts now think both approaches are needed to address the crisis.
"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," said Werb, director of the Centre on Drug Policy Evaluation at St. Michael's Hospital in Toronto.
"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."
Looking at the decrease in deaths in the U.S., Werb said his first thought was "Thank god."
"We're talking about thousands and thousands of people who might otherwise be dead, who are alive," he said.
"Whatever the reason for that, I just think it's something to celebrate."
Audio produced by Dawna Dingwall and Arman Aghbali
