DOUBLE DOSE: Colorado fentanyl deaths doubled in 2020, sowing worry about drug’s spread

In the past several years, Lisa Raville, director of the Harm Reduction Action Center, hoped that the drug overdose epidemic that has been growing for decades would finally hit a plateau.

Instead, from 2019 to 2020 the group saw a 63% increase in drug-related deaths in Denver. This March, volunteers treated the highest-ever number of people with the opioid overdose reversal drug naloxone — 83 in one month, and 65% of those were given to people overdosing outdoors.

“We are losing so many people to preventable overdoses,” Raville said.

Founded in 2002, the Harm Reduction Action Center provides clean needles and drug testing kits to injection drug users at its location on Denver’s East Eighth Avenue. Teams of volunteers do outreach to people living in the city’s homeless encampments and other sites, picking up used needles and providing emergency care to those overdosing. Two weeks ago, one volunteer administered six naloxone reversals in one week, Raville said.

Raville believes the increase in drug deaths is caused by several factors. The social isolation and displacement of homeless encampments caused by the pandemic means more people are overdosing alone, putting them at greater risk of dying. People who are relapsing and taking drugs after a period of sobriety are also in more danger. And the ultra-strong synthetic opioid fentanyl is now everywhere, making the region’s drug supply “unpredictable and toxic,” she said.

The problem is by no means limited to Denver. Drug-related poisoning deaths across Colorado were up by more than a third last year, with a total of 1,457 such fatalities in 2020, according to provisional data provided by the state health department. Annual overdose deaths in the state, including accidental, suicidal, homicidal and those with undetermined intent, have doubled in the past 10 years.

In Arapahoe County, which covers nearly 90% of Aurora, accidental overdose deaths shot up by some 40% last year, according to preliminary statistics provided by Arapahoe County Coroner Dr. Kelly Lear. 

“On a countywide level we saw a significant increase in the number of overdose deaths from 2019 to 2020,” she wrote in an email. 

There were 112 accidental deaths tied to alcohol and drugs in Arapahoe County in 2019, making up the largest single group of accidental fatalities, according to Lear’s most recent annual report from 2019. Falls and car crashes made up the respective second and third-largest segments under the accidental deaths umbrella. 

Lear said an outsized portion of the recent deaths were tied to the use of fentanyl, the wildly potent opioid that has slithered into communities across the country in recent years. Lear did not have city-level data on overdose deaths or fatal fentanyl doses immediately available. 

State data mirror that local trend, according to Colorado Department of Public Health and Environment figures. Colorado saw a 140% increase in deaths proven to be linked to fentanyl last year, per preliminary numbers. There had been between about 30 and 50 fentanyl-related deaths in Colorado each year from 2007 to 2017, though totals crept into the triple digits by the end of the decade. There were 102 fentanyl deaths in 2018, another 222 in 2019 and 534 reported last year. Using the latest county-level data available from 2019, there were 26 fentanyl-related deaths in Adams County, 23 in Arapahoe County and fewer than three in Douglas County. 

Denver reported the highest number of fentanyl deaths in the state in 2019 with 61. That marked a 258% increase over the previous year. 

The drug killed more people in Colorado in 2020 than heroin, cocaine and methamphetamine, figures show. After a prolonged dip in cocaine-related deaths in the state for much of the 2010s, fatalities related to the narcotic were at their highest rate in two decades last year. Heroin deaths were flat from 2019 to 2020 and down from 2017 and 2018 totals.

Deaths linked to fatal doses of methamphetamine have increased in Colorado every year since 2012, and 2020 was no exception: 517 people died from meth consumption last year, a nearly 50% increase over the year prior.

But last year marked the first time fentanyl killed more people than methamphetamine since 2010, when both drugs were each linked to 38 deaths statewide. 

Dr. Eric Hill, EMS director at the Medical Center of Aurora, said methamphetamine overdoses remain particularly prevalent across the Aurora region. 

“In our Aurora system we have much more prevalence of methamphetamine abuse than we do opiate abuse, at least those that present in the emergency departments,” he said.

But that’s not to say Aurora has escaped the proliferation of opiates like fentanyl — which is roughly 100 times more potent than morphine — according to Hill. 

“Over the last year, I think we definitely have had an uptick in opiate overdoses, particularly if you look at the percentage of those that were caused by an opiate like fentanyl,” he said.

Hill said fentanyl is often laced with other drugs and sold to sometimes unsuspecting users. The even more potent opiate carfentanil — a tranquilizer often used to sedate animals such as rhinoceroses in the veterinary world — is sometimes mixed into doses as well, a practice that almost always results in the user’s death, according to Hill. A dose of the drug roughly the size of a grain of salt can be fatal.

“There are only a few instances I’m aware of in Colorado where it came into our market, but unfortunately when it does, it’s almost universally fatal,” Hill said. 

Outbreaks of carfentanil deaths have been more tied to the region surrounding the Ohio River Basin in recent years. The state health department data tracking carfentanil deaths in Colorado is redacted for privacy as there have been fewer than three recorded cases in each of the past 20 years. 

