Drug overdoses in North Carolina surged in 2017 faster than every other state in the nation but one, as the potent and cheap fentanyl and its derivatives flooded the state.
The Centers for Disease Control and Prevention said 2,323 people in North Carolina died from an overdose of opioids and other drugs in 2017, but the CDC expects that number to rise because there is often a lag in autopsies and reporting. According to its preliminary estimate Wednesday the tally could rise to 2,505, a 22.5 percent increase from 2016.
The spike in deaths is taking place despite efforts to curb the epidemic that has claimed more than 12,000 lives in the state since 1999. Public officials have not been able to keep up with the rapid spread of synthetic fentanyl, which is not only cheap but also about 40 times more potent than heroin.
Fentanyl and its “analogues” are deadly also because they are mixed in unpredictable proportions with other commonly used illicit drugs, so that users can inadvertently inject a fatal cocktail, said Larry Greenblatt, a medicine professor at Duke University who leads the opioid safety initiative for the Duke University Health System.
“The fentanyl and fentanyl analogue deaths are just skyrocketing,” Greenblatt said in a phone interview. “It’s a crap shoot. People put something in their vein and who knows what it’s going to be.”
A fentanyl analogue is a drug created to imitate the effects of fentanyl. New fentanyl analogue are constantly developed and introduced into the black market. The North Carolina Department of Health and Human Services has estimated there are at least 42 different kinds of fentanyl analogues on the market.
North Carolina officials have grappled with the public health problem in a number of ways, from restricting opioid prescriptions for first-time patients to legalizing a program that makes clean syringes available to people with drug addictions. The state has launched an Opioid Action Plan to make naloxone, the overdose antidote, widely available, and to expand treatment and care.
The N.C. Harm Reduction Coalition has distributed 1,296 fentanyl test strips this year to drug users to detect the presence of fentanyl in drug cookers used to prepare narcotics for injection. Users who find fentanyl in their drug mix are urged to inject a smaller quantity as a safety precaution. So far 82 percent of the test strips are coming back positive for fentanyl, said Robert Childs, the Wilmington-based coalition’s drug policy expert.
The national epidemic, which started in the 1990s with prescription drugs, claimed about 72,000 lives in this country last year, according to CDC projections, an increase of 6.6 percent over 2016. The steepest increase in drug-related deaths took place in Nebraska, where the CDC projected 2017 overdoses increased by 33.3 percent, to 152 deaths. Pennsylvania had the most deaths, totaling 5,515, an increase of 8.1 percent.
The CDC said some drug overdose deaths require lengthy investigations and are not reported for six months after the death, so the health agency uses statistical methods to project the actual death total. Opioids by far claim the most lives of all overdoses. Of North Carolina’s total drug-related deaths in 2017, data from the state medical examiner’s office shows that 570 were caused by non-opioids, such as cocaine, methamphetamine and benzodiazepenes.
North Carolina data show that the synthetic drugs manufactured in laboratories overtook pure heroin deaths by a wide margin just in the past year.
Overdoses involving heroin peaked in North Carolina in 2016 and slightly dipped in 2017, with 534 deaths last year, according to data issued by the N.C. Medical Examiner. The same year, 543 North Carolinians died from fentanyl or its analogues. But fentanyl deaths have been doubling annually in recent years, surging to 1,231 overdoses last year, nearly half the total projected deaths.
“Fentanyl came to NC with a vengeance in 2017,” said Corey Davis, senior attorney at the National Health Law Program, an organization that advocates for the health rights of low-income people. “There was this dramatic increase.”
An opioid overdose may involve more than one drug, the CDC said, and the most common killers, in addition to heroin and fentanyl, are morphine, codeine, oxycodone, methadone and tramadol.
Fentanyl is a prescription medication typically used to manage pain after surgery, according to the National Institute on Drug Abuse. On the streets, fentanyl or fentanyl-laced heroin is sold as Apache, China Girl, White China, Dance Fever, Jackpot, Murder 8, TNT, Tango, Cash, Perc-O‐Pops or Chiclets, according to online public health sites.
“In North Carolina, law enforcement is not only seeing heroin cut with fentanyl, but also seeing cocaine and methamphetamine being cut with fentanyl, and bulk fentanyl being sold as heroin,” said a March article in the N.C. Medical Journal. “This is especially problematic given the potency of fentanyl when compared to heroin and has led to an increase in overdose deaths across the state. Law enforcement officers project that this trend will continue because of the increasingly varied users and the large number of persons addicted to prescription opioids switching to heroin.”