CINCINNATI -- Despite a summertime spike in overdoses that stunned Cincinnati, only half as many people died from overdoses in 2016 compared with the year before.
Fewer synthetic opioids circulating in the local drug trade may be one reason overdoses have started to decline in recent months.
Experts also point to another possible reason for fewer fatalities: More people have access to overdose-antidote naloxone, and they know how to use it.
According to preliminary data from the Cincinnati Health Department:
"One of the concerns we keep hearing is, 'What is the next, new synthetic opioid?'" Interim Health Commissioner Dr. Marilyn Crumpton said.
Some drug-overdose deaths may still be under investigation, so they wouldn't be reflected yet in the numbers Crumpton and Dr. Jennifer Mooney gave to the city's Human Services, Youth and Arts Committee on Monday.
When asked if the trend was leveling out, Mooney replied there is some confidence, but: "I don't think we know with certainty."
"What we do know from meeting with Police and Fire is you'll see waves of when things like fentanyl and carfentanil hit the streets, and that's when you see those spikes," she added. "So far -- fingers crossed -- as of late, we haven't had those, so that might be why you're seeing the decline."
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Crumpton also said greater access to naloxone, frequently known by brand name Narcan, also might be helping to prevent deaths.
"That availability, plus the awareness that we were dealing with much more rapidly fatal overdoses, I think has changed the response," she said. People who have overdosed on synthetic opioids frequently need more than one dose of naloxone to be revived.
In Northern Kentucky, St. Elizabeth Healthcare saw overdoses spike last September -- like Cincinnati -- and then decline through December. The hospital system tracks overdoses treated at its emergency rooms in Covington, Edgewood, Florence, Ft. Thomas, Grant and Owen counties. St. Elizabeth treated 1,584 overdose cases in 2016, and that figure has steadily increased since at least 2011.
In Cincinnati, first-responders went to 2,008 heroin overdose calls in 2016. September, the peak, had 451 runs. By December, there were just 99.
Crumpton credited the "fabulous job" by police officers, firefighters and paramedics for reducing deaths, but noted the work has started to wear on them.
"It's definitely taking its toll with exhaustion in very many ways," she said.
One source of frustration: First-responders revive the same people with naloxone multiple times -- sometimes more than once in the same day. Paramedics worry about being stuck with a drug needle and contracting an infectious disease. Mooney also said they feel they don't have enough resources to drive an intervention once the person has been revived.
First responders also face issues of inadequate training and a system that's "really not congealed" in trying to help addicts.
"So police run into dead-ends a lot of times," Mooney said.
Even though Hamilton County is "resource rich" with treatment options -- including intensive outpatient care, 28-day programs and long-term residential programs -- there's not enough capacity for all the people who need help right now, Mooney said.
And, she said, there's no one-size-fits-all approach to intervention. In a perfect world, once a person is revived, they'd enter treatment.
"That's not really how it works. People come out it if, they're OK, and they walk away," she said. "Some interventions address it a few days after that. Some do it right then and there. Both have varying degrees of success and failure."
Crumpton added that all those dealing with the heroin epidemic -- primary care doctors, emergency rooms, first-responders, addiction treatment centers and public health officials -- are trying to work better together to get patients the care they need -- and figure out who brings money to the table.