An employee of Charm City Care Connection, a Baltimore organization that provides naloxone and sterile needles to drug users to prevent drug overdoses, hands out information. Photo courtesy of Charm City Care Connection.

The number of Marylanders dying from overdoses has dropped over the past year, mirroring a national trend, but lagging behind the nation in the rate of decline, according to the latest federal data.

Data from the Centers for Disease Control and Prevention estimate that from April 2023 to April 2024, 2,348 Marylanders died from overdoses, up from 2,506 deaths the year before, a 6.16% decline. Current estimates show that overdose deaths in the U.S. have declined by 10% over the same period.

Still, the gains made state health officials and substance use researchers optimistic that the state’s opioid crisis could improve.

“There’s a lot of hope at this point,” said Special Secretary for Overdose Response Emily Keller, who leads Maryland’s Office of Overdose Response.

Becky Genberg, an associate professor at the Johns Hopkins Bloomberg School of Public Health who focuses on epidemiology, said it will take time to understand why overdoses are decreasing and could be due to a number of factors, such as people’s access to opioid reversal medications. and avoiding the more common lethal drugs on the market.

“These are not final data. The way overdose data is measured shows some lag,” Genberg said. “But if you consider it in the context of all the other things we know… and you think about other data that might suggest that maybe this is true.”

“At the same time, I think we should remember that almost 100,000 people still die from overdoses in this country. So it’s not like the ‘problem is 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 premature deaths of thousands of Americans, including Marylanders.

In a May press release, the CDC said overdose deaths had been rising since 2018 and only began to decline in 2023.

“There were an estimated 107,543 drug overdose deaths in the United States in 2023, a 3% decrease from the 111,029 estimated deaths in 2022. This is the first annual decline in drug overdose deaths since 2018 ” – the CDC reported at the time.

More recent estimates suggest this trend continued into 2024, although the changes varied widely by state – nine states and the District of Columbia actually saw an increase in overdose deaths during this period.

“We would expect differences from state to state given the differences in drug markets,” Genberg said. “You can think about the fact that there may be different state or even local policies that may be related to access to harm reduction or other things that may be helpful in preventing overdoses.

“I think with more research we could try to unravel why we’re seeing these changes in different places at different rates, but it’s hard to say exactly what’s behind it unless we do the right work,” she added.

Keller, with the Maryland Office of Overdose Response, speculates that larger cities may have difficulty curbing overdoses.

“I think we have made great progress. “I really think there are some big cities in Maryland, like Baltimore, that have a lot of problems,” she said.

The CDC data includes separate data for New York, which showed a 6.44% decline in overdose deaths, similar to Maryland. California also showed a 5.26% reduction in overdose deaths.

Nebraska had the largest percentage decline in overdose deaths, from 218 to 153, a 29.8% decline. North Carolina came in second, with a 22.9% decline from 4,470 deaths in 2023 to 3,448 in 2024.

The state with the largest percentage increase in overdose deaths is Alaska, which increased by 41.8%, from 275 deaths in 2023 to 390 in 2024. Oregon increased by 22.3%, from 1,542 overdose deaths in 2023 until 1886 a year later.

However, overdose deaths have declined in the vast majority of states.

“As for why are we seeing reductions? I don’t think we know that yet,” Genberg said. “I think there are a lot of potential causes.”

She noted that more drug users may be aware of fentanyl saturating the drug market and may change their behaviors to use drugs more safely.

“If you talk to people who use drugs or people who work with people who use drugs, I think many people have adjusted their drug use strategies to keep themselves and others safe, given the power of drugs on the market right now,” Genberg said. “They may use less or use slower. Taking advantage of having someone nearby to help — that could be part of it.”

At the same time, I think we should remember that almost 100,000 people still die from overdoses in this country. So it’s not like the “problem is solved”, right?

– Becky Genberg, associate professor, Johns Hopkins Bloomberg School of Public Health

Keller says part of the challenge is keeping up with the ever-changing drug landscape.

“It’s definitely constantly evolving,” she said. “I mean, for a long time we looked at it as a prescription pill crisis, opioid crisis, heroin crisis…. We still see it, but it has now evolved into illicit fentanyl, which is contributing to the overdose crisis. Fentanyl is much more deadly than heroin. We also see the presence of fentanyl in other drugs, such as cocaine.

“So it’s not just people who have primarily used heroin or fentanyl in the past. We now have people who have used cocaine that contains fentanyl and didn’t know it. Fentanyl gets mixed with xylazine and that causes other problems like terrible sores and things like that,” Keller said.

Xylazine is a respiratory depressant used as an animal tranquilizer and also used to kill dogs. It is not approved for use in humans. However, it can enhance and prolong the effects of opioids and is often used in combination with illicitly manufactured fentanyl or other drugs.

While opioids are not the only cause of overdose deaths, they are the leading cause.

According to the state’s overdose registry, there were at least 1,934 overdose deaths from September 2023 to August 2024. Of these, 1,669 deaths involved opioids and 1,545 related to fentanyl.

According to the panel, 962 people died from cocaine overdoses, 335 from alcohol and 138 from heroin. The department notes that a single overdose death may involve multiple substances.

Keller believes one reason for the decline in overdoses in Maryland is the state’s recent efforts to prevent overdoses by providing free test strips of fentanyl and naloxone, an opioid overdose reversal drug. Genberg agrees that increased access to naloxone has likely contributed to the overall decline in overdoses.

“We’ve done a really good job getting naloxone — most people know it by the brand name Narcan — 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 know how to respond in the event of an overdose so they can save a life.”

He believes that using local data to tailor state resources and programs to specific regions will continue to reduce overdoses.

“It’s definitely not for lack of effort, and I think given the very targeted community outreach that we’re doing and the measures that we’re putting in place,” she said, “such as customizing data at the zip code level, for example, collaborating across all jurisdictions and creating a plan cooperation…we will see Maryland continue to improve.

“We do a lot of great work and one death is too many,” Keller said.