“What we’re seeing now is not only a fentanyl overdose crisis, it’s also a poly-drug overdose crisis,” Raville said. “So there’s usually more than one drug on board and because a lot of people don’t think you can overdose on stimulants, that puts people at higher risk.”

Synthetic opioids like fentanyl drove a spike in overdose deaths across the country last year that resulted in the highest number of fatal overdoses ever recorded in a single, 12-month span between May 2019 and May 2020, officials with the Centers for Disease Control and Prevention announced late last year. 

While deaths were already increasing before lockdowns ensnared quotidian existence in spring 2020, “the latest numbers suggest an acceleration of overdose deaths during the pandemic,” CDC officials wrote in a December news release. 

“The disruption to daily life due to the COVID-19 pandemic has hit those with substance use disorder hard,” CDC Director Dr. Robert Redfield said in a statement. “As we continue the fight to end this pandemic, it’s important to not lose sight of different groups being affected in other ways. We need to take care of people suffering from unintended consequences.”

Hill with the Medical Center of Aurora said lapses in turnaround time for COVID-19 tests required by local detox clinics stymied efforts to hand someone with a propensity to overdose from emergency physicians to treatment programs. That process has improved with the newfound abundance of tests and vaccines, according to Hill. 

Overall, the medical director of the hospital’s primary hub on South Potomac Street agreed that the pandemic has proven particularly problematic for addicts.

“I think it’s kind of universally true that this year was incredibly hard for people both on a personal level and a financial level,” Hill said. “And any time you have a situation like that with people with economic troubles … drug and alcohol abuse go up. That’s been consistent forever.”

In an effort to combat that phenomenon, federal authorities have urged local service providers to expand treatment options for those at risk of abusing illicit drugs, endeavor to more quickly detect “overdose outbreaks” and expand naloxone use. 

All EMS teams in the city carry the substance that is often administered as a nasal spray, according to Hill. And more than 140 Aurora police patrol and SWAT officers now carry the antidote, which often goes by the brand name Narcan, according to a department spokesperson. 

The term Narcan has appeared in Aurora police reports 39 times in the past year, a department spokesperson said, though its unclear whether the drug was merely mentioned or used. Aurora police record keeping related to Narcan deployments is largely anecdotal.

Nationally, the number of positive fentanyl drug tests reported to law enforcement more than doubled over a one-year span in the middle of last decade, according to statistics from the CDC.

Hill said local emergency doctors have pivoted to handing naloxone to people who have overdosed right as they leave emergency care in an effort to remove all barriers to access, including travel hiccups, financial burdens or social stigma. 

Handing addicts a means to quell their abuse from the comfort of their homes is still a new concept and far afield from the training Hill received as he was coming up in the profession, he said.

“That was a completely foreign topic when I trained 15 years ago — there was nothing like that and that was totally not done,” Hill said. “And when I first heard about someone prescribing Narcan at home it seemed like a crazy idea.”

He said his intentional skepticism was moored to the notion that opiates like heroin and fentanyl can keep people in coma-like states of sedation for hours on end, whereas Narcan is only effective for about 15 minutes at a time. But data has swayed his thinking on the prescription system, which has been common practice at his facility for the past several years, Hill said. 

“The data actually says it’s a safe thing to do,” he said. “And it does save lives to do it.”

Getting access to treatment in Aurora has only become more difficult due to the coronavirus pandemic.

“Addiction work is challenging to begin with and the events of the past year just added to the challenge,” said Malcolm Jobe, the director for the Aurora Mental Health Center’s substance use disorder programs.

The center has about a 40% reduction in beds in residential programs due to social distancing needs during the pandemic, he said. Staff quarantines mean that there are fewer people on hand to provide treatment, and hospitals, which provide about a third of referrals to the program, have also been stretched thin due to COVID and haven’t had as much ability to provide drug treatment as usual.

The one silver lining is that the expansion in telehealth has made it easier to reach people who are continuing treatment after finishing an inpatient program, something that chief clinical officer Michael Marsico at Mile High Behavioral Healthcare concurred with.

“We’ve gotten more referrals from folks who are really happy with the idea that they don’t have to leave their home and can just work remotely with us,” Marsico said.

In the past, AMHC patients were mainly dealing with alcohol or meth addictions. But over the past year, Jobe said he’s seen an explosion in fentanyl cases.

“It had been in other areas, but it really made a major entry into the suburbs of Aurora over the last year,” he said.

Some people are taking fentanyl deliberately because of its intense potency, while others are consuming it unintentionally because so many other drugs are laced with it, Jobe said.

“Things are so impure right now,” he said. “It’s a real scary gamble to try to buy something off the street, because you don’t know what you’re getting.”

Jobe believes that there are many people who are accidentally overdosing because of how potent fentanyl is but don’t know how to get help. Across Colorado, the crisis is spurring a new call to arms to address the overdose epidemic, he said.

“We’re faced with one of the single worst drugs we’ve faced in a long time,” he said. “Fentanyl just really adds to the sense of urgency.”

If you or someone you know is struggling with substance abuse, call the national helpline of the Substance Abuse and Mental Health Services Administration at 1-800-622-4357.