One hundred people died in Alaska from opioid overdoses in 2017, according to new preliminary data from state public health officials.
The total number of overdose deaths is about the same as the year before, when the state recorded 96 opioid-related deaths.
But the numbers show a dramatic shift in Alaska's opioid epidemic: Fatal overdoses from fentanyl or other synthetic opioids more than quadrupled in a year, from eight cases recorded in 2016 to 37 last year, according to the Alaska Division of Public Health.
"We saw some declines in deaths related to prescription opioids. Some declines in heroin," said Jay Butler, a doctor who is Alaska's top public health official. "But these gains are pretty wiped out by fentanyl."
Thirty six of the 100 overdose deaths involved heroin. Fifty were linked to prescription opioid painkillers.
The subcategories add up to more than 100 because of concurrent use of more than one type of opioid, officials said. The data represents a preliminary count and the numbers could change slightly over time, Butler said.
The rise of fentanyl is a disturbing front in the unfolding opioid epidemic, Butler said.
"In terms of how we think of approaching epidemics from a public health perspective, it's fairly unique. The influx of fentanyl is as if a flu virus has completely changed and the vaccine will not work and it's also drug resistant."
Heroin is increasingly cut with cheaper, highly potent fentanyl, which is 50 to 100 times stronger than morphine. Even a small amount can cause an overdose.
The dangers of fentanyl have been on the radar of public health authorities for some time: The drug was blamed for a rash of overdoses in Anchorage last May. Four people overdosed — one fatally — on heroin mixed with fentanyl in a Western Alaska village last August.
Alaska's increase in fentanyl deaths tracks with what's happening nationally, he said. Deaths due to fentanyl are up around the country as the potent synthetic painkiller is more often mixed with heroin available on the street — sometimes without users knowing about it.
Meanwhile, there are signs that a statewide project to distribute Narcan, a medication that counteracts opioid overdoses, is saving lives.
The kits are distributed for free with no requirement to report if they are used or not, so data collection is difficult. But people who voluntarily fill out a report form have relayed more than 120 instances where Narcan was used to reverse an overdose last year, said Andy Jones, the head of Rural and Community Health Systems for the Department of Health and Social Services.
"That's what I can tally and tell you," he said. "But I think it's probably triple or quadruple that."
Some of the reports of successful Narcan use have come from members of the public. Others have come from police officers and other first responders.
"We know of more incidents where Narcan was used and an overdose reversed than actual fatal overdoses," Butler said.