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SALT LAKE CITY — The devastating impacts of the opioid epidemic in Utah reached its peak in 2014 when the state had the fourth-most overdose deaths in the country.
The unnerving statistic served as a wake-up call for Utah officials. The Utah Attorney General's Office, in collaboration with legislators, community activists, the medical community, and the Drug Enforcement Agency organized the Utah Opioid Task Force in 2017 to better understand and combat the crisis. The task force and policy efforts have had considerable success since 2014, with most recent data placing Utah at 42nd in the nation for overdose deaths.
But the crisis isn't over yet.
Overdose deaths had remained steady for several years before a significant increase in 2020 with 68,630 reported deaths and again in 2021 with 80,411 reported overdose deaths, according to the Centers for Disease Control and Prevention.
"A number we'd never hit before as a nation. And Utah initially was holding its own, but then we lost all the ground that we had made in the months before," Sen. Jen Plumb, D-Salt Lake City and also a Utah pediatric trauma doctor, said during the meeting Tuesday.
The increased deaths statewide and recent appearance of mixed substances appearing in drugs were concerns of the Utah Opioid Task Force on Tuesday. The task force met to discuss the deaths, current trends in substances and treatment, laws passed in the legislative session to better combat the epidemic and an update regarding the settlement.
Ongoing concerns
As fatal fentanyl overdoses have continued to persist, the Food and Drug Administration recently opted to make the opioid reversal drug naloxone over the counter. The move had been pushed for by advocates for years, but Plumb has some reservations.
"The biggest problem is that drug companies charge between $50 and $75 for the antidote to something that costs between $5 and $10. And so I'm concerned that people will not be able to have prescriptions covered anymore with an over-the-counter substance," said Plumb. "I'm going to try to be optimistic that there will be more silver linings than clouds. But I do think more access to naloxone is always great, but I'm not sure over the counter is the panacea that some folks think."
Other areas of concern outlined by Plumb included the recent use of xylazine in substances. Xylazine is a drug used for sedation, anesthesia, muscle relaxation, and analgesia in animals such as horses. The drug is not a form of an opiate so naloxone does not work to reverse its effects, making the deep sedation of a user hard to treat. The emergence of the drug in substances was declared as an emerging threat to the United States by the Biden-Harris administration last month.
The use of the xylazine also results in ulcers and infections when injected into the skin.
"Just keep it on your radar that this is something we want people to know about. I really don't want us to go that way that we sometimes tend to do to the hype and hysteria, hysteria and panic. It's about knowledge and informing people," Plumb said.
Despite ongoing concerns and roadblocks, Plumb maintains hope for the future.
"We've been able to hold back the increase," she said. "Utah had put a lot of safeguards in place. We had changed some of the cultural climate around this and I am really proud of this state."
Legislative successes
Liz Klc, director of the Utah Substance Use and Mental Health Advisory Council, presented a policy update to the task force on the successes of the recent legislative session.
Klc also outlined two bills that failed to pass while urging elected officials attending the meeting Tuesday to persuade their colleagues on their merit.
A drug-induced homicide is defined as "the practice of charging individuals who supply drugs that result in a fatal overdose with homicide, even in the absence of specific intent to cause death."
A drug toxicity death occurs nearly every 7 minutes in America. There were 106,699 drug-involved overdose deaths reported in the U.S. in 2021, according to the Centers for Disease Control and Prevention. Synthetic opioids other than methadone (primarily fentanyl) were the main driver of drug overdose deaths with a nearly 7.5-fold increase from 2015 to 2021.
"Most recent cases of fentanyl-related overdose are linked to illicitly manufactured fentanyl, which is distributed through illegal drug markets for its heroin-like effect. It is often added to other drugs because of its extreme potency, which makes drugs cheaper, more powerful, more addictive, and more dangerous," according to the CDC.
The lethal addition of fentanyl to drugs sold on the streets and rising overdoses are what prompted the creation of drug induced homicide charges. Currently, 24 states have laws on the books regarding drug induced homicide.
"That did not pass but it brought up an interesting conversation surrounding some responsibility and things that we could do to better strengthen the bill," said Klc. "A few concerns about affecting the populations the unintended populations, you're not going to be able to get to the individuals that were really the focus of and the intention of the bill. It's been an ongoing conversation."
Settlement updates
Efforts to manage the fallout of the crisis has been ongoing and nationwide. The Biden-Harris administration divvied up $1.5 billion to all states and territories to aid in the crisis last year. Additionally, Utah is anticipated to receive hundreds of millions of dollars in award money from a multistate settlement from drug companies.
The settlement payouts are estimated to begin at the end of June or early July and will be split between the state and counties. The money will be used to bolster services for treatment, recovery and harm reduction, as well as implement other programs to address the opioid epidemic.
"We're in the process of talking to stakeholders and various state agencies just to make sure that any claims that would be released by the settlement agreements are addressed. That process is ongoing, but hopefully we'll start to see some movement and work toward resolution," said assistant attorney general Kevin McLean.
The distribution of the settlement funds to the counties will be overseen by the Utah Department of Health and Human Services.
"Distributing these funds, there's a kind of a sensitive balance. The Legislature does not want to give up their appropriation authority," said Sen. Evan Vickers R-Cedar City. "That's kind of a fine line that we're going to continue to have to walk. I think that being diligent and monitoring how money is spent this year and how successful that money is is going to be critical."
