The number of drug-overdose deaths in Kentucky hit a new high in 2016 because of rising abuse of heroin and a painkiller called fentanyl, according to a report released Tuesday.
The state recorded 1,404 overdose deaths, up from 1,248 in 2015, according to the report from the state Office of Drug Control Policy.
“Nearly every community in Kentucky experienced a fatal drug overdose last year — if that’s not a wake-up call, I don’t know what is,” Gov. Matt Bevin said in a news release with the overdose report. “We don’t have the luxury of pretending there isn’t a massive problem.”
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The number of deaths would have been higher without the availability of a drug called naloxone — commonly known by the brand name Narcan — which blocks or reverses the effects of an overdose of opioid drugs such as heroin.
Many emergency responders in Kentucky began carrying naloxone as heroin and fentanyl deaths spiked in 2015, though availability varies around the state.
There have been hundreds of reports of police, other first responders and even family members using naloxone to revive someone, said Van Ingram, executive director of the state Office of Drug Control Policy
“Think of where the numbers could be” without it, Ingram said.
To put the numbers in perspective, the total number of Kentucky overdose deaths from 2012 through 2016, at 5,821, outstripped the total number of highway fatalities in the state by more than 2,000.
The 2016 total of 1,404 will almost certainly go up as county coroners get additional information in cases or as other states send information about deaths to Kentucky.
The overdose report counts deaths of Kentucky residents wherever they occurred, and deaths of non-residents that happened in Kentucky.
The report found that fentanyl was involved in 47 percent of overdose deaths, either alone or in combination with heroin. That was up from 34 percent the year before, indicating a continued rising abuse of the dangerous drug.
Fentanyl is 30 to 50 times more powerful than heroin, so it can be lethal at low levels, according to a news release with the overdose report from the state Justice and Public Safety Cabinet.
One problem is that drug traffickers often mix fentanyl with heroin to increase the supply, or press fentanyl into a pill form. That means people who think they are taking heroin or a prescription painkiller such as oxycodone get a much stronger dose than anticipated, increasing the chance of a fatal overdose.
“Users have no way of knowing what drugs they are taking, and even the smallest amounts can trigger a lethal reaction,” Ingram said. “We’ve seen cases where a bad batch of drugs has led to dozens of overdoses in a single community overnight.”
The drug is so powerful that it can take several doses of naloxone to revive an overdose victim.
Fentanyl is synthesized in laboratories overseas, notably in China, and smuggled into the U.S. from Mexico by drug groups, according to the U.S. Drug Enforcement Administration.
“To me, the story in this (overdose) report is the cartels flooding the illicit drug market with fentanyl,” Ingram said.
However, there also is a problem with people being able to buy fentanyl on the internet and have it shipped to their homes, Ingram said.
Heroin also is still a major problem.
The report showed 34 percent of 2016 Kentucky overdose deaths involved heroin, up from 28 percent of overdoses in 2015.
The report showed that the percentage of deaths involving prescription painkillers went down. One reason could be that people shifted to heroin, which can be cheaper.
The painkiller oxycodone was detected in 19 percent of deaths, which was a decline of 4 percent from the year before, and hydrocodone was seen in 16 percent of cases. That was down 5 percent.
The report also illustrates regional trends in drug abuse in the state. The top five counties for heroin-related deaths were the state’s most urban areas: Jefferson, Fayette, Kenton, Campbell and Boone.
Those five also were top in fentanyl-related deaths and deaths involving both heroin and fentanyl.
Jefferson County, the state’s most populous, reported 364 overdose deaths last year, by far the most in the state and up from 255 in 2015. Fayette County had the second-highest number at 162, up from 141 in 2015, according to the report.
When considering all overdose deaths as a share of the population, however, the top five counties were Leslie, Bell, Powell, Gallatin and Campbell.
Abuse of prescription drugs such as oxycodone has traditionally been worse than abuse of heroin in Eastern Kentucky counties such as Bell and Leslie.
The report said overdose deaths actually went down by half in Bell County and adjoining Knox County.
But Jackie Steele, the commonwealth’s attorney for Knox and Laurel counties, questioned whether overdoses had really gone down that much in one of his counties given that there is no indication the drug problem has abated.
“It’s no less — absolutely no less, and I hate to say that it may be worse,” he said.
Steele said that until there is a requirement for mandatory toxicology testing in unexplained deaths, there will be gaps in accounting for overdoses.
Ingram said reporting on overdoses by coroners has gotten “vastly” better, but the system isn’t perfect.
Of the 1,404 fatal overdoses counted in the report, there was toxicology data available in 1,330.
Ingram said wider availability of naloxone and expanded access to drug treatment are two key needs in the effort to push down overdose deaths in the state.
State lawmakers, health providers and others have taken a number of steps the last few years to battle the state’s drug problem, including educating drug prescribers; approving legislation to crack down on unscrupulous prescribing at so-called “pill mills” and to create tougher sentences for selling heroin or fentanyl; and making naloxone more widely available.
Bevin and legislators also have increased funding for anti-drug efforts.
“The consequences of the opioid crisis are far-reaching, affecting every corner of our communities,” Bevin said. “We must stand united against the opioid scourge and work together to find solutions. Failure is not an option.”