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Deadly overdoses fell in U.S. for first time in five years, new estimates show

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Deadly overdoses fell in U.S. for first time in five years, new estimates show

Deaths from drug overdoses fell last year in the United States as fewer people lost their lives to fentanyl and other opioids, marking the first time the death toll had dropped in five years, according to newly released estimates from the Centers for Disease Control and Prevention.

Federal officials said the numbers show a 3% decline in the estimated overdose fatalities between 2022 and 2023. That downturn equates to nearly 3,500 fewer deaths across the U.S. than the year before.

The new figures are tentative and could still be updated. Even a slight decline could be a balm for a country where drug overdoses have taken a devastating toll: In one survey, more than 40% of adults said they knew someone who lost their life to a drug overdose, according to a Rand study published this year.

“I’m thrilled that there wasn’t an increase, but we’re still talking about 107,000 people dying, which is completely unacceptable,” said Beau Kilmer, co-director of the Rand Drug Policy Research Center. Kilmer said better data on drug use are needed to untangle exactly what is driving the changes.

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Community groups and health officials grappling with the devastating toll of fentanyl have pushed to equip more people with naloxone, a medicine that can stop opioid overdoses and is commonly sold as a nasal spray under the brand name Narcan. Los Angeles County officials, for instance, credited an effort to hand out Narcan on the streets when they announced last week that overdose deaths had stopped surging among homeless people. To try to reduce the deadly risks, people who use drugs have also turned to test strips to detect fentanyl and avoided using drugs by themselves, among other strategies.

Health researchers have also noted that broader changes in the population could be affecting the numbers: Many heroin users who switched to fentanyl have died, and if fewer people are newly turning to fentanyl use, that could mean fewer people are now at risk, said Dr. Daniel Ciccarone, a UCSF addiction medicine professor.

“Based on utterly anecdotal, street-level observations, I’ll say there aren’t a lot of newbies,” Ciccarone said. “We’re looking for them, but we don’t see them. We don’t see the 22-year-old who says, ‘Hey, I want to use fentanyl.’ This is an aging cohort.”

Even as U.S. deaths linked to fentanyl and other opioids dropped between 2022 and 2023, the country saw an uptick in deaths tied to stimulants such as methamphetamine and cocaine, according to the new estimates. Drug researchers said that in recent years, many deaths involving meth have also involved opioids.

And not all parts of the country saw an overall drop in fatal overdoses. “In the East Coast and in the Midwest, we are seeing declines, but on the West Coast — particularly in the upper Northwest — we’re still seeing increases,” said Farida Ahmad, a health scientist at the National Center for Health Statistics.

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The federal figures show that in California, the estimated number of overdose deaths continued to rise in 2023 compared with 2022, increasing by 4.1%. In Oregon and Washington, increases were significantly steeper — roughly 30% and 27% respectively.

Drug use can differ from region to region, shaping ensuing overdoses and deaths: Fentanyl hit the eastern U.S. before spreading west, and methamphetamine use generally has been more common on the West Coast.

Ciccarone lamented that the West Coast should have been better prepared for fentanyl after seeing it hit other parts of the country years earlier, calling it a “failure of public policy.”

“We saw this coming. So why didn’t we prepare for it better?”

Ciccarone credited states in the Midwest and East Coast that had seen notable decreases in overdose deaths, saying that although the exact reasons are unclear, there has been a panoply of efforts that could play a role, including ramping up naloxone distribution and easing access to buprenorphine to treat opioid addiction.

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“These are places that were hard hit by fentanyl,” Ciccarone said. “So they’re doing something right.”

The federal estimates released Wednesday do not detail how many deaths linked to methamphetamine also involved other drugs, a phenomenon that has gained growing attention as American mix drugs both knowingly and unknowingly.

Researchers drawing on both federal and local data have found substantial overlap in methamphetamine and opioid use: In L.A. County, for instance, a recent report indicated that in 2022, nearly half of overdose deaths among homeless people involved both methamphetamine and fentanyl.

