For years, we had only heartbreaking stories and grim trendlines to report when it came to opioids, addiction, and overdoses. So, a recent CDC announcement that overdose deaths in the US have decreased by about 12 percent compared to last year, and in New York by about 17 or 18 percent, was met with justified relief. There is a guarded optimism that collective, herculean harm reduction efforts have started to pay off.

However, that decline still leaves us with around 101,000 overdose deaths in the past year. That’s more than firearms and car accidents, combined.

The biggest declines have come in Eastern states, which is good news for New York. For Ulster County, there has been really good news.

“We are also seeing a decline,” Jillian Nadiak-Bruck, Community Engagement Coordinator for Opioid Prevention at the Ulster County Department of Mental Health, told the Shawangunk Journal. “Since 2021, Ulster County opioid-related fatalities have been on the decline with our greatest reduction of 40.9% taking place this year compared to 2023.”

The decline went further than many had hoped. Nadiak-Bruck reported a 31 percent decrease in non-fatal overdoses – which may suggest that it’s not only that efforts to save people have improved, but fewer people are being put in danger. “This is the first time we have seen a decrease in non-fatal overdoses.”

This coincides with the major effort put into this area by Ulster County’s administration and other players.

“This has been a group effort,” Nadiak-Bruck said, “and certainly was not accomplished by any one individual or organization. In recent years, our county has devoted significant time, resources, and funding to combat the opioid epidemic in our community.”

The primary culprit for the deaths is, no surprise, fentanyl. Although fentanyl emerged quickly in the American drug landscape, it has existed for decades.

International drug cartels saw a huge opportunity in fentanyl when the overprescription of OxyContin began to be regulated in the late 2010s, and supplies of legal opioids dried up. A small, powerful narcotic powder originally invented in the late 1950s as an intravenous analgesic for surgery, fentanyl is so powerful (commonly cited as 100 times more powerful than morphine, although it’s unclear where that figure comes from) that it was rarely used in medicine until a dermal patch was invented in the 1990s.

Fentanyl has been such a difficult drug to manage because, as has been widely reported, it doesn’t require fields of poppies or painstaking harvesting efforts. “Losing product is relatively unimportant,” explains Jonathan Caulkins, drug policy expert at Carnegie Mellon University. “With merchandise that expendable, you can use straightforward and low-tech ways of smuggling,” like sending inexperienced American drug mules over the border in droves. Hence, the incredible potency is coupled with incredible quantity.

That’s what makes this such a dangerous time for drug users. “From January 2023 to July 2024, the leading substances involved in overdose fatalities reflect a combination of illicit drugs and prescription medications,” Nadiak-Bruck points out. “Fentanyl remains the primary substance contributing to these deaths, followed by cocaine.”

One of the greatest dangers is so-called “pressed pills,” which Nadiak-Bruck described as “counterfeit drugs made to look like legitimate prescription medications,” sometimes even with pharmaceutical company names impressed on them.

“Dealers have created pill presses that can make incredibly convincing counterfeit pills,” Nadiak-Bruck explains. “This does not only apply to prescription opioids like OxyContin, Percocet, or Vicodin. Other common medications such as Adderall, benzodiazepines, or sleep medications are being created with pressed fentanyl. The only sure way to know what you have is to test with a fentanyl test strip.”

These test strips are a low-cost way to tell if an illicit drug has been adulterated with fentanyl. Governor Hochul announced in August that the state would distribute 20 million of these strips throughout the state, though they have been controversial. Some harm reduction professionals have said they can be hard to use, and they are considered drug paraphernalia in some other states, heavily restricting sales and distribution there. Still, a two-pack can be had for $5.20 on Amazon.

It’s still unclear which of the many tools and policies implemented to reduce overdose deaths deserve the credit for the downward trend, but a growing body of evidence points to the availability of Narcan, a naloxone nasal spray, as a major factor.

In 2020, Ulster started installing Narcan kits in government buildings and high-risk areas like some public parks. About 5,000 kits have been distributed in the county this year.

Nadiak-Bruck emphasizes that test strips and Narcan are now widely available in Ulster County. “Our department distributes test strips at all of our outreach initiatives. The majority of our Opioid Strategic Action Team partners also distribute these strips alongside naloxone trainings. The challenge is ensuring our community knows they are available.”

In addition to fentanyl, a new drug mix called ‘pink cocaine’ has been getting media attention since it was found in the system of One Direction singer Liam Payne when he died on October 16. It’s not cocaine, but a mixture of drugs that mimic the effect of club drugs like MDMA.

Pink cocaine may not be cocaine, but it is pink. “The pink usually comes from food coloring,” Nadiak-Bruck says. “Its composition can vary widely because it is produced illicitly without any standardization or regulation. This variability makes the drug particularly risky, as users may not know what substances or dosages they are consuming.”

Ulster County hasn’t seen any deaths that appear to be associated with this drug cocktail, but they’re monitoring for it.

Ellenville residents have another big resource in the Ellenville Hospital harm reduction text line. By texting ERHRescue to 21000, anyone can request harm reduction supplies from test strips to safe sex kits.