Overdose deaths falling in NM, but fentanyl’s impact remains stark

ESPAÑOLA — The first time Lupe Sanchez tried fentanyl, she didn’t know it.

Growing up in an abusive household, she had yet to develop all her adult teeth the first time she took hard drugs, finding a warm, safe place she could escape to in the form of a little pill she was told was a Percocet.

She later learned it was one of the early street forms of a synthetic opioid that’s become all but synonymous with a drug epidemic that’s killed more than half a million Americans to date: fentanyl.

Sanchez graduated to smoking heroin and eventually injecting it. “I just got caught up in a lifestyle that grabbed me — grabbed me by my soul, pretty much,” she said.

After becoming pregnant with her first child in 2017, Sanchez finally decided to get clean. A clinician in Española prescribed her methadone, a synthetic analgesic that binds to the same opioid receptors in the brain as fentanyl or heroin.

Over the last three years, more and more Americans like Sanchez have been finding their way out of the grip of opioid addiction through medication-assisted treatments, like methadone, buprenorphine and Suboxone. And fewer are dying from opioid abuse due to the increased availability of the overdose-reversal drug naloxone.

Provisional data released this month by the Centers for Disease Control and Prevention (CDC) show a nearly 27% decline in drug overdose deaths in the U.S. in 2024 and a more than 23% decrease in New Mexico, where fentanyl continues to show an outsized and often indiscriminate impact on the state’s population.

Still a leading cause of accidental death in the U.S., drug overdoses were nearly double those caused by car accidents in 2024, according to the National Safety Council.

Nearly all states followed a downward trend, with Louisiana, Michigan, New Hampshire, Ohio, Virginia, West Virginia, Wisconsin and Washington, D.C., seeing decreases of 35% or more.

While final data is still pending complete reporting from state health agencies, opioids are again poised to account for an estimated 60% of all U.S. overdose deaths, according to the CDC.

Blue pills

According to Dr. Eric Ketcham, medical director of Addiction Medicine at Presbyterian Española Hospital, most opioid overdose deaths in recent years “have been attributed to fentanyl or fentanyl analogs.”

A synthetic drug used to treat severe pain in hospitals and ambulances for decades, fentanyl has gained notoriety since 2014 through its cheaply produced and often deadly street forms, which mainly come in the form of blue pills.

“There have been multiple types (of fentanyl) that have been used pharmaceutically,” Ketcham said, “and there are others that form in the process of making street fentanyl, which is a very messy process that comes up with all kinds of other junk, of course.”

U.S. Drug Enforcement Administration (DEA) officials have previously said cartels switched to producing the drug as its profit margins are gargantuan compared with heroin, which must be cultivated on clandestine farms susceptible to raids. Authorities say a cartel can invest $5,000 in precursor chemicals, often from Asia, and produce $1.5 million worth of fentanyl in labs south of the border.

Ketcham said the potency of illegally produced fentanyl can be highly variable, explaining its pronounced role in the overdose epidemic.

“It’s very effective at what it does and at much lower doses than heroin or morphine or oxycodone or other types of opioids,” Ketcham said. “So, therefore, it can be lethal at very small amounts.”

An estimated 42% of pills tested by the DEA contain at least 2 milligrams of fentanyl, an amount considered potentially fatal.

A toxicology report for Rio Arriba Sheriff Billy Merrifield, found dead in his patrol unit outside his home in Abiquiú on April 20, revealed a concentration of 23 nanograms per milliliter of fentanyl in his blood. In accidental overdoses involving fentanyl only, studies have found levels ranged from 9.7 to 41 nanograms per milliliter.

“It’s a tiny concentration compared to what would be considered the minimum testable concentration of, let’s say, morphine or heroin,” Ketcham said, emphasizing that Merrifield’s death remains the subject of a New Mexico State Police investigation. “What this could indicate is that he really had no opioid tolerance. It could mean that he was not a user of fentanyl. Once again, the drug is so potent, so powerful, that in somebody who has no opioid tolerance who doesn’t use it, that could certainly be a lethal dose in the right environment.”

Nasal sprays

Roman Sanchez, street outreach coordinator at Inside Out Recovery in Española, said between September and March, 22 Inside Out clients died, the majority from complications of either illness or drug overdose.

“Fentanyl’s affected them tremendously,” Sanchez said, “and I think the difference between that and heroin is it’s cheaper, but it doesn’t last as long. People are more desperate, so the crime rate is going up, too.”

Kathy Sutherland-Brauw, founder and executive director of Inside Out, said their organization relies heavily upon naloxone, an overdose reversal nasal spray provisioned under the brand name Narcan, to keep opioid users alive in the event of an overdose.

The continued decline in drug overdose deaths in the U.S. in recent years can be partly attributed to the increased distribution of Narcan through pharmacies, community programs and first responder agencies. Gov. Michelle Lujan Grisham issued a standing order in 2020 requiring law enforcement officers to carry Narcan.

However, Outreach programs like Inside Out have developed a need to keep more of the life-saving medication on hand as fentanyl has become more powerful, cheaper and easier to access.

“Before, with heroin, I used to have to give them one or two Narcan back in the day, and that would be enough for them to get out of their OD,” Sanchez said. “Now I give them up to seven to reverse the OD. So I don’t know if there’s something in it or what’s going on.”

Ketcham said fentanyl additives are largely to blame. Mixtures containing the veterinary sedative Xylazine, known as Tranq, for example, can be especially lethal, he said.

The provision of medication-assisted therapies continues to prove vital to helping people transition from opioid dependency.

Over the course of the decade he’s worked in addiction medicine, Ketcham said he’s seen opioids impact every segment of the socio-economic spectrum. He echoed one of the central themes of author Sam Quinones seminal work on the opioid epidemic, “Dreamland.”

“Fentanyl, like all opioids, doesn’t care what color your skin is, how rich you are, how poor you are, what your occupation is,” Ketcham said. “Fentanyl doesn’t care, doesn’t discriminate.”

But even as more potent opioids continue to emerge in Española, and communities all across the U.S., the continued decline of drug overdose deaths demonstrates that more robust treatment modalities are succeeding.

“We can’t help everybody to stay in treatment,” he said, “but we’ve helped a lot of people, and it’s been really life-saving and life transforming. It’s been just a thrill to see folks, you know, go from having their lives just destroyed and controlled by this drug to having their lives back and living normally — holding down a job, their home, transportation and contributing wealth to society.”

Lupe Sanchez, now 32, has two healthy daughters and works as a supervisor for Bernalillo County Protective Services Division.

It’s difficult work, she knows, but it provides her with the opportunity to help other parents find the resources and the motivation necessary to cut loose of the substance abuse that so often splits New Mexico families apart.

“I talk about this stuff because I want people to know and see that it is possible,” she said. “Yes, it’s extremely hard. Yes, it’s a battle you fight every day, probably for the rest of your life. Because after all these years, there’s still times where I struggle. There’s still times where I do get triggered there, you know? It’s a battle, an ongoing battle that you’re going to have to be willing to fight every single day.”