People who use fentanyl may turn to stimulants for energy to get themselves through daily activities, said Chelsea Shover, an assistant professor at UCLA’s David Geffen School of Medicine. For those facing the dangers of living outside, “you know what helps you stay up at night and stay vigilant? Meth.”

Shover said in recent years, national data have consistently shown the majority of methamphetamine deaths also involve opioids. Those findings were echoed in local research by Shover and other researchers, which found that between 2012 and mid-2021, the bulk of meth-related deaths in L.A. County also involved other drugs or medical conditions, rather than being driven solely by the stimulant.

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To help prevent such deaths, “we need to keep doing what we’re doing for opioid-related deaths — because a lot of meth-involved deaths are also opioid-involved,” Shover said.

Scholars have also urged more attention to methamphetamine itself: As it stands, there are no medications approved by the Food and Drug Administration to treat addiction to meth, although some existing medicines have shown promising results, as has offering incentives such as gift cards for people to stay off stimulants.

“The massive investment in reducing overdose deaths has been almost exclusively targeted to opioids,” said Steven Shoptaw, director of the UCLA Center for Behavioral and Addiction Medicine. “There’s been no systematic investment to reduce methamphetamine deaths” — a lapse that Shoptaw said had hindered effective interventions from being widely adopted.

Americans have been eager for any signs of hope amid the overdose crisis, but experts have cautioned against declaring victory too soon in reaction to year-to-year changes in overdose deaths.

For instance, University of Pittsburgh researchers found that the last time fatal overdoses dropped nationally in 2018, the downturn coincided with stricter regulations in China on carfentanil, a highly potent synthetic opioid. The following year, deaths from drug overdoses rose again.

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Dr. Donald Burke said that the estimated number of overdose deaths in 2023 was still above the level that researchers had forecast, based on the historic trajectory of such fatalities. The death numbers had jumped higher than expected during the COVID-19 pandemic, Burke said — and may just be returning to the same levels that would have happened in its absence.

“You can make a case that it’s come down, but it’s come down because the COVID impact is less now,” said Burke, dean emeritus of the University of Pittsburgh School of Public Health.

“Without knowing what are the drivers, it’s really hard to tell whether a reduction is a return to the expected trajectory or some other change,” said Dr. Hawre Jalal, an associate professor at the University of Ottawa who has partnered with Burke on such research.

Ciccarone was reluctant to even characterize the newly released estimates as a decrease in overdose deaths, instead referring to “a flattening of the curve.”

“Can we sing hosannas over that? No,” Ciccarone said. “We’re still fighting. We still have a lot of work to do to bend this overdose curve down.”

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After bold pledge, EPA shelves microplastics testing in U.S. drinking water

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After bold pledge, EPA shelves microplastics testing in U.S. drinking water

For the next five years, the Environmental Protection Agency has indicated it will not require public water utilities to test for microplastics or pharmaceuticals in drinking water, according to a proposed rule published in the Federal Register.

On Friday, the EPA submitted a list of chemicals it plans to test for under the Unregulated Contaminant Monitoring Rule, a mandatory testing program used to collect information about concerning chemicals in drinking water that could be harming human health. It did not include microplastics or pharmaceuticals.

The omissions come after announcements by EPA Administrator Lee Zeldin earlier this year that his agency was designating microplastics and pharmaceuticals priority contaminants for testing.

“This is a direct response to the concern of millions of Americans who have long demanded answers about what they and their families are drinking every day,” he said at an April news conference with Health and Human Secretary Robert F. Kennedy Jr. at EPA headquarters.

Zeldin’s announcement was seen at the time as a move to placate the increasingly disgruntled Make America Healthy Again contingent of Trump supporters.

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Now the agency says it has no validated or standardized method to test for the plastic particles in drinking water, and wouldn’t be able to develop one before December, when testing is required to begin.

Among the 33 chemicals the EPA will require water utilities to test for are seven PFAS, or forever chemicals, and three pesticide residues.

