Wyoming’s opioid crisis: You can’t manage what you can’t measure

More than half of Wyoming’s drug deaths last year involved fentanyl, a potent synthetic opioid that illicit drug dealers often lace into other drugs. It’s 50 times stronger than heroin, and 100 times stronger than morphine.

Data gathered and distributed by the state about drug overdoses is so limited, many people working to save lives don’t learn about an influx of tainted drugs, or a spike in overdoses like Wyoming experienced in January, until it’s too late to do anything.

We know that now thanks to “Withheld,” WyoFile’s four-part series on the opioid crisis by health and public safety reporter Madelyn Beck. She spent six months researching and filing records requests to shine a light on this disturbing trend.

In January, the Wyoming Division of Criminal Investigation told legislators that law enforcement seized about 1,600 “dosage units” of fentanyl in 2020, and nearly 13,500 units in just the first three quarters of 2022. 

Data obtained by WyoFile shows during the same month, EMS workers responded to a significant spike in suspected overdoses. That critical information, however, wasn’t readily available to the public and many local decision makers.

There are other important elements highlighted in the series that I hope aren’t overlooked as state and local officials work to identify effective solutions to the opioid crisis.

While money is almost always an issue in state responses to crises, resources to expand Wyoming’s efforts will be available, thanks to an estimated $9.4 million in legal settlement funds. More money will be available after other liability lawsuits addressing the overprescription of opioids are closed.

Wyoming is putting together a plan to spend the funds, with input from the state Department of Health, medical professionals, law enforcement, coroners, and behavioral health providers, among others. The state will receive 35% of the money, and 65% will go to city and county governments.

I don’t believe, as some have suggested, that Wyoming should put all of the money into one pot and enact a consensus statewide strategy, especially one concocted by the Legislature. That would be a disaster, and I guarantee any such plan would suffer mightily from regional and personal conflicts. 

Cities and counties face different challenges and should develop their own sets of solutions, including drug abuse prevention and education in schools. But Beck noted the overall task is considerably harder to achieve locally because “many officials — the people who will decide how to allocate the fresh influx of resources — are working with limited information about overdoses happening in their own communities and how best to combat them.”

That’s why state and local collaborations should be pursued wherever it makes sense, as data collection is improved. The Department of Health, county commissions and city councils could examine ways to mutually benefit, particularly by avoiding duplication of efforts.

One way the Legislature can help is to stop cutting the Office of Emergency Medical Services budget. Lawmakers reduced OEMS’s budget by nearly 30% in 2020, despite EMS being on the frontlines of opioid overdoses and mental health crises in Wyoming.

Mental illness and trauma often contribute to substance use disorders. More than 10% of drug overdose deaths in Wyoming between 2018 and 2022 are believed to be suicides.

Regional long-term behavioral health facilities and substance abuse disorder treatment should be at the top of most counties’ priorities for spending opioid settlement money. It’s necessary because the days of sustained energy industry “booms” are long gone and the Legislature routinely cuts funding for both when mineral severance tax revenues decline.

It would be helpful if EMS data differentiated between fatal and nonfatal drug overdoses, but they’re currently lumped together. To learn specifically about overdose deaths, one must instead query the state’s 23 county coroners. That information, however, not only pairs imperfectly with the EMS numbers, it’s also inconsistent from county to county, primarily because there isn’t a uniform way coroners collect overdose death data. Timely data is also difficult to obtain because toxicology reports that help medical practitioners determine the cause of a death can take weeks to complete.

Natrona County Coroner James Whipps told Beck that adoption of a uniform statewide system may require legislation, which is probably the only way it will get done. 

“A lot of our state is still stuck in the 1940s in the coroner’s offices,” Whipps said. “I don’t know how we drag people kicking and screaming into the future here, but we have to.”

We must also emphasize public education in responding to the fentanyl crisis.

For example, Wyoming needs to know that as dangerous as opioids are, there are non-opioids that are even more lethal being mixed into fentanyl, methamphetamine and other street drugs to enhance their effects.

Xylazine, also known as “tranq,” is a horse tranquilizer used by veterinarians. Dr. Nabarun Dasgupta, a University of North Carolina researcher, told National Public Radio that state and federal agencies lack the capacity to identify and track such new drug threats in real time.

“We only find out what’s in the street drug supply when it’s too late, when people are either dead or arrested,” Dasgupta said.

Xylazine can cause prolonged unconsciousness and terrible flesh wounds that may require amputation. One person with an opioid addiction told NPR the chemical “just eats your skin away and leaves a hole, and then it leaves a scar.”

For Wyoming, which is still lacking in developing public fentanyl data, the emergence of xylazine represents a huge challenge — to say nothing of all its successors waiting in the wings. Drug dealers who leave death and destruction in their wake on the road to higher profits are often several steps ahead of the government. 

I am grateful that Beck chose to include recommendations from unhoused Wyomingites at the COMEA Shelter in Cheyenne. Their voices need to be heard by government officials at all levels because they are particularly vulnerable to substance use disorders and illicit drug use.

They shared stories about abuse, childhood trauma, mental illness and military service. One man recalled how a female friend was in rehab to recover from fentanyl addiction, which she told him was possibly even harder to get over than meth or heroin.

And the group wanted improved access to mental health resources and access to medically supervised detox facilities, which are both approved uses for the opioid settlement funds.

As someone who spent his teenage years in the early 1970s, I know how tempting it is for youth to experiment with many types of drugs. I don’t want to minimize the fact that such behavior could be foolish, dangerous and even deadly, but I’m grateful there were no drugs laced with fentanyl or horse tranquilizers on the street then.

But I’m scared that so many people, for myriad reasons, are willing to risk their health and lives today by taking substances that are far more powerful than heroin, methamphetamine or morphine, to name just a few. It’s one of the prime reasons why the public needs good data about the opioid crisis.

Funds from major pharmaceutical distributors and manufacturers of fentanyl-based painkillers must be spent to provide adequate mental health and substance use disorder treatment, and to fund public education, law enforcement, medical care and other services. 

We should do it in the name of the more than 110,000 Americans who died in 2022 due to opioid addictions, in the hope that far fewer will join them in the years ahead.

Correction: This story was changed to reflect that fentanyl is up to 50 times stronger than heroin, not 500 times stronger as originally stated. — Ed.