HELENA — State officials said the alarming increase of fentanyl-related fatalities in Montana that occurred in 2020 does not appear to be slowing down thus far into 2021.
The Montana Department of Justice’s State Crime Lab reported 41 fentanyl-related deaths in 2020, up from 19 in 2019. Through May 2021, there have already been 22 total confirmed fentanyl-related fatalities, including 11 statewide in April alone.
“This latest trend is extremely concerning and adds to the already existing deadly and costly impact illegal drugs have in Montana communities,” said Gov. Greg Gianforte.
According to the Department of Public Health and Human Services (DPPHS), fentanyl is a synthetic and short-acting opioid analgesic. It was developed for pain management treatment of cancer patients and is 50-100 times more potent than morphine. Due to its powerful opioid properties, fentanyl is abused and illegally manufactured.
Montana Attorney General Austin Knudsen said the Department of Justice (DOJ) continues to work with local law enforcement and other states to investigate the situation. DOJ officials believe that fentanyl is being sold as a substitute for heroin meant for injection drug use, or in the form of counterfeit pills.
DOJ reports counterfeit pills, disguised to look like a legitimately prescribed opioid, but containing fentanyl have been found in the state.
“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 Knudsen said. “Even a small amount of fentanyl is enough to be fatal. No one should take pills that were not prescribed to them and parents need to talk to their kids about the dangers of ingesting unknown substances.”
DPHHS Director Adam Meier expanded on this message, "do not take pills that you can’t prove came from a pharmacy and only take pills prescribed to you."
"Remember that street drugs may look like prescription pills but may be counterfeit," Meier continued. "Do not rely on markings, size, or lettering.”
Bryan Lockerby of the DOJ Division of Criminal Investigation said it’s important people understand the dangers of ingesting any unknown substance.
“This is critically important,” Lockerby said. “It’s crucial that Montanans – especially youth - understand how dangerous these pills can be, especially when you take into account the pills have likely been tampered with and can contain highly potent fentanyl.”
A DPHHS Health Alert Network message to medical providers was recently issued through a cross-agency information-sharing effort involving DOJ and DPHHS. Lockerby said the U.S. Drug Enforcement Administration, the DOJ-Division of Criminal Investigation, and local law enforcement have all been working together on the criminal investigation as well.
It's an issue impacting multiple counties as the 11 deaths in April occurred in Missoula, Gallatin, Cascade, Yellowstone, Butte-Silver Bow and Flathead counties.
Overall opioid calls on the rise
Not only has there been a sharp rise in fentanyl-related deaths, but DPHHS data also indicates that simultaneously there’s been an uptick in overall opioid overdose calls to Emergency Medical Services (EMS) statewide.
Meier said the health department collects and analyzes EMS data which provides information to identify potential drug overdose trends because EMS are often the first on the scene. When a sharp rise in drug overdose-related calls is detected, DPHHS shares this information with medical providers and other partners.
“Clearly, overall opioid-related calls to EMS statewide are trending upward, and this continues in 2021,” Meier said. “To have 68 opioid overdose calls one month this year is significant.”
Montana averaged 45 opioid overdose calls per month in 2020. Thus far in 2021, the state has averaged 54 opioid overdose calls per month, including a sharp increase that began in March with 68 calls – the highest number of calls in one month over the last three years. In 2018, the state averaged 18 calls a month, and in 2019 it was 24 monthly calls.
Some cases also required high doses of naloxone to reverse the overdose.
“In Missoula County, 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 at the scene is occurring,” said Don Whalen of Missoula Emergency Services.
DPHHS says naloxone is a safe medication and should be administered any time there is a suspected overdose and the individual is exhibiting symptoms such as loss of consciousness, extreme drowsiness (nodding out), irregular or absent breathing, vomiting, snoring or gurgling noises, has pale/cold or clammy skin and slow or no heartbeat.
Counterfeit pills laced with fentanyl may require additional naloxone.
The 2017 Legislature passed HB 333 that made it possible for the State of Montana to issue a standing order to prescribe naloxone on a statewide basis. The standing order allows Montanans to get naloxone from select community organizations and pharmacies at no cost.
First responders, public health professionals, and others can also access naloxone for free by participating in a DPHHS-sponsored Master Trainer course and can then train others to administer naloxone. Multiple state agencies, including DPHHS, DOJ, Montana Medical Association, Board of Pharmacy, Board of Medical Examiners were involved in the statewide rollout in 2017 of naloxone through the standing order issued by DPHHS.
Giving naloxone to a person who has not taken an opioid will not hurt them.
“If someone is experiencing the signs of an overdose but you are unsure if it is due to an opioid, it is recommended to administer naloxone,” Meier said.
“By saving lives, we are providing individuals with the opportunity to get the treatment they need," Meier concluded.