<p style='box-sizing: border-box; background-repeat: no-repeat; margin-top: 0px; word-spacing: -1px; color: rgb(99, 99, 99); font-family: "Whitney SSm A", "Whitney SSm B", "Helvetica Neue", HelveticaNeue, Arial, Helvetica, Roboto, sans-serif; font-size: 16px;'>In an opioid epidemic that began in the late 1990s, drug deaths have been climbing steadily every year, in nearly every state. A break in that trend, even if limited to just 14 states, has prompted cautious optimism among some public health experts.</p><p style='box-sizing: border-box; background-repeat: no-repeat; margin-top: 0px; word-spacing: -1px; color: rgb(99, 99, 99); font-family: "Whitney SSm A", "Whitney SSm B", "Helvetica Neue", HelveticaNeue, Arial, Helvetica, Roboto, sans-serif; font-size: 16px;'>“It could be welcome news,” said Caleb Alexander, an epidemiologist and co-director of Johns Hopkins University’s Center for Drug Safety and Effectiveness.</p><p style='box-sizing: border-box; background-repeat: no-repeat; margin-top: 0px; word-spacing: -1px; color: rgb(99, 99, 99); font-family: "Whitney SSm A", "Whitney SSm B", "Helvetica Neue", HelveticaNeue, Arial, Helvetica, Roboto, sans-serif; font-size: 16px;'>“If we’re truly at a plateau or inflection point, it would be the best news all year,” he said. “But we’re still seeing rates of overdose that are leaps and bounds higher than what we were seeing a decade ago and far beyond any other country in the world.”</p><p style='box-sizing: border-box; background-repeat: no-repeat; margin-top: 0px; word-spacing: -1px; color: rgb(99, 99, 99); font-family: "Whitney SSm A", "Whitney SSm B", "Helvetica Neue", HelveticaNeue, Arial, Helvetica, Roboto, sans-serif; font-size: 16px;'>The reported drop in overdose deaths occurred in Wyoming, Utah, Washington, Alaska, Montana, Mississippi, Kansas, Rhode Island, Oregon, California, Tennessee, Massachusetts, Arizona and Hawaii. That compares with declines in only three states — Nebraska, Washington and Wyoming — reported for an earlier 12-month period that ended in January 2017.</p><p style='box-sizing: border-box; background-repeat: no-repeat; margin-top: 0px; word-spacing: -1px; color: rgb(99, 99, 99); font-family: "Whitney SSm A", "Whitney SSm B", "Helvetica Neue", HelveticaNeue, Arial, Helvetica, Roboto, sans-serif; font-size: 16px;'>But even as more states saw a drop in deaths, several saw death spikes of more than 30 percent, most likely due to the increasing presence of the <a href="http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2017/05/08/as-fentanyl-spreads-states-step-up-responses" style="box-sizing: border-box; background-repeat: no-repeat; background-color: transparent; color: rgb(0, 122, 215); word-wrap: break-word; text-decoration-line: none; transition: color 150ms ease-out, background-color 150ms ease-out;" target="_blank">deadly synthetic drug fentanyl</a> in the illicit drug supply, drug experts say. Those are Delaware, Florida, New Jersey, Ohio and Pennsylvania, along with the District of Columbia.</p><p style='box-sizing: border-box; background-repeat: no-repeat; margin-top: 0px; word-spacing: -1px; color: rgb(99, 99, 99); font-family: "Whitney SSm A", "Whitney SSm B", "Helvetica Neue", HelveticaNeue, Arial, Helvetica, Roboto, sans-serif; font-size: 16px;'>Published monthly since August, the new CDC statistics are a compilation of death certificate data from all 50 states for a rolling 12-month period ending seven months prior to release of each report. The seven-month delay is roughly the amount of time it takes for states to complete death investigations and report causes of death, and for the CDC to compile the data.</p><p style='box-sizing: border-box; background-repeat: no-repeat; margin-top: 0px; word-spacing: -1px; color: rgb(99, 99, 99); font-family: "Whitney SSm A", "Whitney SSm B", "Helvetica Neue", HelveticaNeue, Arial, Helvetica, Roboto, sans-serif; font-size: 16px;'>Previously, the CDC only made death data available once a year and it was 12 to 14 months behind. In a fast-moving opioid scourge, epidemiologists say the increased frequency of overdose death reporting is a welcome improvement.</p><p style='box-sizing: border-box; background-repeat: no-repeat; margin-top: 0px; word-spacing: -1px; color: rgb(99, 99, 99); font-family: "Whitney SSm A", "Whitney SSm B", "Helvetica Neue", HelveticaNeue, Arial, Helvetica, Roboto, sans-serif; font-size: 16px;'>Farida Ahmad, a public health expert with the CDC, cautioned that the monthly provisional death numbers are subject to change because as many as 2 percent of death certificates for the time period have not been reported. A final death count for 2017 will not be available until November, she said.