It will be five years before the EPA proposes another list.

The EPA did not respond to a request for comment.

The agency noted in its proposed rule that it will collaborate with other federal agencies to “evaluate risks and exposures” of microplastics for future monitoring.

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Environmentalists reacted with frustration and resignation. They pointed out that the European Union has developed methods to test for the tiny plastic particles, which have been found in people’s blood, brains and lung tissue. California has one in the works.

“The California water board has spent a lot of time and money on how to measure in drinking water,” said Judith Enck, a former EPA regional administrator and president of the anti-plastic environmental group Beyond Plastics. “EPA should give them a call.”

California was required by a 2018 state law to establish a protocol for local water utilities to test for the particles in drinking water. The state has not yet begun reporting its results, but protocols were established in 2021. Blair Robertson, a spokesman for the State Water Resources Control Board, said it’s not “a fully validated, end-to-end regulatory method” yet.

At the April meeting, Zeldin announced that he would place microplastics on what is known as the Contaminant Candidate List, which acts as a preliminary “watch list” of unregulated, priority contaminants in drinking water. Like the mandatory monitoring list, it is updated only every five years. The most recent list was published on April 2 — the day he made his announcement.

“Americans have been ignored as they sound the alarm about plastics in their drinking water,” Zeldin said during the announcement. “That ends today by placing microplastics on the contaminant candidate list for the first time ever. EPA will follow the science, will pursue answers and will hold ourselves to the highest standards to protect the health of Americans.”

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There appears to be no clear association between these two lists, although the contaminant list is supposed to inform the monitoring list. Seventy-five chemicals and four chemical groups (microplastics, pharmaceuticals, PFAS chemicals, and disinfection byproducts) were listed on the 2026 contaminant list. Only seven of those chemicals were also on the proposed monitoring list (as well as seven PFAS chemicals).

When Zeldin announced microplastics as “‘a priority contaminant for regulation,’ and called it ‘a historic action on microplastics,’ he made it seem like the administration was going to take microplastics seriously,” said Mary Grant, water policy director for the environmental group Food & Water Watch.

“By not including them, they made it clear they don’t actually have plans to immediately address this crisis by getting the real-world monitoring data that we need right now to really start correcting ourselves,” she said.

Craig Davis, senior director of plastics chemistry at the American Chemistry Councilthe nation’s largest trade group for chemical companies — said that while his organization supports microplastic research, it also agrees with the EPA’s decision not to include them in the monitoring list.

“National drinking water monitoring should be based on validated, standardized methods that can produce reliable and comparable data,” said Davis in a statement. He said “limited” national monitoring resources should be focused where data can produce “actionable public health information.”

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The public has 60 days to comment once the plan is published in the Federal Register.

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Hospital visits for smoke inhalation spiked during Boyle Heights warehouse fire

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Hospital visits for smoke inhalation spiked during Boyle Heights warehouse fire

The number of Angelenos who went to the hospital with throat pain and concerns about smoke inhalation spiked as a fire burned through the massive Lineage cold storage warehouse in Boyle Heights this month, The Times has learned.

The blaze burned for eight days beginning June 17 and involved solar panels, insulation foam and other industrial materials.

During that time, more than three times as many people went to emergency departments within 10 miles of the warehouse mentioning the fire or smoke inhalation compared with the two weeks prior, according to data from the Los Angeles County Department of Public Health obtained through a public records request.

The agency also noted a near doubling of patients mentioning throat pain within five miles of the fire June 21 — 1.9 times the baseline levels.

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Usually, fewer than 50 people go to the emergency room each day for throat pain, and fewer than 20 people for smoke inhalation, the department said.

The hospitalization data was tracked through the department’s syndromic surveillance project, which monitors trends in what people report when they come to emergency departments in L.A. County, as well as diagnosis codes noted by providers. The system is not as comprehensive as full patient health records, and clinicians may not always include key words about “fire,” “smoke” or other circumstantial information in their diagnoses, the public health department said.

