Both fatal and nonfatal drug overdoses in Louisville have significantly fallen in the first three quarters of this year compared with the record highs set in 2017, according to Insider Louisville’s review of records from the Jefferson County Coroner’s office and Louisville Emergency Medical Services.
While these figures indicate that 2018 will finally show a decrease in overdoses after consecutive years of record highs amid the national opioid epidemic, the totals are still staggering and well above what Louisville witnessed as recently as 2015.
Once led by prescription painkillers, then heroin, this epidemic of opioid overdoses is now increasingly driven by fentanyl — the powerful opioid that was involved in 71 percent of all accidental fatal overdoses in Louisville so far in 2018.
According to records of the coroner’s office, there were 234 accidental fatal overdoses in Louisville this year through the end of September, which is a nearly 29 percent decrease from the 328 overdoses through the first nine months of 2017, a year that ended with a record 398 fatal overdoses.
If fatal overdoses continue at the same pace throughout the rest of this year, the 2018 totals may actually be lower than the 324 victims Louisville recorded in 2016, when there were 262 fatal overdoses within the first three quarters of that year.
However, the number of fatal overdoses in the first nine months of this year has already surpassed the 220 recorded in the entire year of 2015, which had also been a record-high total for Louisville at the time.
As the chart below shows — tracking monthly fatal overdoses in Louisville since the beginning of 2015 — fentanyl has been the main driver of Louisville’s fatal overdoses since entering the market in early 2016.
While toxicology reports from the coroner’s office show that fentanyl was only involved in 11.8 percent of fatal overdose victims in 2015, that figure increased to 43 percent in 2016 and 64 percent in 2017. Fentanyl’s presence has only grown further in the first three quarters of 2018, as it was present in the system of over 71 percent of fatal overdoses.
Despite the heavy and consistent influence of fentanyl remaining this year, Louisville appears on track to record its lowest number of overdose fatalities since 2015 because of the apparent lack of any dramatic spikes that occurred during the previous two years. A surge in fentanyl overdoses led the two previously record months for fatalities in the summer of 2016, which were greatly surpassed during Louisville’s worst spike in February of 2017, when there were 65 fatal overdoses.
The coroner’s office recorded only 16 fatal accidental overdoses in September, which was the lowest monthly total for Louisville since February of 2016, a month before the city’s first spike in fentanyl overdoses. While this preliminary figure for September could still rise — as some toxicology reports take up to three months to be completed — a review of Louisville EMS records provides additional evidence that this was a promising month.
Nonfatal overdoses recorded by EMS also down
According to Louisville EMS, 1,801 patients on the city’s overdose runs through September of this year received at least one dose of naloxone, the drug that is used to revive the victims of an opioid overdose.
This total from 2018 amounts to a 12.7 percent decrease from the 2,062 patients receiving naloxone that EMS recorded in the first three quarters of 2017, but — unlike fatal overdoses recorded by the coroner — is still on pace to surpass the total from 2016.
While there were still 586 EMS overdose runs in September of this year, the 129 patients receiving naloxone on those runs amounted to the second-lowest total of any month in Louisville since February of 2016. Additionally, the ratio of naloxone patients to overdose runs was 22 percent, the lowest since January of 2016.
The fact that nonfatal overdoses (indicated by this number of naloxone patients) are on pace this year to exceed that of 2016, while fatal overdoses are not, could be an indicator that the city’s push to increase access to naloxone among the public and the friends and family of opioid addicts could be saving a significant number of lives.
Methamphetamine increases, but still overshadowed by opioids
As if the percentage of fentanyl-related fatal overdoses weren’t enough to display the extent of the opioid epidemic, the numbers become even more glaring when including deaths involving any kind of opioid, including heroin, morphine and prescription painkillers.
Of the 398 accidental fatal overdoses last year, 87 percent of them involved at least one type of opioid, while that figure has only decreased slightly to 85 percent in the first three quarters of 2018. Of the over 632 overdose deaths from the beginning of 2017 through the end of this September, only 85 did not involve any opioids.
Fatal ODs involving the non-opioid painkiller gabapentin and cocaine appear to have fallen significantly so far in 2017 compared with last year, though most of these victims also had fentanyl or another opioid in their system as well. Cocaine was present in 30 victims through September, compared with 53 throughout last year, and gabapentin was present in the toxicology reports of 38 victims — half the total from the same nine-month period in 2017.
Dr. Rachel Vickers Smith — an assistant professor in the University of Louisville School of Nursing who has researched the rise in gabapentin abuse — told Insider that the drop in fatal overdoses related to that drug this year is likely due to Kentucky becoming the first state to designate gabapentin as a Schedule 5 controlled substance, which happened in July of last year. Gabapentin was involved in just four fatal overdoses in Louisville in 2015, but that figure rose to 93 last year.
One drug that is now more prevalent in Louisville’s fatal overdoses so far this year is methamphetamine, as it was present in the toxicology report of 83 victims in the first nine months of this year, or 35 percent of total deaths. Though almost three-quarters of these fatal overdose deaths involving methamphetamine also had an opioid in their system — mostly fentanyl — 23 did not involve any opioid, which matched the figure from all of 2017 and amounted to nearly 10 percent of the total overdose deaths in 2018 through September.
Methamphetamine abuse has surged nationally over the past decade, and the amount of fatal overdoses involving the drug more than doubled in Kentucky last year, as it was present in the toxicology report of 29 percent of overdose deaths statewide. Fentanyl was involved in 52 percent of Kentucky’s record-high total of overdose deaths in 2017.
Dr. Sarah Moyer, director of the Louisville Metro Department of Public Health and Wellness and the city’s chief health strategist, told Insider in a statement that while it is promising that overdose deaths and nonfatal overdoses may be trending downward, “we still have a lot of work to do,” citing the Fischer administration’s two-year plan released in March.
“Since we published our two-year action plan to respond to Louisville’s substance use crisis in March, Public Health and Wellness has been working with groups and individuals across the community to implement the report’s recommendations,” stated Moyer. “Fewer overdoses are good news and a measure of our progress, but we must continue to work on preventing substance use, reducing stigma, improving access to treatment and giving people in recovery the support they need to lead healthy and productive lives.”