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Patrick Sison, Associated Press
FILE - This Tuesday, Aug. 15, 2017, file photo shows an arrangement of pills of the opioid oxycodone-acetaminophen in New York. In an innovative experiment, doctors prescribed fewer opioids after learning of their patient's overdose death in a letter from a county medical examiner. More than 400 “Dear Doctor” letters, sent in 2017 in San Diego County, were part of a study that put a human face on the U.S. opioid crisis for many doctors.

SALT LAKE CITY — Defying a worrisome national trend, Utah recently recorded the nation's second-largest drop in drug overdose deaths in estimates from the Centers for Disease Control and Prevention.

The day after related data was first reported, officials in Utah expressed cautious optimism about a 12 percent decline in fatal overdoses over a one-year period ending January 2018.

They credited local efforts to reduce the number of opioids being prescribed and to distribute a life-saving overdose reversal drug known as naloxone. But they also said drug deaths — increasingly heroin and maybe soon synthetic opioids — remain of dire concern in a state that ranked seventh in opioid deaths from 2013 to 2015.

“There’s much to celebrate there, but we have to be careful not to overstate it,” said Lisa Nichols, community health partnership director at Intermountain Healthcare, the state’s largest employer and health care provider.

Fatal overdoses increased 7 percent nationwide in the CDC's provisional data, which may change slightly as investigations into some deaths continue.

Only Wyoming, which saw fatal overdoses fall by a third, had a better year than Utah in terms of improvement. To the east of Wyoming is the opposite end of the spectrum: Nebraska, which had the lowest fatal overdose rates in the nation in 2016 but is estimated to have had a 33 percent increase in 2017.

Eight of 12 states with a decline in overdose deaths are west of the Mississippi.

That may be because white powder heroin, more commonly in the East, blends easily with more powerful synthetic opioids like fentanyl — a cost-cutting measure for drug distributors that results in unreliable and sometimes deadly doses.

Black tar heroin prevails out West, and though it can often be fatal on its own, it's rarely mixed with synthetic opioids.

David Goldman, Associated Press
FILE - In this June 13, 2017, file photo, a man injects heroin into this arm under a bridge along the Wishkah River at Kurt Cobain Memorial Park in Aberdeen, Wash. The government said non-fatal overdoses visits to hospital emergency rooms were up about 30 percent late last summer, compared to the same three-month period in 2016. The Centers for Disease Control and Prevention reported the numbers Tuesday, March 6, 2018.

About 40 percent of the nation’s 72,000 overdose deaths involved synthetic opioids over the 12-month period ending in January, compared to just 13 percent of Utah's overdose deaths.

Stephen Gilley, an information analyst with Utah’s Department of Public Safety, said that he has seen reports of fentanyl being combined with black tar heroin, but not in Utah.

Synthetic opioids can already be combined with other drugs common in Utah, though. Utahn Aaron Shamo stands accused of using imported fentanyl to make hundreds of thousands of counterfeit pills at his Cottonwood Heights home, then shipping the pills nationwide to reap millions of dollars in profits.

Drug poisoning remains the leading cause of injury deaths in Utah. In 2016 — the most recent concrete CDC data — Utah was 19th in the nation in overdose deaths per capita.

But preliminary data from the Utah Department of Health show promise in the fight against opioids, which have been Utah's primary scourge. Total deaths from opioids fell by at least 60 in 2017, or about 14 percent of the previous year’s total.

Angela Stander-Ito, prescription drug overdose prevention coordinator for the Utah Department of Health, said the overall reduction in fatal overdoses is largely a reflection of a downward trend in prescription drug overdoses, which fell in 2015 and then again in 2016 in the most recent finalized state numbers.

Toby Talbot, Associated Press
FILE - This Feb. 19, 2013 file photo shows OxyContin pills arranged for a photo at a pharmacy in Montpelier, Vt. A report found drug overdose deaths among U.S. teens inched up in 2015 after years of decline. The report was released on Wednesday, August 16, 2017 by the Centers for Disease Control and Prevention.

Intermountain Healthcare set a goal to cut opioids prescribed for acute pain by 40 percent by the end of 2018, and state departments have similarly tried to reduce the amount of pills prescribed elsewhere through coordinated messaging to doctors, patients and health care decision-makers.

Utah doctors also now benefit from a patient dashboard in the state’s controlled substance database, which flags them when a patient has prescriptions from multiple providers.

Officials also credit Utah Naloxone. Founder Jennifer Plumb, also an assistant professor of pediatrics at the University of Utah, said Thursday the group had distributed more than 60,000 doses of the opioid overdose-reversal drug since July 2015, with more than 2,300 known reversals.

Plumb said the CDC’s Utah numbers may be preliminary but they represent “a glimmer of hopefulness in an otherwise bleak realm.”

By allowing naloxone to be distributed so widely — including to first responders and at needle exchanges — Plumb said Utah leaders have ensured that naloxone is carried by those who need it most.

“I think Utah has really allowed us to get kits where they’re going to actually save lives, which is pretty unique and pretty amazing,” Plumb said.

But while she lauded the state’s tandem efforts to increase public awareness of opioid dangers and control prescription drugs, Plumb noted that Utah's heroin-related deaths rose in recent years. And if more heroin is coming, or more synthetic drugs, Plumb worries the community might not galvanize the same way it did for prescription drugs, which may have a cleaner-cut image.

“When it becomes bigger and badder and bolder, it’s going to be absolutely terrifying, and we as a state have to address it like any other public health problem,” she said.

Patrick Sison, Associated Press
FILE - This Tuesday, Aug. 15, 2017, file photo shows an arrangement of pills of the opioid oxycodone-acetaminophen in New York. In an innovative experiment, doctors prescribed fewer opioids after learning of their patient's overdose death in a letter from a county medical examiner. More than 400 “Dear Doctor” letters, sent in 2017 in San Diego County, were part of a study that put a human face on the U.S. opioid crisis for many doctors.

Brian Besser, special agent in charge for the Drug Enforcement Administration in Utah, said the state continues to receive an abundant supply of high-quality Mexican heroin. He sees "walking wounded" who would be dead without the naloxone supplied by Plumb's group, but who aren't yet free of the drug's grasp.

"That is chipping away at our mortality rates," Besser said, "but bear in mind, the difference between mortality rates and actual drug overdoses is huge."

In 2017 alone, he said, Unified police and fire departments received nearly 5,000 overdose-related calls, many of which were resolved by the fast-acting administration of naloxone.

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Other state initiatives include the year-old Operation Rio Grande, in which federal, state, county and city agencies partnered to curb drug dealing near Salt Lake City’s downtown homeless shelter and provide treatment and work opportunities for drug users. And in May, Utah Attorney General Sean Reyes announced a lawsuit against Purdue Pharma (which manufactured OxyContin and other opioids) for misstating the risks of addiction.

A note: The CDC maintains an online dashboard that displays its drug overdose estimates on a six-month delay. When the CDC's data was reported Wednesday by The New York Times, it compared the calendar years 2017 to 2016. The same day, the CDC made a regular update to compare the 12-month period ending January 2018 with the 12-month period ending January 2017. The Deseret News chose to use the most recent data.