Fentanyl-related deaths in Montana doubled from 2019 to 2020 and this year's deaths have already outpaced the tally from two years ago.
There were 41 fentanyl-related deaths last year, a dramatic jump from 19 in 2019. This year there have been 22 fentanyl-related fatalities confirmed by the state crime lab, according to a press release Monday.
Eleven of those deaths were in April, the release from the state health department and Department of Justice said.
Fentanyl is a synthetic opioid. It's unclear what is behind the increase in deaths, but the press release pointed to possible counterfeit pills being sold as a substitute for heroin, according to the release.
“This is an ongoing investigation, but we know that counterfeit pills laced with fentanyl are manufactured overseas and smuggled across the border before coming to Montana," Attorney General Austin Knudsen said in the release.
Bryan Lockerby, who heads the Division of Criminal Investigation in the Department of Justice, said agencies reported seeing unusual increases in fentanyl both on the post-mortem autopsy side as well as test results from DUIs and just hearing from law enforcement earlier this year.
Lockerby said toxicology work is not instantaneous and half the time turnaround can take a month. So his division contacted the state health department, which has access to more real-time data from places like hospital emergency departments.
“Collectively we were able to discover we had a very significant increase in fentanyl issues around the state,” Lockerby said.
During DCI’s investigation, Lockerby said the state was able to determine the latest wave came in part in the form of a batch of fake pills stamped with an M on one side and a 30 on the other, meant to look like prescription medication.
The pills most likely came out of Washington and passed through Idaho, which has also seen an uptick in fentanyl overdoses, and ended up in Montana. Idaho authorities have one suspect in custody, Lockerby said.
Fentanyl is usually sourced in China and then is smuggled into either Canada or Mexico, Lockerby said. It can then either be mixed into other drugs or pressed in a pill press into something that looks like an oxycodone pill.
When awareness about limiting the prescription of oxycodone made it harder for people to get and abuse, Lockerby said some turned to heroin as a substitute. Fentanyl, which is 100 times more potent than heroin, produces the same effect of euphoria and became the path of least resistance, he added.
Department of Public Health and Human Services Director Adam Meier said in the release that people should not take pills that are not prescribed to them and obtained from a pharmacy.
"Remember that street drugs may look like prescription pills, but may be counterfeit. Do not rely on markings, size or lettering,” Meier said in the release.
Lockerby said pills that have been tampered with can have "highly potent fentanyl" that make them more dangerous. The U.S. Drug Enforcement Administration, DCI and local law enforcement have been investigating the deaths, Lockerby said in the release.
The April deaths happened in Missoula, Gallatin, Cascade, Yellowstone, Butte-Silver Bow and Flathead counties.
The press release also said data from statewide emergency medical services calls shows an increase in opioid overdose calls across Montana.
Last year the state averaged 45 opioid overdose calls each month. This year the monthly average is 54, including a spike of 68 calls in March. That's the highest monthly tally in the last three years. The monthly average was 19 in 2018 and 24 in 2019.
The press release cited overdose cases, including in Missoula County, requiring naloxone to reverse opioid overdoses.
"We are seeing a tremendous increase in the application of naloxone and in some instances the use of higher doses used by law enforcement prior to EMS arriving to the scene is occurring,” Don Whalen, of Missoula Emergency Services, said in a release.
In 2017 the Legislature passed a bill that made naloxone available to first responders, public health professionals and others.
Alyssa Johnson, the trauma system manager for the state health department and an emergency room nurse for more than 21 years, said that when used for approved uses, like in the hospital for pain management, fentanyl is beneficial to patients. But when it’s used by people it hasn’t been prescribed to and in higher doses, it causes major problems.
Over 2020, emergency medical service providers gave, on average, 1.26 doses of naloxone per EMS activation, an indicator that people are taking higher doses of fentanyl.
DPHHS has a grant to provide naloxone to a variety of emergency medical services providers and first responders, and also to individuals who are at high risk of overdose.
While there’s not good data, Johnson said anecdotally most of the time when someone comes in from an emergency medical services provider the naloxone has been administered before arrival.
In 2020 there were 548 overdose-related calls and naloxone was administered in 320 of those cases.
“If we didn’t have that naloxone available to provide lifesaving care, I think that’s an additional 320 potential injuries or deaths that were prevented,” Johnson said.