Reducing drug-, alcohol- and suicide-related deaths is a pressing need in the US, and there has been positive change in some areas, experts note – but there is still a long way to go. Expert panelists discussed policy and program ideas to spur further progress in a recent Trust for America’s Health webinar. Regina Labelle of the Georgetown University Law Center, Christina Mullins of the West Virginia Department of Health and Human Services and Sharon Gilmartin of the Safe States Alliance delved into the details.
The fentanyl impact
Labelle pointed out that in 2010, before the rise of fentanyl, the US had approximately 20,000 overdose deaths a year. Now, that figure is about 82,000, with some groups such as American Indians and Alaska Natives disproportionately affected.
“At that point [2010], it was mostly driven by prescription opioids, and we knew it was a nationally urgent issue,” Labelle said. “It’s taken us a long time to get to the problem we are in now, and it’s going to take us a while to get out of it,”
Labelle also noted that overdose and death rates have declined west of the Mississippi River, compared with other areas, and she cited concerns about federal government agency reorganizations affecting data availability on the subject.
Mullins explained that West Virginia has the highest rate of overdose deaths in the nation at nearly 91 per 100,000 residents, but the state is also taking a number of proactive steps to do something about it.
“In response to rising numbers, we laid out a plan to invest our federal dollars, our state dollars and our [opioid] settlement dollars toward evidence-based practices, and some of those efforts included establishing a cross-agency data system to evaluate emerging trends,” Mullins said. The state also increased access to opioid use disorder medications and expanded residential treatment services, growing from fewer than 200 beds to more than 1,800.
Mullins said West Virginia also worked to integrate treatment in community mental health centers, free clinics and federally qualified health centers, and it increased its naloxone distribution.
West Virginia has created recovery housing, expanded transitional support, established informational programs for the media and clinicians, and boosted its investment in community-based prevention. And state government put together a foundation to manage opioid settlement funds in the future.
Encouraging signs
There continues to be reason for hope, Mullins noted. “We’re seeing now that overdose deaths have fallen back below pre-pandemic levels,” she said. The number of children removed from families due to an adult’s substance use fell by 38.7% from 2017 to 2024, EMS responses to suspected overdoses declined by 39.7% from 2021 to 2024, and the number of infants with neonatal abstinence syndrome dropped 44.2% from 2022 to 2023.
“We can’t afford a victory lap, though,” Mullins said, adding that West Virginia is continuing its partnerships with government leaders to build on current successes. Next steps involve maximizing available funding and continuing to invest wisely in effective programs.
“It’s not just the state government that is [working on the issue],” Mullins said. “It’s been universities and colleges, community members, boots on the ground, first responders – so many different sectors that have helped address this. Families have been deeply impacted by the epidemic. They are the reason we do this.”
Gilmartin agreed that progress in the area of reducing substance use deaths is measurable and encouraging, but it’s also fragile, as the “systems that support this progress are under threat.”
“We have saved an estimated 81 lives a day from overdoses, and that is truly extraordinary, but the fact remains that more than 80,000 people still died from overdoses last year, suicide claimed nearly 50,000 more lives and alcohol-related deaths are climbing. So, we’re facing a moment of both hope and concern,” Gilmartin said. “We need to focus on protecting the systems that are making progress possible.”
Funding concerns
Gilmartin raised the topic of widespread budget cuts and stressed the importance of reaching out to legislators and local governments to press for the release of full funding. She expressed particular concern about cuts to funding and agencies that have been instrumental in reducing deaths.
“That would be shortsighted, dangerous and demoralizing to the public health workforce,” Gilmartin noted. “We know what works, we know what communities need, and we know that sustained and coordinated investments [are] the only path forward.”
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