NASHVILLE, Tenn. (WKRN) — Five hundred-and-twenty people died of a suspected overdose death in Davidson County during the first three quarters of 2023, according to a new report from the Metro Public Health Department (MPHD), which is a slight decrease compared to this time last year when 538 overdose deaths were reported.

Both years, fentanyl was detected in 76.2% of the overdose deaths.

“With fentanyl in the supply as commonly as it is, I’m surprised more people aren’t dying,” said Dr. Chapman Sledge, chief medical director at Cumberland Heights.

Sledge told News 2 the opioid epidemic has progressed in phases, beginning with prescription pain pills in the late 90s and shifting to heroin a few years later.

According to Metro’s report, approximately three-quarters of overdose-related emergency department visits so far this year involved non-heroin opioids, pointing to the continued shift from heroin to synthetic opioids.

Fentanyl is now the main opioid of abuse, according to Sledge. The drug is stronger and deadlier than heroin, and it triggers addictions that are much harder to treat compared to heroin, because the patient has to wait longer before beginning detox medication.

“It’s really a challenge to be able to keep the patient comfortable long enough to be able to safely start detox medication without making it worse, and it’s hard for them to tolerate that waiting period because it is so uncomfortable and goes on for so long,” Sledge said.

Sledge added fentanyl is commonly mixed into the drug supply on the streets, putting anyone who uses street drugs at risk of a potential overdose.

“People use what they think are prescription opioids, and it’s fentanyl,” Sledge said. “People think they’re taking a Xanax, and it’s fentanyl. It’s really scary…we see everyday people showing up thinking they were using cocaine, and there’s fentanyl present in the methamphetamine, or there’s fentanyl present in the cocaine supply. It’s so common.”

Sledge said some patients aren’t even aware they took fentanyl until it shows up in a drug screening.

Sledge was slightly surprised at the subtle decrease in overdose deaths in Davidson County, partly due to the deadliness of fentanyl and because Cumberland Heights hasn’t seen a decline in the number of patients seeking treatment. He suspects part of the reason for the decline is because more people have access to the overdose reversing drug, Naloxone, which is now available over-the-counter.

“I think people with opioid use disorders have accepted overdose as the cost of doing business, and I think the presence of at-home naloxone is much more prevalent than it has been,” Sledge said.

To read MPHD’s full drug overdose Quarter 3 report, click here.