A staffer at Charm City Care Connection, a Baltimore organization that provides Naloxone and sterile needles to drug users, with the goal of preventing drug overdoses, hands out information. Photo courtesy of Charm City Care Connection.
The number of Marylanders dying from overdoses fell over the past year, mirroring a national trend but lagging behind the nation on the pace of the decline, according to recent federal data.
The Centers for Disease Control and Prevention data estimates that 2,348 Marylanders died of an overdose from April 2023 to April 2024, down from 2,506 deaths the year before, a 6.16% drop. Overdose deaths in the U.S. during the same period fell 10%, according to current estimates.
Still, the gains left state health officials and substance use researchers optimistic that the state’s opioid crisis might be improving.
“There’s a lot to be hopeful for right now,” said Special Secretary of Overdose Response Emily Keller, who leads the Maryland Office of Overdose Response.
Becky Genberg, an associate professor at Johns Hopkins Bloomberg School of Public Health who focuses on epidemiology, said that understanding why overdoses are decreasing will take time, and could be due to many factors — such as people having access to opioid reversal agents and avoiding more lethal drugs on the market.
“This isn’t final data. The way that overdose data is measured, there’s sort of a time lag,” Genberg said. “But when you consider it in the context of all of the other things that we know … and thinking about other data points that might lend themselves to suggest that, maybe, this is real.”
“At the same time, I think we need to remember that almost 100,000 people are still dying from overdose in this country. So it’s not like, ‘problem solved,’ right?” she added.
The data comes as the nation continues to grapple with the evolving battle against synthetic opioids and other illicit drugs that are leading to the untimely deaths of thousands of Americans, including residents in Maryland.
In a May press release, the CDC said that the number of overdose deaths had been rising since 2018 and only began to decrease in 2023.
“There were an estimated 107,543 drug overdose deaths in the United States during 2023 — a decrease of 3% from the 111,029 deaths estimated in 2022. This is the first annual decrease in drug overdose deaths since 2018,” the CDC said then.
The more-recent estimates suggests the trend continued into 2024, although the changes varied widely by state, with nine states and the District of Columbia actually posting increases in overdose deaths during the period.
“From state to state we would expect to see variations, just given that drug markets are different,” Genberg said. “You might think about how there might be different state or even local jurisdiction policies that might be related to access to harm reduction or other things that might be helpful in terms of the prevention of overdose.
“I think with more research we could try to unpack why we see these changes in different places at different rates, but it’s hard to say exactly what is driving it without doing that work,” she added.
Keller, with the Maryland Office of Overdose Response, speculated that larger cities can struggle to reduce overdoses.
“I think we’ve made great strides. I do think Maryland has some large cities, like Baltimore city for example, that have had their fair share of problems,” she said.
The number of overdose Ddaths by place of cccurrence from September 2023 to August 2024. Courtesy the Maryland Department of Health Overdose Data Portal.
The CDC data has a separate data for New York City, which showed a 6.44% reduction in overdose deaths, similar to Maryland. California also showed a 5.26% reduction in overdose deaths.
Nebraska posted the biggest percentage drop in overdose deaths, going from 218 death to 153, a 29.8% decrease. It was followed by North Carolina, which fell 22.9%, from 4,470 deaths in 2023 to 3,448 in 2024.
The state with biggest percentage increase in overdose deaths is Alaska, which posted a 41.8% increase, from 275 deaths in 2023 to 390 in 2024. Oregon rose 22.3%, from 1,542 overdose deaths in 2023 to 1,886 a year later.
But the overwhelming majority of states saw overdose deaths decrease.
“As far as why are we seeing reductions? I don’t think we know that yet,” Genberg said. “I think there are a lot of potential reasons.”
She noted that more people who use drugs may be aware of the presence of fentanyl saturating the drug market and may be changing their behavior to use more safely.
“If you talk to people who use drugs, or people who work with people who use drugs, I think a lot of people have adapted their strategies for drug use to keep themselves and keep others safe, given how potent the drugs are in the marketplace right now,” Genberg said. “They might be using less or using slower. Using when someone’s around to help — that could be part of it.”
At the same time, I think we need to remember that almost 100,000 people are still dying from overdose in this country. So it’s not like, ‘problem solved,’ right?
– Becky Genberg, associate professor, Johns Hopkins Bloomberg School of Public Health
Keller says that part of the challenge is keeping up with the ever-changing drug landscape.
“It’s ever-evolving for sure,” she said. “I mean, for a long time we were looking at this as a prescription pill opioids and heroin crisis…. We are still seeing that, but it’s evolved now into illicit fentanyl, which is playing into the overdose crisis. Fentanyl is much more deadly than heroin was. We are also seeing the presence of fentanyl in other drugs like cocaine for example.
“So, it’s not just people who primarily use heroin or fentanyl in the past. Now we have people who have used cocaine that has fentanyl in it that they weren’t aware of. Fentanyl is being mixed with xylazine, which is causing other issues like horrific wounds and whatnot,” Keller said.
Xylazine is a respiratory depressant that is used as a sedative for animals, and is also used in euthanizing dogs. It is not approved for human use. However, it can enhance and extend the effects of opioids and is often used in combination with illicitly manufactured fentanyl or other drugs.
While opioids are not the only source of overdose deaths, they are a major contributor.
According to the state’s overdose dashboard, there were at least 1,934 overdose deaths from September 2023 to August 2024. Of those, 1,669 deaths involved opioids and 1,545 included fentanyl.
There were 962 overdose deaths that involved cocaine, 335 that involved alcohol, and 138 that involved heroin, according to the dashboard. A single overdose death can involve multiple substances, the department notes.
Naloxone (Narcan) nasal spray on display at the Department of Health and Human Services in Washington in 2023. Photo by Drew Angerer/Getty Images
Keller believes that part of the reason overdoses have gone down in Maryland is recent state efforts to prevent overdoses by providing free fentanyl test strips and naloxone, an opioid overdose reversal medication. Genberg agrees that increased access to naloxone has likely contributed to overdoses decreasing overall.
“We have done a really good job of getting naloxone – most people know it as Narcan, the brand name – but naloxone is our best tool for reversing opioid overdoses and saving lives,” Keller said. “So we want to make sure people have universal access to it and that they know how to respond to an overdose so that they can save a life.”
She believes using local data to tailor state resources and programs to specific regions will continue to bring overdoses down.
“It’s definitely not for a lack of effort, and I think with all the very targeted outreach that we are doing and the measures we’re putting in place,” she said, “like tailoring to ZIP-code level data, like partnering with all of the jurisdictions and creating a collaboration plan … we’re going to see Maryland just continue to get better.
“There’s a lot of great work going on, and one death is too many,” Keller said.
by Danielle J. Brown, Maryland Matters
September 30, 2024
Maryland Matters is part of States Newsroom, a nonprofit news network supported by grants and a coalition of donors as a 501c(3) public charity. Maryland Matters maintains editorial independence. Contact Editor Steve Crane for questions: [email protected]. Follow Maryland Matters on Facebook and X.
