Wisconsin records significant drop in overdose deaths, although officials remain cautious

For the first time in six years, Milwaukee County is seeing a decline in overdose deaths.

It's modest compared to the statewide decline — the county saw a decline of nearly 4% versus the state's decline of 9.69% — but Ben Weston, chief health policy adviser for Milwaukee County, expressed cautionary optimism.

"I'm hopeful that it's the start of a trend, and when we see it nationally, when we see it across just about every state, I think it's hopeful that this is a true change in the trajectory of overdose deaths, specifically opioid overdose deaths," Weston said.

Many public health leaders and user advocates across the state who spoke with the Journal Sentinel shared Weston's sense of hope, even as they hedged. Fentanyl, the powerful synthetic opioid responsible for more overdose deaths than heroin since 2017, has "completely taken over the illicit drug supply" in Milwaukee County, and continues to make its way into other drugs, including stimulants like cocaine and methamphetamines, Weston said.

Michelle Haese, the director of substance use initiatives at the state Department of Health Services, said she's also painfully aware of the shift from the opioid epidemic to a polysubstance epidemic. It's a shift that many, including Weston, view as the fourth wave of the opioid crisis.

The U.S. Centers for Disease Control and Prevention defines the first three waves as:

• Beginning in the 1990s, a wave of deaths due to a rise in overdoses involving prescription opioids.
• From 2010 to 2013, a second wave driven by a spike in heroin-involved deaths.
• Beginning in 2013, a third wave marked by a rapid increase in deaths due to synthetic opioids.

Whether we're now still in the third wave or into a fourth, the national overdose death decline of 10%, reported in a provisional count by the CDC , is the first sign that harm reduction efforts and fentanyl awareness campaigns are, potentially, working.

"While we cannot definitively state why this trend is being seen in Wisconsin or across the nation, we do know the data is real," Haese said.

Many of those efforts were bolstered by the first batch of Wisconsin's opioid settlement funds, of which the state was awarded a total of more than $750 million to be received through 2038.

For the 2024 fiscal year, Wisconsin invested its $8 million into the following strategies:

• $5 million into Narcan and fentanyl test strips.
• $2.5 million into covering room and board costs for Medicaid members at residential substance use disorder treatment programs.
• $2 million into medication-assisted treatment, often referred to as MAT, for people with an opioid use disorder.
• $300,000 into a substance use disorder treatment directory called Atlas .
• $300,000 to train surgeons on best practices to prevent opioid misuse following surgery through a program operated by Surgical Collaborative of Wisconsin .

The state is expected to receive another $36 million in fiscal year 2025, which includes targeted funding aimed at Wisconsin's K-12 students and its 11 federally recognized tribal nations . Indigenous people across Wisconsin's tribal nations are dying from overdoses at nearly three times the state rate , according to recent data. Haese said the Department of Health Services is investing in the Tribal Nation Opioid Abatement Efforts to address conditions, doing so in a manner that builds the strengths of local tribal culture, tradition, and practices.

The opioid settlement fund was the result of a national litigation against the pharmaceutical industry, of which Wisconsin was a part. The fund was set up as part of a $26 billion deal between the plaintiffs and opioid manufacturer Johnson & Johnson and distributors AmerisourceBergen, Cardinal Health and McKesson.

The settlement was reached in 2021. Distributors have 18 years to pay up to $21 billion while Johnson & Johnson will pay up to $5 billion over no more than nine years.

Overdose breakdowns across Milwaukee, Dane and Brown counties

It wasn't until 2017 that the opioid epidemic reached a turning point. That's when fentanyl edged out heroin as the most deadly opioid in the illicit drug supply. Today, fentanyl is responsible for 96% of overdose deaths in Milwaukee County, Weston said.

In 2018, 305 people died from overdoses in Milwaukee County. That number continued to climb until it peaked in 2022, with 565 deaths — an 85% jump. In 2023, the latest comprehensive year of data, there were 21 fewer narcotic deaths, signaling what Weston hopes is the beginning of a downward trend.

The landscape in Dane County, meanwhile, looked a bit different. Overdose deaths peaked in 2021 at 166. The number declined 11% to 147 in 2022. And while Dane County's 2023 numbers are still being analyzed, Morgan Finke, the communications coordinator for Public Health Madison & Dane County, told the Journal Sentinel 142 deaths so far have been confirmed.

Wisconsin's largest northern county saw a dramatic decline, and more up-to-date data. Brown County reported a 73% decline in overdose deaths and a 77% drop in fentanyl-related deaths through mid-September this year, compared to 2023.

"There's always the next thing that could come down the road. Right now, it's fentanyl, and it could be something else tomorrow," said Anna Nick, the public health officer and administrator of Brown County Public Health. "But I'm holding on to hope. The efforts over the past few years are having an impact, and there's been considerable work in raising awareness in our community."

Drug users are integral to policy discussions

The caution that health officials express is not just because there's a long way to go. It's also because a decline in a geographic area may mask an uptick in a particular demographic group. For example, Weston is particularly concerned about Black adults aged 55 and older in Milwaukee County. From 2020 to 2021, narcotic deaths among older Black adults jumped more than 50%, he said. It went up another 13% in 2022. Weston said the department is putting together more comprehensive data for 2023 that it plans to release soon.

Anecdotally, Weston said, these specific deaths appear to be the result of drug users not being aware that the stimulants they're using are laced with fentanyl.

Going forward, Haese said, it's important to listen to those with "lived and living experiences with drugs."

Mat Hazelberg strongly agreed. He's co-founder of P.U.L.S.E. , an organization that tries to have drug users included in policy-making discussions.

"We need to engage people, give them education and materials to stay safe and alive, and have a better awareness about the substances they're ingesting," Hazelberg said.

He noted the Wisconsin Good Samaritan Law was amended in 2017 to protect from prosecution "aiders" who helped an overdosing person, but that provision sunset in 2020.

"People shouldn't be afraid to call, to ask for help, especially when they're in that critical moment and seconds matter," Hazelberg said.

That includes protecting people on probation or parole, Hazelberg said. He's talked to too many people who have been sent back to prison "merely for doing the right thing" — calling 911, doing rescue breathing and administering naloxone.

Hazelberg also wants to see the state improve how it distributes methadone, a medication-assisted treatment used to help people safely quit opioids by reversing withdrawal symptoms. As it stands, people attempting to quit sometimes have to drive multiple counties daily to receive medication.

Wisconsin is one of seven states and territories in the United States that don't have flexibility around take-home treatment, which would allow people to receive up to 28 days of take-home doses for medication-assisted treatment.

Weston, from Milwaukee County, said there need to be more opportunities for education on medication-assisted treatment like methadone and buprenorphine following an overdose. Often, after the paramedics arrive and lifesaving interventions are done, that's the end of it, he said. Not only may users feel shame and embarrassment, but they may not be able to afford going to a hospital for medication-assisted treatment.

Natalie Eilbert covers mental health issues for the Milwaukee Journal Sentinel. She welcomes story tips and feedback. You can reach her at neilbert@gannett.com or view her X (Twitter) profile at @natalie_eilbert .

This article originally appeared on Milwaukee Journal Sentinel: Wisconsin records significant drop in overdose deaths, although officials remain cautious