Opioid deaths decreased in 2024, but other drugs heighten concerns
ADMH state opioid coordinator Debbi Metzger spoke at the 23rd Annual Alabama Child Safety Conference at Decatur Baptist this week and discussed the trend of opioid and other narcotic addictions over the years.
Metzger said in 2024, the state Department of Mental Health distributed about 40,000 naloxone kits, used to reverse opioid overdoses, to agencies across the state.
"Our reported (fatal) overdoses (in 2024) were around 1,265, the predicted overdoses were under 1,290 and we like seeing that," Metzger said. "Our overprescribing dropped 50%. We went from 143.8 scripts for 100 people (in 2012) to 71.4 for 100 people in 2023."
In Morgan County, there were 59.7 opioid prescriptions per 100 people in 2022, compared to 161.6 prescriptions per 100 people in 2012, according to the state's Central Data Repository.
Morgan County Coroner Jeff Chunn said he has seen a decrease in opioid overdose deaths in the last eight months, but said it is still an "epidemic."
"I don't know whether it's supply or what, I really don't know why," Chunn said of the decrease. "I know law enforcement is getting a lot off the streets right now."
In 2024, Chunn said Morgan County had 66 overdose deaths.
"We've even seen fentanyl in vapes," Chunn said.
Chunn said fentanyl remains the top opioid choice for individuals, and over the last year, he has heard of users mixing it with other narcotics, such as cocaine or methamphetamine, to intensify the effects. He said a majority of overdose deaths he encounters are from these drug combinations.
"Very seldom do we find just pure fentanyl," Chunn said.
Metzger said over the last few years, synthetic opioids like nitazenes have become more prevalent.
"It does respond to naloxone, you just have to take a lot more," Metzger said. "(Nitazenes) are often mixed with other substances, which makes it difficult to detect."
Metzger said synthetic cathinones, known on the street as bath salts, are beginning to become popular among youths, mainly because most drug tests fail to detect it.
"It's still very dangerous for our youth," Metzger said of bath salts. "It creates neurological and psychiatric issues such as paranoia and self-destructive behaviors. We are seeing an increase in this."
Chunn said he occasionally hears of individuals overdosing on bath salts and said as far as their prevalence that "they come and go."
"I haven't seen a lot just here recently," Chunn said. "Every time something gets outlawed, they find a way to mix something different."
Metzger said marijuana and alcohol remain the top recreational substances among juveniles and young adults, just as they were 30 years ago. However, she said while opioid use among ages 12 to 25 is relatively low, it presents a new concern that did not exist before.
"We've seen dramatic increases in the last five to 10 years, largely with our college-age (individuals)," Metzger said.
Metzger said another drug that is becoming popular is xylazine, or tranq. According to the National Institute on Drug Abuse, xylazine is a non-opioid veterinary tranquilizer that has been found mixed with opioids such as fentanyl.
Metzger said because it is not an opioid, naloxone will have no effect on an individual who overdoses on xylazine.
"We don't see as much of it in the South as there is in the Northeast, however, it has very damaging consequences for the user," Metzger said. "Typically, it's people who are injecting it in sites on their legs and arms and bodies and we typically see individuals who are homeless or without shelter who are using this, and they usually have compromised immune systems anyway."
Chunn said one of the earliest instances of a xylazine overdose death in Alabama happened in Decatur.
"There for a while, I hadn't had any in quite a few months, but at the beginning of the year last year, we had several overdoses on xylazine," Chunn said.
Metzger said Jefferson County had the highest fatal overdose percentage and Morgan County was in the top 10 counties of the state in fatal overdoses per capita in 2024.
"What does that tell you?" Metzger said. "It tells you we need more services."
In 2015, the Alabama Legislature passed the Good Samaritan Law, which provides immunity to anyone prescribing or administering naloxone.
The following year, the Legislature passed a law authorizing the state health officer or a county health officer to write a standing order for dispensing naloxone. Like a prescription, the standing order can be provided to a person who is at risk of an overdose or someone who is in a position to assist an at-risk person.
Metzger said individuals and agencies can now receive free naloxone kits from the state Department of Mental Health.
Michele Moore, of Quest Prevention Services in Morgan County, said she believes the availability of naloxone to be a lifesaver for individuals of all ages.
"I think the decrease in overdoses (in 2024) would probably be from the (naloxone)," Moore said. "There are still people who need to stop using but that's available to them where there's not deaths for sure."
— wesley.tomlinson@decaturdaily.com or 256-340-2442.
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