As such, it “cannot capture the true number of [emergency department] visits related to symptoms from the fire and likely underestimates the true burden of fire related symptoms,” the department said.

Perhaps unexpectedly, the department said it did not note a substantial increase in asthma, acute respiratory symptoms or chronic obstructive pulmonary disease-related emergency department visits during the fire.

But even these preliminary findings are concerning, experts said. The fire is believed to have started on the solar array on the roof of the 500,000 square-foot building, which housed 85 million pounds of frozen food. It then reached an ammonia line, prompting two brief shelter-in-place orders for nearby residents.

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Over the next week, the fire continued to burn through dense insulation foam within the building’s walls and other unknown industrial materials, blanketing much of L.A. in acrid smoke. Residents in downtown L.A., northeast L.A., Burbank, the San Gabriel Valley and many other parts of the city and county reported seeing and smelling the fumes.

The South Coast Air Quality Management District issued multiple warnings about unhealthy levels of PM 2.5, or fine particulate matter. The city and county opened two smoke respite shelters in the immediate area so that people could breath cleaner air.

It is still unclear what exactly was in the smoke that people breathed in. Industrial fires release far more materials than the burned wood smoke that is emitted during wildfires.

“The makeup of the smoke can include toxic chemicals, fine particles and other serious risks to lung health depending on fire conditions and what is burned,” Will Barrett, assistant vice president for nationwide clean air policy at the American Lung Assn., said as the fire was burning. Children and elderly people are particularly at risk.

David Eisenman, director of the UCLA Center for Public Health and Disasters, said urban industrial fires also can represent a hazard that standard PM 2.5 warnings don’t always address. Those advisories are “blunt instruments” that don’t adequately capture emissions from burning man-made goods — or convey that the source of pollution may include burning batteries or toxic refrigerants, he said.

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The fact that initial numbers don’t show a spike in asthma attacks is “somewhat reassuring,” Eisenman said. But “people may have gone to their primary care doctors, which this would not capture. This data deserves follow up.”

The air district and the U.S. Environmental Protection Agency deployed air monitors to assess particulate matter, airborne toxic metals and other harmful compounds during the early days of the blaze. The air district said it didn’t find significant levels of air toxics during the first two days of the fire, although it did record significantly elevated concentrations of particulate matter within the plume downwind.

Some of the measurements it took with mobile monitors, which are five-minute snapshots, also showed increased bromine and chlorine, which often are found when buildings burn and were at levels “below short-term health-based exposure thresholds,” the air district said. It began continuous PM 2.5. monitoring at two nearby elementary schools on the third day.

The L.A. Fire Department said it detected low-levels of toxic hydrogen fluoride on the second day of the fire, which can be a byproduct of burning lithium-ion batteries.

Lineage, the tenant-operator of the warehouse, said no concentrations of ammonia were detected in the air at any time.

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“There’s no doubt this fire has had a huge impact on the local community, and we are committed to showing up in every way we can,” company officials wrote in a statement last week. They said Lineage worked closely with the Fire Department during the blaze and delivered masks, air purifiers and other supplies to the community, and will work to ensure the fastest cleanup possible.

The long-term health effects of the fire and its smoke probably won’t be known unless researchers conduct a follow-up study, said Eisenman of UCLA.

For example, there may have been delayed pulmonary effects from the hydrogen fluoride and burning insulation foam that — when combined with the elevated PM 2.5 levels in a dense urban environment — produced health effects that didn’t show up in the emergency room data.

“They will show up in increased primary care office visits and exacerbations of chronic disease over the next few weeks,” he said. “So from a public health standpoint, this fire is not over.”

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Water from Boyle Heights warehouse fire carries foam into L.A. River, sparks testing

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Water from Boyle Heights warehouse fire carries foam into L.A. River, sparks testing

All the water unleashed onto the warehouse fire in Boyle Heights — some of it 480 gallons at a time by helicopter — had to end up somewhere.

