UTAH OPIOID CRISIS: RETURN TO SURGING OVERDOSE DEATHS WAS PREDICTABLE AND NOT A WEST COAST EFFECT
As in San Francisco, Nevada, Tennessee and Washington: lack or delay of effective naloxone campaigns to reduce harm due to expert treatments predicts OD death trends
by Clark Miller
Published April 25, 2025
The state of Utah is nothing like the four Pacific Rim regional states to the west – Alaska, Washington, Oregon and California – nor for that matter like its immediate neighbor Nevada, nor its three “Four Corners” neighbors Colorado, New Mexico, and Arizona. Certainly not much like Tennessee.
Utah is unique.
But when it comes to understanding opioid crisis death trends in the U.S. – what has been driving the persistent surge in fatal overdoses over decades, the recent, dramatic drop in OD deaths that are mystifying, and the exceptions to those trends – Utah has much in common with all of those states. They are exceptions that prove a lethal rule.
Back over a period of about a decade, 2012 to 2021, Utah went from 2nd highest among states for per capita opioid overdose deaths to near the lowest, at 42, a change attributed seemingly universally to an intensive campaign to distribute Narcan, described in this post.
“They referred to Utah as Appalachia West,” said Jen Plumb, a physician who started the nonprofit Utah Naloxone after her brother died of an overdose in the late 90s.
By 2021, the most recently available public data compiled by the Centers for Disease Control and Prevention, Utah had 14.1 deaths per 100,000 people, falling to 40th overall, and well below the national average of 24.7. . . .
But perhaps the easiest explanation for the drop in deaths, according to Plumb, is the amount of naloxone in Utah, a life-saving opioid overdose reversal drug that can be administered via nasal spray or syringe.
Between 2017 to 2021, the state recorded 297,881 doses of naloxone distributed, according to Department of Health and Human Services, or DHHS, data. A whopping 80% of those doses came from Utah Naloxone, and the rest came from DHHS programs.
“I’m going to say most of that — going from fourth to 42nd — was Dr. Plumb flooding Utah with naloxone,” said Riley Drage, who teaches naloxone training classes for Utah Naloxone.
But later in that decade, other changes had started including increased provision of the substitute opioids buprenorphine and methadone, established as fueling the opioid crisis and contributing to deaths.
Utah was one of a minority of states in which methadone provision was increasing over 2019 to 2021, and programs to provide buprenorphine (Suboxone) to high-risk opioid users leaving jails had begun and were expanding, including in the jail in Utah’s largest metro area, Salt Lake City.
In the past several years, some of Utah’s county jails have developed their own MAT programs. In 2020, the Salt Lake County Jail unveiled its new MAT program and last legislative session Rep. Christine Watkins, R-Price, passed a bill allowing jails to either work with private practitioners or create MAT programs of their own.
In 2023 (using the interactive map graphic), Utah was toward the top of Western states for per capital dispensing of the common street currency for fentanyl (also known as buprenorphine).
So it was no surprise, in fact predictable, that things would change.
The problematic return to mounting opioid high-risk use and overdose hasn’t gone away, with report of a “spike” early this year, 2025.
SALT LAKE CITY (KUTV) — Public health officials are raising concerns over reports of a spike in overdoses.
According to the Utah Medical Examiner’s Office, drug overdose deaths in the state hit a record 606 in 2023, with fentanyl driving the surge. Fentanyl-related deaths have risen 1,160% since 2014 and are now linked to nearly half of all overdose fatalities.
A state healthcare director, quoted here, doesn’t sound optimistic.
“I wish we had a solution because we would have already done it,” said Jessica Serfustini, health promotion director for the Southeast Utah Health Department.
Mindy Vincent, a licensed social worker who founded the Utah Harm Reduction Coalition, notes problems with access to naloxone, alluding to a longstanding history of cultural and political resistance if not opposition to harm-reduction strategies in the state, leaving naloxone provision largely to the limited resources of the nonprofit organization run by Dr. Jennifer Plumb, founder of Utah Naloxone.
Speaking to Filter magazine in 2020, Plumb explained that her organization distributes naloxone throughout the state, but its work is self-funded: The state government gives no money to support it.
Added Vincent, “the most important thing lawmakers can do is appropriate funding for naloxone … Our state just doesn’t do enough to make it accessible financially”.
Similar complaints came from a county emergency manager in 2024, here.
Additional reporting in Filter points to Utah’s unique cultural forces restricting availability of the overdose-reversing drug responsible for recent widespread drops in fatal opioid overdose numbers.