</p><h3 style='box-sizing: border-box; background-repeat: no-repeat; font-size: 1.3125rem; font-family: "Whitney SSm A", "Whitney SSm B", "Helvetica Neue", HelveticaNeue, Arial, Helvetica, Roboto, sans-serif; color: rgb(33, 87, 138); letter-spacing: -1px; line-height: 1.5; margin: 1.5em 0px 0.3em; text-rendering: optimizeLegibility; overflow: hidden;'><strong>Increased Volatility</strong></h3><p style='box-sizing: border-box; background-repeat: no-repeat; margin-top: 0px; word-spacing: -1px; color: rgb(99, 99, 99); font-family: "Whitney SSm A", "Whitney SSm B", "Helvetica Neue", HelveticaNeue, Arial, Helvetica, Roboto, sans-serif; font-size: 16px;'>In Alaska, where deaths declined more than 11 percent between the 12-month period ending July 2016 and the 12-month period ending July 2017, the state’s public health chief, Jay Butler, said the trend has been cause for some optimism.</p><p style='box-sizing: border-box; background-repeat: no-repeat; margin-top: 0px; word-spacing: -1px; color: rgb(99, 99, 99); font-family: "Whitney SSm A", "Whitney SSm B", "Helvetica Neue", HelveticaNeue, Arial, Helvetica, Roboto, sans-serif; font-size: 16px;'>The greatest portion of that decline was in prescription opioids, drugs such as OxyContin, Percocet and Vicodin, Butler said.</p><p style='box-sizing: border-box; background-repeat: no-repeat; margin-top: 0px; word-spacing: -1px; color: rgb(99, 99, 99); font-family: "Whitney SSm A", "Whitney SSm B", "Helvetica Neue", HelveticaNeue, Arial, Helvetica, Roboto, sans-serif; font-size: 16px;'>“And we may be seeing a plateauing, if not a decline, in overdose deaths from heroin,” he added. “The bad news is that we’re seeing more deaths from fentanyl.”</p><p style='box-sizing: border-box; background-repeat: no-repeat; margin-top: 0px; word-spacing: -1px; color: rgb(99, 99, 99); font-family: "Whitney SSm A", "Whitney SSm B", "Helvetica Neue", HelveticaNeue, Arial, Helvetica, Roboto, sans-serif; font-size: 16px;'>Indeed, fentanyl-related deaths spiked more than 70 percent nationwide in the 12-month period ending July 2017, according to the report.</p><p style='box-sizing: border-box; background-repeat: no-repeat; margin-top: 0px; word-spacing: -1px; color: rgb(99, 99, 99); font-family: "Whitney SSm A", "Whitney SSm B", "Helvetica Neue", HelveticaNeue, Arial, Helvetica, Roboto, sans-serif; font-size: 16px;'>“Using illicit drugs has always been a game of roulette,” Butler said. “There’s just more bullets in the chamber now.</p><p style='box-sizing: border-box; background-repeat: no-repeat; margin-top: 0px; word-spacing: -1px; color: rgb(99, 99, 99); font-family: "Whitney SSm A", "Whitney SSm B", "Helvetica Neue", HelveticaNeue, Arial, Helvetica, Roboto, sans-serif; font-size: 16px;'>“When the epidemic was driven primarily by prescription opioids, we saw a smoldering and chronically escalating problem,” he said. “Now we’re seeing outbreaks and clusters of death resulting from bad batches of heroin or counterfeit pills laced with fentanyl.”</p><h3 style='box-sizing: border-box; background-repeat: no-repeat; font-size: 1.3125rem; font-family: "Whitney SSm A", "Whitney SSm B", "Helvetica Neue", HelveticaNeue, Arial, Helvetica, Roboto, sans-serif; color: rgb(33, 87, 138); letter-spacing: -1px; line-height: 1.5; margin: 1.5em 0px 0.3em; text-rendering: optimizeLegibility; overflow: hidden;'><strong>Still Rising</strong></h3><p style='box-sizing: border-box; background-repeat: no-repeat; margin-top: 0px; word-spacing: -1px; color: rgb(99, 99, 99); font-family: "Whitney SSm A", "Whitney SSm B", "Helvetica Neue", HelveticaNeue, Arial, Helvetica, Roboto, sans-serif; font-size: 16px;'>The recent drop in opioid deaths in some states might be significant, experts say, but they caution it should be seen in the context of the worst drug death epidemic in U.S. history.</p><p style='box-sizing: border-box; background-repeat: no-repeat; margin-top: 0px; word-spacing: -1px; color: rgb(99, 99, 99); font-family: "Whitney SSm A", "Whitney SSm B", "Helvetica Neue", HelveticaNeue, Arial, Helvetica, Roboto, sans-serif; font-size: 16px;'>In 2016, the annual overdose death count reached nearly 64,000, more than three times as many as in 1999. It surpassed the number of fatalities from automobile crashes and homicides, becoming the No. 1 cause of death among Americans 50 and younger.