That somewhere is the Los Angeles River.

Los Angeles Fire Department crews ripped through 50-foot walls filled with foam insulation to get to the building’s steel skeleton and its storage racks.

Charred chunks of foam have been floating from the burn site, partially blocking storm drains. Now organizers from East Yard Communities for Environmental Justice are teaming up with scientists from UCLA and Columbia University to find out more about what’s in the runoff.

“The community here is really interested in knowing, ‘Are there any contaminants that are potentially making their way down to the L.A. River?’” said Yoshira “Yoshi” Ornelas Van Horne, UCLA assistant professor in environmental health sciences. “We really can’t answer that unless we actually have measures and samples analyzed.”

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Water samples collected directly from the warehouse fire runoff have been shipped to Columbia‘s Multi-Element Trace Analysis Laboratory in New York, which has a spectrometer that can identify trace levels of elements. The lab also has relationships with researchers in Southern California.

1

2 Casey Cooper holds a water sample.

1. Emmanuel Carrera Ruedas, left, and Casey Cooper prep containers to take water samples from the L.A. River. 2. Casey Cooper holds a water sample. (Christina House / Los Angeles Times)

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The data will then come back to UCLA for analysis. For now, the scientists and community advocates only have the money to test for copper, lead and arsenic, Ornelas Van Horne said. Residents have expressed interest in testing for more contaminants.

As the water from the firefighting efforts trickles through the warehouse in rivulets, it forms a stream at the corner of S. Indiana and Noakes streets, that gushed into the storm drain. On a recent visit, the water traversed a smoky 10-foot canyon of charred foam and twisted wall panels on its way to the drain.

From there, the water flows to the L.A. River. Despite the fact that its concrete design is intended to whisk water out of the city as fast as possible, life stubbornly persists in the river and nearby. Recreational swimming is not permitted, yet anglers fishing for tilapia, largemouth bass and carp are a common sight along the rocky sides of the soft-bottom areas.

The L.A. River, and all it carries with it, meets the ocean in Long Beach.

The L.A. County Public Works Department said it has deployed three containment booms — floating barriers — on the L.A. River, and is continuing to monitor the water as it makes its way to the ocean.

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Emmanuel Carrera Ruedas takes a water sample.

Emmanuel Carrera Ruedas takes a water sample.

(Christina House / Los Angeles Times)

Before it gets there, the river passes through the Dominguez wetlands, where Public Works is removing some number of dead fish. The wetland has absorbed toxic runoff from a warehouse fire before, resulting in a fish die-off.

“For so long, the L.A. River has been used as a dumping ground for all kinds of chemicals,” said Emmanuel Carrera Ruedas, a community scientist and member of East Yard Communities for Environmental Justice.

Pollution has plagued the L.A. River, but it does have allies. In the 1980s, the Friends of the LA River pushed to address street runoff and trash that had made the water body infamous. Significant progress from advocacy and government initiatives improved water conditions, but these efforts have not been equally distributed.

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Carrera said the samples represent “proof of what’s actually going on, and accountability, too, for the city, of not just what’s happening in our air, but what’s actually happening in our waterways.”

The first samples for the project were taken last Friday, the second day of the fire.

They were the first of 20 samples the research groups have agreed to test at no cost to see if any exceed regulatory standards and could pose a risk to people nearby.

The warehouse fire represents the latest environmental disaster for people in Boyle Heights and East L.A. Just four weeks ago, a telecommunications crew accidentally struck one of the many oil pipelines beneath the L.A. area, spilling 25,000 gallons of crude oil near Eastern and Cesar Chavez avenues — including into storm drains feeding to the L.A. River.

“I think it really is difficult to see disaster after disaster hit the communities here, with not a lot of talk about how we can move through these disasters together,” said Casey Cooper, a volunteer community scientist involved in the sampling. They were inspired, they said, by the response of neighbors, and how people were supporting one another.

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Results from the laboratory analysis could be back to Ornelas Van Horne within a month.

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