MONTPELIER — Vermont saw a spike last year in deaths involving the powerful painkiller fentanyl, emphasizing the danger of a synthetic drug that is at least 50 times more potent than heroin.
There were 68 fatal overdoses attributable at least in part to fentanyl in 2017, an increase of 33 percent from the year prior. The number of deaths involving a combination of fentanyl and heroin also rose.
Those statistics are featured in a recent state report that otherwise contained evidence that the state might be making some headway in combating opioid-related deaths. Fentanyl, however, is bucking that trend.
"We're very concerned about the fentanyl situation," Deputy Health Commissioner Tracy Dolan said. "We are seeing it more and more in the fatalities that are coming in, and we're seeing it in combination with other drugs."
The state Health Department's annual report to the Vermont Legislature tracks overdose deaths due to Schedule II, III and IV drugs under the federal classification system. That covers a wide variety of drugs but does not include substances with "no currently accepted medical use."
There were 104 such deaths in 2017, matching the state's total for 2016. Overdoses involving a prescription opioid accounted for the majority of those deaths: There were 93, up from 83 the year before.
Those statistics involve only accidental overdoses or those that have been labeled "undetermined." They do not include suicides.
Noting that heroin- and fentanyl-related deaths have "increased dramatically" since 2012, the department's report also includes new information about overdoses specifically attributed to those drugs.
The number of deaths involving heroin declined, from 51 in 2016 to 41 in 2017. But fatal overdoses involving fentanyl increased from 51 to 68.
Fentanyl has been around since the late 1950s. The U.S. Drug Enforcement Administration says illicit uses of the drug initially appeared in the 1970s, but the painkiller's widespread abuse — and its rising death toll — have only recently been generating headlines.
Last year, a Washington Post analysis of two dozen densely populated areas found that fatal fentanyl-related overdoses had jumped nearly 600 percent from 2014 to 2016. A federal agent in charge of New England told the newspaper that fentanyl is "a weapon of mass destruction" and labeled it "manufactured death."
In Vermont, officials have been sounding similar warnings about fentanyl. And the new Health Department report shows that the drug isn't going away.
The document says fentanyl, while still used as a prescription painkiller, "is often manufactured illicitly and not prescribed." Dolan said Vermont officials believe most of the state's overdoses are attributable to illegally manufactured fentanyl.
That makes the issue a law enforcement problem, at least in part. State officials have taken some steps to address that, as Gov. Phil Scott last year signed Act 62, which created penalties of three to 30 years in prison for "knowingly and unlawfully" dispensing, selling or trafficking fentanyl.
Dolan also believes it's a public-awareness problem. She said fentanyl often is mixed with other drugs, increasing the potential for accidental overdose.
"I think there are people using who don't know that fentanyl is in their drugs," she said. "I think there are dealers who don't know."
Even among those who are struggling with opioid addiction, public education "may help," Dolan said. "People who are in the throes of this disease can still make some good choices, and do."
She also emphasized the importance of talking to young people. The department has an educational website, [http://parentupvt.org/], designed to help parents talk to teens about substance abuse.
"That communication channel is really important," Dolan said.
The state has been deploying a number of tools in a years-long effort to deal with the opioid epidemic. They include the "hub and spoke" system of medication-assisted treatment, which has been credited with decreasing drug use and overdose.
Vermont also distributes free doses of the overdose-reversal drug naloxone statewide. Officials say there were 6,123 such kits distributed in 2016, which was more than twice as many as were handed out the year before.
The drug doesn't always rescue an overdose victim, especially when a powerful drug like fentanyl is involved. But overall, state officials say the naloxone-distribution program "has led to a large amount of overdose reversals and saved hundreds of lives."
In the Health Department's recent report, there are signs that the state's work is making a difference. In addition to the decline in heroin overdose deaths last year, Dolan also noted that prescription opioid-related overdose fatalities increased at a slower rate from 2016 to 2017 than they had from 2015 to 2016.
She said the state's recently imposed restrictions on opioid painkiller prescriptions may be playing a role, along with public education. Patients are "more aware and asking more questions and being open to alternatives" to opioids, Dolan said.
Scott also has continued the opioid-related work of his predecessor by creating an Opioid Coordination Council that issued its first report earlier this year.
"Overall, we're really increasing our overall comprehensive approach," Dolan said. "We think we're bending the curve in some areas."
However, the department's recent statistics show that, overall, the state's opioid problem remains far worse than it was in the not-so-distant past.
There were just 37 overdose deaths related to prescription opioids in 2014, in contrast to 93 last year. And there were only 18 fentanyl-related deaths in 2014.
Asked whether she gets discouraged by the state's overdose numbers, Dolan replied that "preventable death is always discouraging. Every single one of these numbers is a person."
"Despite that, I think it really helps us to hang onto some hope," Dolan said. "I believe that the power of community is stronger than this epidemic."