A pharmacist empties a prescription bottle of opioid painkillers that she filled for a patient at the pharmacy inside the facility in Boston.

John Tlumacki | Boston Globe | Getty Images

Drug overdose deaths are declining in the United States.

The finding is being greeted as a sign that we may have reached a turning point in the relentless epidemic of opioid death and addiction that’s ravaged the nation for three decades.

But the small decline masks a disturbing new trend that portends a lot of danger for the future.

While deaths are down substantially in East Coast states such as Ohio and Pennsylvania, states in the Western U.S. have witnessed a disturbing spike in overdose deaths.

The Centers for Disease Control and Prevention reported earlier this month preliminary numbers showing that U.S. overdose deaths last year fell for the first time in nearly three decades. Drug overdose deaths had been rising each year since 1990, reaching a total of 70,000 in 2017. Last year they fell to about 68,000. A drop in the number of deaths from heroin and prescription painkillers were at least partially responsible for the reduction. The CDC estimates that in 2019 overdose deaths nationally could decline by another 3.4% from last year.

But in the nation’s West, the growing popularity of cocaine cut with fentanyl — known on the street as speedballs — or combinations of methamphetamine and fentanyl — known as a goofballs — are driving a growing number of new overdose deaths.

The rising fashion of these dangerous opioid combinations is a harbinger of danger. There’s good reason to expect the popularity of these deadly arrangements to spread into communities and cities across the entire nation.

The biggest risk may be the resurgence of methamphetamine as a widespread drug of choice.

Nationwide, overdose deaths from methamphetamine and similar drugs rose by 7.5 times between 2007 and 2017. About 15% of all drug overdose deaths involved methamphetamine in 2017. Among those who died from this drug, 50% involved goofballs where the meth was mixed with an opioid.

Fentanyl and methamphetamine have each benefited from synthetic manufacturing processes that make these two drugs much cheaper and easier to create. The ubiquitous supply is contributing to sharply higher flows of these two illicit drugs into the United States. Meth is primarily coming from Mexico, while China is the biggest source of synthetic fentanyl.

The rising popularity of speedballs and goofballs could trigger a resurgence in overdose deaths just as the widespread abuse of prescription opioid pills was showing some signs of leveling off.

Fatal overdoses attributed to prescription painkillers alone have been relatively stable in recent years, though deaths related to illicit narcotics — primarily fentanyl — have steadily increased since 2014. By 2016, fentanyl and similar illicit narcotics such as carfentanil were involved in nearly 50% of opioid related deaths, overtaking prescription opioids as the biggest drug killer.

While the opioid epidemic began with prescription drugs such as OxyContin, in recent years it’s been evolving toward a crisis marked by wider use of street drugs.

The latest data may show that trend is accelerating.

At one time, most people who became addicted to opioids became medically addicted. Their first exposure was through a legal prescription. Now, more of the new addiction is being fueled by people whose first exposure to opioids will be through an illicit drug such as fentanyl.

An addiction crisis forged by prescription pills may give way to a new and perhaps wider disaster.

Dr. Scort Gottlieb is a CNBC Contributor and served as commissioner of the Food and Drug Administration from 2017 to 2019.



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