Colorado is on track to surpass its record-breaking overdose death toll from last year, state data show, with fentanyl continuing to play a larger and deadlier role in the state’s spiraling overdose crisis and even as lawsuits against pharmaceutical companies and opioid manufacturers begin to wind down.

Total data for 2021 is not yet available, state officials said, and full statistics are complete only through August. But even with four months of data still to be fully analyzed, preliminary figures show fentanyl has been involved in more overdose deaths in 2021 than in any previous year, outpacing the combined totals from 2015 to 2019.

“If you’re angry, you’ve been paying attention,” said Lisa Raville, who leads Denver’s Harm Reduction Action Center. “People we know, love and serve are dying of preventable overdoses, and it doesn’t have to be this way. The overdose crisis is a public health emergency that demands a public health response.”

The preliminary data, provided Tuesday by the state Department of Public Health and Environment, does not break down how many overdoses various classes of drugs contributed to, and not all are opioid-related. Between Jan. 1 and Aug. 31, 1,230 people fatally overdosed in Colorado. During that same period in 2020, 1,017 people had died of lethal drug doses. In the first eight months of 2020, an average of 4.2 Coloradans fatally overdosed each day. During that same time period in 2021, that number climbed to more than five.

State figures show at least 1,340 Coloradans have overdosed in 2021, though that is not complete for the last third of the year and will increase as more data are received and processed by the state, said Kirk Bol, the manager of the state’s Vital Statistics Program. The total overdose death toll in 2020 was 1,477, itself a significant jump from 2019’s 1,072 deaths.

On Monday, Denver City Attorney Kristin Bronson told members of the City Council that the state’s fatal overdose estimate for 2021 would exceed 1,800. That would surpass 2020’s death toll by at least 22%. 

“It doesn’t seem to be getting much better,” Bronson said Monday, adding that 2021 is “another bleak year as far as the human tragedy that this crisis has caused.” 

A spokesperson for the state health department did not respond to an email asking about the state’s overdose projections for this year.

Fentanyl has played a role in 643 of 2021’s known fatal overdoses, accounting for about half of the state’s overdose deaths. Even with the limited data that’s available, fentanyl’s lethal role is already more prominent than in the entirety of 2020, when the synthetic opioid contributed to 534 deaths. 

In 2015, for comparison, 41 overdose deaths involved fentanyl.

More Coloradans have already died of overdoses involving fentanyl in 2021 than in 2015, 2016, 2017, 2018 and 2019 combined. The state also surpassed that total last year. 

Don Stader, an emergency and addiction medicine physician, said he isn’t surprised by the data, given what he sees every day.

“We have seen a dramatic increase in substance use and complications of substance use,” he said. “The numbers reflect the reality we are seeing on the ground.”

He added: “Fentanyl has changed the game.”

In April, The Denver Gazette spoke with 20 providers, advocates, experts and members of law enforcement about the overdose wave. Deaths had spiked significantly in 2020, and various experts said twin crises had hit Colorado at once, fueling the surge in death.

One is the rise in fentanyl. The synthetic opioid, easy to produce and distribute, is highly potent and ubiquitous, officials said. It’s becoming increasingly present in other drugs, including heroin, methamphetamine, cocaine and illicit pills, where it’s mixed with Xanax and pressed to look like legitimate tablets.

The other factor driving the worsening crisis, they said, is the isolation and stress caused by the pandemic, which is nearing its two-year anniversary.

Colorado is not alone in seeing its overdose deaths jump. In November, the U.S. Centers for Disease Control and Prevention said more than 100,000 Americans died of a drug overdose between April 2020 and April 2021, the first time the country had surpassed that threshold in a 12-month period.

“With every overdose statistic, there is a story – loved ones, friends and neighbors who are forever changed by loss,” Madelynn Ruble, spokeswoman for the Colorado Department of Human Services, said in a statement. “The impact is incalculable, and it only underscores the urgency of this challenge we face.”

She and Andres Guerrero, the manager of the state’s overdose prevention unit, both described steps the state is taking to address the crisis. Ruble said the state will receive $113 million over the next four years in federal money to help with prevention, treatment and recovery. Another $114 million has been allocated for state mental health programs, she said.

Colorado will also receive $389 million over the next 18 years from recent settlements with opioid manufacturers and Johnson & Johnson, with more money from other litigation likely to follow. 

Guerrero noted the state’s efforts to increase the supply of naloxone – a medication used to reverse opioid overdoses – and support local harm reduction programs. Services like Raville’s provide clean needles, fentanyl test strips and access to treatment for those with substance abuse disorders.

Guerrero said the state is also “supporting our state’s coroners by funding toxicology testing so the state can obtain accurate counts of overdose deaths in order to target our prevention efforts in the geographic areas with the highest need.”