Three in five overdose deaths had a moment where someone could have intervened

16,236 drug overdose deaths, 24 states and DC, January–June 2019:

About 80% involved at least one opioid, and **illicitly manufactured
fentanyls were in three of every four opioid-involved deaths.** **Fentanyl,
heroin, cocaine or methamphetamine — alone or combined — were in 83.8% of all
of them.**

The number this report exists for

**More than three in five (62.7%) overdose deaths had documentation of at
least one potential opportunity for overdose prevention intervention.**

Not a theoretical opportunity — one documented in the record of the death.
A prior non-fatal overdose, a release from incarceration, a missed treatment
appointment, a bystander present. Each is a moment when something known to work
could have been offered, and was not.

That reframes the statistic. **Overdose deaths are not, mostly, events with no
warning.** They are events with a warning nobody acted on.

Why the stimulant column matters so much

A third of deaths involved opioids and stimulants together, and that
combination changes two things at once:

• Prevention: advice built around opioids alone — treatment regimens,
  naloxone access, not using alone — is aimed at one half of what the person
  is taking
• Response: **stimulant use can affect the response to administered
  naloxone.** Naloxone reverses an opioid overdose. It does nothing about a
  stimulant, so a reversal may not produce the recovery a bystander expects,
  and they may conclude it did not work

**Illicitly manufactured fentanyl adds a third problem: rapid overdose
progression.** Advice designed around the timescale of a heroin overdose — get
help, someone will arrive — assumes minutes that fentanyl does not give.

What follows

**Identifying opportunities to intervene before an overdose death and
implementing evidence-based prevention policies, programs, and practices
could save lives.**

With two additions the data forces: strategies should **address the
characteristics of fentanyl overdoses, including how fast they progress**, and
the co-involvement of opioids and stimulants — and all of it should be
**complemented by preventing people starting prescription misuse and illicit
drug use** in the first place.

Source: Centers for Disease Control and Prevention, MMWR Vital Signs.