Highland County saw half the number of drug overdose deaths in 2023 that it did in 2022, according to Highland County Coroner Jeff Beery. There were 16 drug overdose deaths in Highland County in 2022 and eight in 2023.

The main drugs involved in the Highland County deaths during both years were fentanyl followed by methamphetamine. Xylazine, marijuana and other prescription drugs were also involved in some of the other 2023 Highland County deaths, Beery said.

The final autopsy results for one of the 2023 overdose deaths are not complete. Beery said there are no drug overdose deaths to report in Highland County so far for 2024.

“Fentanyl was number one,” said Beery. “I don’t think people manufacture fentanyl in a lab, and I don’t think people manufacture methamphetamine in a lab for the most part now, so I think it comes through the southern border — that’s what I’m hearing at my conferences and talking to other coroners, so yeah, I think the border is the conduit for that so those people walk into the country, and some of them are going to be drug dealers, and they bring the drugs that kill us.”

Although the Centers for Disease Control and Prevention (CDC) has not released national statistics for 2023, drug overdose deaths in the U.S. went up slightly in 2022 after two big leaps during the pandemic. Officials with the CDC said the numbers plateaued for most of 2021.

Experts aren’t sure whether that means the deadliest drug overdose epidemic in U.S. history is finally reaching a peak, or whether it’ll look like previous plateaus that were followed by new surges in deaths.

“The fact that it does seem to be flattening out, at least at a national level, is encouraging,” said Katherine Keyes, a Columbia University epidemiology professor whose research focuses on drug use. “But these numbers are still extraordinarily high. We shouldn’t suggest the crisis is in any way over.”

An estimated 109,680 overdose deaths occurred in 2022, according to numbers posted by the CDC. That’s about 2 percent more than the 107,622 U.S. overdose deaths in 2021 but nothing like the 30-percent increase seen in 2020 and 15-percent increase in 2021.

Highland County saw 16 overdose deaths in 2022 and 14 in 2021.

Beery said even marijuana without other substances can cause an overdose. “We don’t see it as often as we do those others, but we see it,” he said. “I think the most common way marijuana kills you is because the dealers put fentanyl on it to make it more addictive and the person overdoses on fentanyl.”

While the overall national number was relatively static between 2021 and 2022, there were dramatic changes in a number of states: 23 reported fewer overdose deaths, one (Iowa) saw no change, and the rest continued to increase.

Eight states — Florida, Indiana, Kentucky, Maryland, Michigan, Ohio, Pennsylvania and West Virginia — reported sizable overdose death decreases of about 100 or more compared with the previous calendar year.

Some of these states had some of the highest overdose death rates during the epidemic, which Keyes said might be a sign that years of concentrated work to address the problem is paying off. State officials cited various factors for the decline, like social media and health education campaigns to warn the public about the dangers of drug use; expanded addiction treatment, including telehealth, and wider distribution of the overdose-reversing medication naloxone.

Beginning in the mid-1990s, abuse of prescription opioid painkillers was to blame for deaths before a gradual turn to heroin, which in 2015 caused more deaths than prescription painkillers or other drugs. A year later, the more lethal fentanyl and its close cousins became the biggest drug killer.

In 2022, most overdose deaths continued to be linked to fentanyl and other synthetic opioids. There were about 75,000 overdose deaths, up 4 percent from the year before. There also was an 11-percent increase in deaths involving cocaine and a 3-percent increase in deaths involving meth and other stimulants.

Overdose deaths are often attributed to more than one drug. Some people take multiple drugs and officials say inexpensive fentanyl is increasingly cut into other drugs, often without the buyers’ knowledge.

Research from Dr. Daniel Ciccarone, a drug policy expert at the University of California, San Francisco, suggests “there appears to be some substitution going on,” with a number of people who use illicit drugs turning to methamphetamines or other options to try to stay away from fentanyl and fentanyl-tainted drugs.

Ciccarone said he believes overdose deaths finally will trend down. He cited improvements in innovations in counseling and addiction treatment, better availability of naloxone and legal actions that led to more than $50 billion in proposed and finalized settlements — money that should be available to bolster overdose prevention.

“We’ve thrown a lot at this 20-year opioid overdose problem,” he said. “We should be bending the curve downward.” But he also voiced caution, saying “we have been here before.”

Reach John Hackley at 937-402-2571.