Deaths involving opioids, methamphetamine and other drugs have reached record highs in Utah. The state government passed legislation in 2016 to create syringe exchanges, but harm reduction advocates still battle against stigma from conservatives and liberals alike to implement programs in a unique cultural context.
In Utah, “many people view harm reduction programs, even naloxone, as enabling addiction,” Mindy Vincent, executive director of the Utah Harm Reduction Coalition, told Filter. “We are a very abstinence-based state in every sense of the word. Utah is dominated by the LDS church [Church of Jesus Christ of Latter-Day Saints, whose adherents are known as Mormons] in culture, social practices and in our political system. This religious stronghold has compounded the shame around addiction here and for many, it is a moral failing.” …
“Most of Utah is rural, so people in those areas still have a difficulty accessing even naloxone,” Vincent explained. “Most are unable to access a syringe exchange. In our rural areas, we lack transportation, treatment, shelters, housing, employment and so on. This creates an insane amount of barriers for services and a perfect storm for chaotic use and addiction. And due to the shortage or lack of funding for harm reduction, expanding services to these areas continues to be difficult.”
Perhaps most telling, reported February 20, 2025, in the context of state, cultural and dominant religion attitudes posing barriers to funding for and implementation of effective naloxone campaigns in Utah, separate supplemental funds from opioid crisis settlements already distributed to Utah counties are going unspent.
That of course is in the context of record surges in opioid overdose deaths in Utah concurrent with moderate to remarkable decreases in other states caused by naloxone distribution campaigns.
A review by The Utah Investigative Journalism Project of account ledgers, budget documents, funding proposals and other public records found that a majority of counties in the state have spent little to none of the opioid funding they’ve received. …
The funding comes from national legal settlements with drug companies that have resulted in billions flowing to state and local governments across the country. More money will be dispersed over the next decade.
Utah counties have received a combined $56 million, but only 14% of the funds have been spent. …
Although counties began receiving opioid settlement payments more than two years ago, some counties don’t yet have a concrete plan.
Of 29 counties providing information on expenditures using settlement funds:
6 reported allocating or planning to use funds for MAT (substitute opioid provision) in jails
5 reported use for naloxone
Of the 5 counties reporting allocating or planning to use funds for naloxone:
2 had spent no funds
1 had spent 3% of its funds
18% and 69% spent for the 2 remaining
In Grant County (69% spent), “Funds went to Moab Regional Recovery Center to buy naloxone, Narcan and buprenorphine”. The Moab Regional Recovery Center is a program within Moab Regional Hospital, the Center’s staff all medical professionals providing or supporting “addiction medicine”. What portion of funds went to purchasing the substitute opioid buprenorphine versus naloxone is not clear. What is clear is that there is no indication that this Suboxone Clinic is involved in the type of targeted, community based distribution of naloxone to lay persons in high-risk opioid use areas that has been required in successful naloxone campaigns.
Two counties, Millard and Sevier (0% and 18% of funds spent) allocated funds to local Sheriff’s Departments for use by sheriff’s deputies and first responders. It is critically important that first responders carry and effectively use naloxone. It is also apparent that it is more important and effective for laypersons in settings where they are proximate to high-risk opioid users carry and effectively use naloxone, because in an overdose, seconds count.
A fourth county (San Juan) has allocated 3% of its funds ($146,820) to “contingency management planning and naloxone”, whatever that might mean.
The fifth county (Wayne) has allocated its $48,457 to “naloxone, prevention, first responders, and admin fees” and has dispersed no funds.
That is, while many states and locales across the U.S. have funded – prior to receipt of opioid settlement funds – and generated intensive, targeted, neighborhood-level, successful naloxone campaigns to dramatically reduce opioid overdose deaths, in Utah new funding sits largely unused or ineffectively used, as of February 2025, while opioid overdose deaths continue to mount.
While ensuring that street currency for fentanyl (buprenorphine) is widely available and increasingly dispensed.
Utah is no more an anomaly in opioid crisis trends than San Francisco, Washington, Nevada, or Tennessee or all the states and locales evidencing notable OD death drops recently, all fitting the consistent nationwide pattern – persistently mounting incidence of opioid high-risk use and overdose, with fatal overdose dramatically decreasing with, and not without, emergence of intensive, targeted, layperson-level distribution and use of naloxone to moderate lethal effects of expert treatments.
What states and locales?
These:
