JOHNSON CITY, Tenn. (WJHL) — Rapidly rising fentanyl-related drug overdoses helped drive an overall 43% increase in Northeast Tennessee overdose deaths from 2020 to 2021, Tennessee Department of Health (TDH) data show. A total of 248 people in the eight-county region died of overdoses in 2021, which is also more than double the total from 2019.

Deaths involving the synthetic opioid fentanyl more than doubled from 2020 to 2021 and were up sixfold from two years earlier. The 139 OD deaths involving fentanyl represented 56% of total overdose deaths — up from 39% in 2020 and just 21% of the total in 2019.

The large increase in overall overdose deaths and rapid rise in those related to fentanyl has vexed people and agencies on the front lines, from law enforcement and first responders to prevention and treatment advocates.

“Being immersed in the recovery field, it’s not getting better,” said Craig Forrester, who runs several sober living houses in the Kingsport area and is on the Sullivan County Overdose Response Team.

“The fentanyl is the stuff that’s causing the death,” Forrest said. “I still think the most prominent drug of abuse in our region’s methamphetamine.”

Deaths related to stimulants, whether in combination with opioids or not, have also risen sharply in the last couple of years.

Overdose deaths that involved a combination of opioids and stimulants nearly tripled in 2021 compared to 2020, rising from 36 to 99.

That total of 99 was five times higher than 2019’s and more than the previous four years combined when a total of 90 people who died from overdose deaths had both an opioid and a stimulant in their systems.

Sources ranging from the Tennessee Bureau of Investigation (TBI) to local law enforcement agencies have reported on the increased occurrence of other drugs being laced with fentanyl. The presence of fentanyl in methamphetamine, cocaine and other stimulants has contributed to increased overdoses.

“They’re just out partying for the weekend, and whether it’s cross-contamination or purposely putting fentanyl in the cocaine as a cutting agent, you see that,” Forrester said.

“It’s a whole different game these days. It’s in meth, it’s in coke – you go to buy drugs these days there’s a high likelihood you’re going to be getting fentanyl.”

When people in those situations aren’t regular opioid users, they can overdose and die from smaller amounts of fentanyl than people who use opioids regularly, whether that’s pills or heroin.

But fentanyl is so strong, Forrester said, it has killed people who’ve been using opiates for years and have a pretty high tolerance.

“When it’s killing them, that’s a little scary because it tells you how potent the drugs are.”

But changes in law enforcement and other trends have made pills like Oxycontin and Percocet much harder to access, while fentanyl is cheap and plentiful. Forrester said opioid users often know they’re going to get fentanyl regardless of what the person selling the drug tells them it is.

“They know those things. It’s just it’s cheap, it’s the best high for the dollar, and it’s everywhere.”

Forrester said the thought that people would avoid using something they know might kill them is naive.

“No person who is in the grips of an opiate dependency has the capacity to wait,” he said.

“If you’re on hour 12, hour 24 of not having any kind of opiates in your system, you would about sell your soul to the devil. So the scare tactic of ‘it’s fentanyl, it’ll kill you,’ that doesn’t register in a user’s mind. They’re just trying not to be sick.”

Statewide data show problem not limited to one region

Northeast Tennessee is not unique in experiencing steady increases in overdose deaths. Statewide, deaths rose by 26% from 2020 to 2021, hitting 3,814 last year.

The 2021 total was nearly double the 2,089 recorded in 2019, and it was 2.1 times higher than the 1,818 overdose deaths in 2018. That’s actually a bigger jump than Northeast Tennessee’s. The region’s 2021 total was 1.7 times higher than the 2018 figure of 144 deaths.

Fentanyl-related deaths, on the other hand, have risen much more rapidly in Northeast Tennessee than statewide, where the drug entered markets earlier in some regions.

Fentanyl-related deaths statewide were 2.6 times higher in 2021 than two years earlier, whereas they were six times higher in Northeast Tennessee. Fentanyl was already a factor in half of the statewide overdose deaths in 2019, but only 21% of deaths in Northeast Tennessee.

That gap has narrowed, with fentanyl factoring into 71% of overdose deaths statewide last year to 56% regionally.

The biggest statewide increase in age demographics in the past couple of years has been among people ages 35 to 44. In 2019, there were 498 deaths in that group, 500 in those 25 to 34 and 491 in those 45 to 54.

Last year, the 35 to 44 group saw 1,106 deaths compared to 893 in the 25 to 34 group and 808 in the 54 to 54 group.

Greene County posts highest rate per population

Regionally, Greene County saw the highest population-adjusted overdose death rate and also the biggest jump from 2020.

The county had 45 overdose deaths last year, which was a rate of 70 per 100,000 population. That was well ahead of the second-highest rate of 54 posted by Unicoi County. Sullivan County’s rate was 50, Washington and Carter counties both had rates of 47 deaths per 100,000, and Hawkins’s rate was 46. Tennessee’s statewide rate was about 55.

Forrester said he doesn’t think 2022 is proving less deadly, despite a growth in acceptance of Narcan, a medication that can stop overdoses, and increasing supportive services for people to move into recovery.

“I think next year if we have this conversation in December of 2023, usage will be up, overdoses will be up, deaths will be up,” he said.

He said it could be even worse and that people who oppose Narcan’s ready availability may not realize how many lives it’s saving.

“You want to talk about crazy numbers – restrict access for the Narcan and cut the funding for the agencies that are helping the people with substance abuse. Those numbers would shock you.”

But Forrester works in the world of drug abuse prevention and recovery every day and makes the trek out to meet families who’ve lost loved ones to overdoses. He said he hopes to see numbers turn someday.

“We’re fighting a tough battle. In my eyes, I believe it’s worth it because every person’s life that’s saved and we’re able to offer them a sense of stability and a second chance at their hopes and dreams – to me that’s worth it.”