</p><p style='box-sizing: border-box; background-repeat: no-repeat; margin-top: 0px; word-spacing: -1px; color: rgb(99, 99, 99); font-family: "Whitney SSm A", "Whitney SSm B", "Helvetica Neue", HelveticaNeue, Arial, Helvetica, Roboto, sans-serif; font-size: 16px;'>Aside from the 14 states seeing declines, there are few signs of relief ahead.</p><p style='box-sizing: border-box; background-repeat: no-repeat; margin-top: 0px; word-spacing: -1px; color: rgb(99, 99, 99); font-family: "Whitney SSm A", "Whitney SSm B", "Helvetica Neue", HelveticaNeue, Arial, Helvetica, Roboto, sans-serif; font-size: 16px;'>Nationwide, the death toll is still rising, although possibly at a lower rate than in the past two years. According to the CDC’s current provisional report, the total number of overdose deaths increased 14 percent in the 12-month period ending in July 2017, compared to a 21 percent increase in the 12- month period that ended in January 2017.</p><p style='box-sizing: border-box; background-repeat: no-repeat; margin-top: 0px; word-spacing: -1px; color: rgb(99, 99, 99); font-family: "Whitney SSm A", "Whitney SSm B", "Helvetica Neue", HelveticaNeue, Arial, Helvetica, Roboto, sans-serif; font-size: 16px;'>One reason could be a decline in the availability of prescription painkillers. Even as overdose deaths spiraled over the last five years, the rate of prescribed opioid consumption began to decline.</p><p style='box-sizing: border-box; background-repeat: no-repeat; margin-top: 0px; word-spacing: -1px; color: rgb(99, 99, 99); font-family: "Whitney SSm A", "Whitney SSm B", "Helvetica Neue", HelveticaNeue, Arial, Helvetica, Roboto, sans-serif; font-size: 16px;'>That could mean lower rates of heroin use, addiction and overdose deaths in the future, Alexander said. A vast majority — 86 percent — of young, urban injection drug users started misusing prescription <a href="https://www.drugabuse.gov/publications/research-reports/relationship-between-prescription-drug-heroin-abuse/prescription-opioid-use-risk-factor-heroin-use" style="box-sizing: border-box; background-repeat: no-repeat; background-color: transparent; color: rgb(0, 122, 215); word-wrap: break-word; text-decoration-line: none; transition: color 150ms ease-out, background-color 150ms ease-out;" target="_blank">opioids before turning to heroin</a>, according to surveys by the National Institute on Drug Abuse.</p><p style='box-sizing: border-box; background-repeat: no-repeat; margin-top: 0px; word-spacing: -1px; color: rgb(99, 99, 99); font-family: "Whitney SSm A", "Whitney SSm B", "Helvetica Neue", HelveticaNeue, Arial, Helvetica, Roboto, sans-serif; font-size: 16px;'>Another likely reason for a tapering in death counts is the widespread use of the overdose antidote naloxone, public health experts say.</p><p style='box-sizing: border-box; background-repeat: no-repeat; margin-top: 0px; word-spacing: -1px; color: rgb(99, 99, 99); font-family: "Whitney SSm A", "Whitney SSm B", "Helvetica Neue", HelveticaNeue, Arial, Helvetica, Roboto, sans-serif; font-size: 16px;'>“It’s hard to imagine how high the death toll would be without naloxone,” said Michael Kilkenny, the Cabell-Huntington public health director in West Virginia.</p><p style='box-sizing: border-box; background-repeat: no-repeat; margin-top: 0px; word-spacing: -1px; color: rgb(99, 99, 99); font-family: "Whitney SSm A", "Whitney SSm B", "Helvetica Neue", HelveticaNeue, Arial, Helvetica, Roboto, sans-serif; font-size: 16px;'>“It’s a little too soon to tell,” he said, “but we may be seeing the beginning of a decline in the number of deaths in Huntington,” a small city that has <a href="http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2016/09/26/still-not-enough-treatment-in-the-heart-of-the-opioid-crisis" style="box-sizing: border-box; background-repeat: no-repeat; background-color: transparent; color: rgb(0, 122, 215); word-wrap: break-word; text-decoration-line: none; transition: color 150ms ease-out, background-color 150ms ease-out;" target="_blank">the highest overdose death rate</a> in West Virginia, the state with the highest overdose death rate in the country.</p><p style='box-sizing: border-box; background-repeat: no-repeat; margin-top: 0px; word-spacing: -1px; color: rgb(99, 99, 99); font-family: "Whitney SSm A", "Whitney SSm B", "Helvetica Neue", HelveticaNeue, Arial, Helvetica, Roboto, sans-serif; font-size: 16px;'>[[{"type":"media","view_mode":"media_original","fid":"630447","attributes":{"alt":"","class":"media-image","height":"3652","style":"width: 560px; height: 1510px;","typeof":"foaf:Image","width":"1354"}}]]</p>
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