Drug deaths are down in one Ohio county and much of the U.S. Why is complex.

CINCINNATI — One of Evelyn Tharp's sons died of a drug overdose. So did her brother. And two nephews and a niece. Her surviving son and daughter wrestle with severe mental illness and drug use. Her family life is chaotic except for the presence of a Hamilton County outreach worker named Sarah Coyne. Each week, Coyne drops by the family's home in the hardscrabble Price Hill neighborhood. She ferries Tharp's 44-year-old daughter to receive medication that treats opioid addiction. Coyne has arranged many stays at hospitals and treatment centers for Tharp's 39-year-old son — and revived him multiple times after finding him unconscious from overdoses."He'd be dead if not for Sarah," Tharp, 67, said. The story of Hamilton County, which includes Cincinnati, is the story of much of America at the start of 2025. Deaths from drug overdoses have fallen sharply, offering hope the crisis will further ease. Here, as in many communities ravaged by the opioid crisis, users are adapting to an evolving illicit drug supply dominated by potent fentanyl and often mixed with other synthetic drugs. At the same time, lifesaving antidotes flood the streets, and teams swoop in to offer services to people who have overdosed. For Coyne, a member of the Hamilton County Quick Response Team, the trends are gratifying but bittersweet. She focuses on users deemed high priority because they have overdosed repeatedly. Coyne, a 35-year-old mother of two who struggled with addiction more than a decade ago, has spent years building trust with wary users. Many at first cursed her or slammed doors in her face. She spends hours on the phone or in person with people manacled to addiction or with worried family members such as Tharp. Sometimes, she is the only one to visit clients in the hospital — or go to funerals when they fatally overdose. Coyne estimates she has attended two dozen in the past year and a half."This job weighs heavy," she said. "But I will always be empathetic, even if I don't want to be." Across the nation, drug deaths fueled primarily by illicit fentanyl reached staggering heights by 2023, topping 100,000 for the third straight year. But in the 12-month period ending in August, deaths had decreased by more than 20 percent from the same period the previous year, according to provisional state data published by the Centers for Disease Control and Prevention. Although the CDC won't publish 2024 estimates for several months, experts say there could be more than 20,000 fewer deaths than the year before. Government officials, researchers and public health organizations have puzzled over the reasons but speculate a decline in deaths represents a confluence of factors that vary regionally.The Biden administration made Narcan, a nasal spray version of the overdose-reversal medication naloxone, available without a prescription and broadened access to medications to treat opioid addiction. Officials touted crackdowns on Mexican criminal groups that manufacture fentanyl and Chinese companies that supply them with chemicals needed to make the opioid. President Donald Trump has emphasized a tough-on-crime approach to the illicit fentanyl trade — and on Saturday imposed steep tariffs on Canada and Mexico, claiming they are not doing enough to stop the flow of drugs into the United States. A White House official told reporters that tariffs might be lifted when Americans "stop dying" from fentanyl. Health departments and community groups that focus on reducing the harms of drugs worry they might face slashed federal funding as part of the administration's quest to overhaul spending.Communities such as Hamilton County — flush with state and federal grants — saturated the streets with naloxone, while performing tests on street drugs and beefing up programs to get users into treatment. Lance Weldishofer, 43, always kept Narcan on him. It saved his life when he overdosed last year in Cincinnati. A dealer used three sprays to revive Weldishofer, who wrestled with addiction for decades following family deaths. He had never tried rehab but credits a court-ordered stint with helping him stay clean since May. Today, he works as a roofer and lives at a Lower Price Hill recovery home run by the LIT Movement ministry. "Smoke cigarettes and drink coffee — that's all I want to do," Weldishofer said. 'The house has burnt down' It remains unclear how much public health policies have contributed to fewer deaths nationally. Some researchers say the answer is more grim. The lethal force of fentanyl has so diminished the population of users that there simply aren't as many people left to succumb to drugs, some experts say. That is happening at the same time that the number of new opioid users is plummeting, said Tse Yang Lim, an epidemiologist at the Harvard T.H. Chan School of Public Health, who led a team that predicted the decline in overdose deaths. According to the estimate, by 2030, the nation could still record more than 50,000 opioid deaths each year, roughly the number of Americans killed during the Vietnam War."Just because overdose deaths are declining, it isn't necessarily a sign of success," Lim said. "We can't take credit for the fire going out if it goes out because the house has burnt down." The reduction in deaths is not distributed evenly. A national decline probably reflects sharp decreases in more populous states that began in mid-2023, said Nabarun Dasgupta, an epidemiologist at the University of North Carolina at Chapel Hill. In many states, declines in deaths started even earlier, he said. "The Trump administration is inheriting an encouraging landscape of declining overdoses," Dasgupta said. In states where illegal fentanyl may have permeated more recently — such as Alaska and Nevada — officials note increases in fatal overdoses.Changes in the ingredients of illegal drugs may also play a significant role in reducing deaths. In Ohio as in many states, fentanyl dealers add drugs such as the animal tranquilizer xylazine, which prolongs the sedating effect but also causes nasty flesh wounds. Paradoxically, the mix may save lives, staving off opioid withdrawal so that users may consume less fentanyl each day, Dasgupta said. "Fewer rolls of the dice," he said.The Drug Enforcement Administration has suggested that counterfeit pills trafficked by criminal groups contain less fentanyl. Thomas W. Synan Jr., chief of the Newtown, Ohio, police and co-founder of the Hamilton County Addiction Response Coalition, believes that many users have built up a tolerance to fentanyl while using drugs more cautiously, making sure they never use alone. Some call hotlines that summon help amid an overdose. In some regions, more users smoke fentanyl, which may be less potent than injecting and allows them to increase their doses a little at a time. "We've gotten better at saving lives, but that does not mean we're ending addiction," Synan cautioned. A tragic arc The experience of Hamilton County reflects a tragically familiar arc of the nation's drug crisis. By the early 2010s, Hamilton and surrounding counties in Ohio and northern Kentucky were flooded with prescription pain pills that wound up on the illicit market. When law enforcement and state officials cracked down on unscrupulous doctors and the legal opioid industry, pills became scarce. Users switched to heroin, which gave way to cheap synthetic fentanyl. Overdose deaths skyrocketed with an influx of carfentanil, a variant that can be up to 100 times more potent than fentanyl and is normally used to tranquilize elephants. In 2017, a staggering 570 people died of drug overdoses in Hamilton County — more than five times the number of homicides. Then, deaths began ebbing. Along came the pandemic. Fear and stress spurred relapses. Social isolation meant people used drugs alone. Overdose deaths in Hamilton County again surpassed 500 in 2021. "A lot of us kind of felt like, 'How can this be happening?' We're pumping more naloxone into the community than we ever have been, and we're still seeing this huge spike," said Tasha Turner-Bicknell, interim executive director of Harm Reduction Ohio and an associate professor of nursing at the University of Cincinnati. Then deaths started dropping again in Hamilton as they did across Ohio and other states. Some researchers attribute the decline, in part, to the pandemic easing and the end of isolation and pandemic-induced stress. They caution that fatalities could rise again. In Hamilton County, officials estimate that drug deaths declined to roughly 270 in 2024, although the tally won't be finalized for months, after toxicology tests are completed. County health officials and grassroots community groups stress that no one reason explains why deaths have declined but credit efforts big and small. Harm Reduction Ohio supplies free naloxone to a network of distributors on the streets. Outside the HIV-prevention nonprofit Caracole in northern Cincinnati, users enter a code at a vending machine to get free supplies that include wound-care kits, fentanyl test strips and Narcan. In telephone surveys, users reported those sprays helped reverse at least 3,500 overdoses since the machine debuted three years ago. Those who use test strips — many are primarily methamphetamine users — often moderate doses, use with a friend or throw away their drugs, said Suzanne Bachmeyer, Caracole's director of prevention. "They are changing behaviors based on what that test strip tells them," she said. Hamilton County also created the Office of Addiction Response, which coordinates with police agencies, the health department, community groups and treatment providers. One signature program is the Quick Response Team, which pairs civilian "navigators" with police officers who do not wear their normal uniforms. They knock on doors of people reported as having overdosed and offer services and education — instead of arrests. For the teams, a typical day reflects the complexities of addiction and overdoses in Hamilton County, home to more than 800,000 residents. One team is devoted to outreach to African Americans — overdose deaths in the Black community surged by 119 percent between 2015 and 2022. On a recent morning, navigator Sophie Melaku and Ohio State Highway Patrol trooper Sharese Williams visited a 43-year-old former truck driver who had recently overdosed in a nursing home. The man said he thought he'd taken cocaine, underscoring how increasing use of stimulants has complicated the latest wave of drug use. "A lot of cocaine is being mixed with fentanyl," Melaku told him, leaving her card and promising to check on him after he moves to a new facility. Across town, Coyne and Hamilton County sheriff's deputy Rod Housley eased into a low-income housing complex in Price Hill. They picked up 21-year-old Alivia Williamson to take her shopping for groceries at a food bank. Williamson's cheerful demeanor belies deep anger she has harbored since her teen years. Her mother died of a heroin overdose. Williamson began using meth at age 12 while in foster care. In her teenage years, her boyfriend was one of three brothers, all of whom abused drugs and had come to Coyne's attention. Williamson, who is diagnosed with bipolar disorder, gave up drugs when she found out she was pregnant. During the past year, Coyne has helped get her into rehab, secure housing and navigate the child dependency system — transporting her to parenting classes, court hearings and doctor visits. "I'm going to break the cycle," Williamson vowed. She hopes to soon regain custody of her 10-month-old daughter, return to school and resume work at an after-school program for at-risk children. But in a stark reminder that the opioid crisis is far from over, her boyfriend — her daughter's father — will not be there to see her achieve those milestones. He died of an overdose at age 20.