In 1989, Ernesto Cruz, a deep-cover DEA agent, leads a troop of DEA agents against a militia in a jungle to take some information on Papa Muerte. After the attack, Ernesto is thrown from a plane and killed: his C.O. Colonel Trust believes it's a drug overdose. Ernesto's son Tommy, a high-ranking DEA agent, goes to Mexico and finds Marco, who is his primary contact with Morales Cartel. Tommy destroys a Virgillo gang convoy and their gas station but is seriously wounded by a grenade explosion. With no alternative, Tommy calls his younger brother Ramiro, an imprisoned criminal, to take the job.

Ramiro then goes to the jungle to Montanez's military base, extracting information about Papa Muerte and the DEA spy. Ram engages and kills Montanez, escaping the jungle. Trust finds out that Papa Muerte had planned to sneak into the DEA and steal the contraband cocaine which the DEA had seized, leaving a bomb to cover their tracks. Ramiro waits at Angel's apartment for extraction, only to find Papa Muerte's henchmen trying to kill him: meanwhile, Agent Johnson reveals himself as the Eagle and induces Tommy and Trust with a lethal drug overdose, although Tommy is able to patch Ramiro in to hear that Johnson had kidnapped Angel and killed their father. Ramiro returns to the DEA, fighting through Muerte's henchmen to save Tommy and Trust with an antidote while Johnson escapes on an armored train with Angel. Using a locomotive to carry the bomb away, Ramiro pursues and boards Johnson's train. Johnson, separating the coaches from the engine, battles Ramiro until Trust sends air support to destroy a canyon bridge ahead: Ramiro rescues Angel, and they jump over the broken rail on a dirtbike as the train falls into the canyon, dragging a trapped Johnson to his doom.


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It's a total mishmash of ideas, and they flood out of its pea-sized brain like it probably thinks the dirty foreigners flood over its precious borders. In the first 15 minutes I zip-lined, shot and then flew my dead father to his death, took over my twin brother and broke his leg, turned out to be the black sheep of the family and learned around 20 specific game mechanics one by one, and got to free-roam around US/Mexican border towns while being told about a billion different icons and points I could build up.

In this post, we build on past tracking analyses and use provisional federal mortality data to assess the level of overdose mortality during the first nine months of 2022 compared to previous years, the impact of synthetic opioids on overdose rates, and how trends varied by state.

An estimated 79,117 Americans died from drug overdoses between January and September 2022, fewer than the 81,155 people who died during the first nine months of 2021, but still 50 percent higher than pre-2020 levels.

Provisional estimates suggest that during the first nine months of 2022, 30 states had fewer overdose deaths than during the same period in 2021. In that year, nearly every state experienced a record number of overdose deaths. There were notable decreases in West Virginia, Kentucky, and Ohio, which have experienced some of the highest overdose mortality rates in the country.

But many states experienced higher mortality rates, including South Carolina, Texas, and Washington State. During the first nine months of 2022, nearly every state had overdose mortality at least 20 percent higher than the same nine-month period in 2019. In 25 states, it was at least 60 percent higher.

In 2012, synthetic opioids were involved in 6 percent of 41,502 overdose deaths. That figure quickly climbed to 18 percent of 52,404 deaths in 2015, 51 percent of 70,630 deaths in 2019, and then 66 percent of 106,699 deaths in 2021. Provisional data suggest this will edge even higher for 2022.

The impact of synthetic opioids did not hit all regions of the U.S. at the same time. In 2015, synthetic opioids were involved in at least 25 percent of overdose deaths in 11 states. By 2018, that number had grown to 28 states, with the impact concentrated in the Northeast, Appalachian, and Midwestern regions. Western states were less affected.

The Biden administration has highlighted some of these priorities in its past two budget proposals, including requesting additional funding for overdose surveillance data, syringe-service programs, and harm-reduction services.

States and localities will have near-term opportunities to fund policies and programs as opioid settlement funds begin to arrive. Their willingness and creativity in deploying those resources and reforming policy can play a meaningful role in saving lives and slowing the overdose crisis.

The new data show overdose deaths involving opioids increased from an estimated 70,029 in 2020 to 80,816 in 2021. Overdose deaths from synthetic opioids (primarily fentanyl), psychostimulants such as methamphetamine, and cocaine also continued to increase in 2021 compared to 2020.

The biggest percentage increase in overdose deaths in 2021 occurred in Alaska, where deaths were up 75.3%, while overdose deaths in Wyoming did not increase at all in 2021 and deaths in Hawaii declined 1.8% from the same point in 2020. The visualization includes:

NCHS releases both reported and predicted provisional drug overdose death counts each month. They represent the numbers of these deaths due to drug overdose occurring in the 12-month periods ending in the month indicated. These counts include all seasons of the year and are insensitive to variations by seasonality. Deaths are reported by the jurisdiction in which the death occurred.

Background:  New Mexico has the highest rate of drug-induced mortality in the United States. The contribution of prescription drugs to the total overdose death rate has not been adequately described.

Methods:  A total of 1,906 unintentional drug overdose deaths occurring in 1994 to 2003 in New Mexico were analyzed. Unintentional drug overdose death was defined as death caused by prescription, illicit, or a combination of drugs, as determined by a pathologist. Deaths were investigated annually by the medical examiner and data were analyzed in 2004-2005. Rates and trends of total and prescription drug overdose death were calculated, decedent characteristics were analyzed, and common drug combinations causing death were described.

Results:  The rate of unintentional prescription drug overdose death increased by 179% (1.9 to 5.3/100,000) from 1994 to 2003. A high percentage of prescription drug overdose decedents were white non-Hispanic (63.2%) and female (43.9%). These decedents were older and less frequently had alcohol listed as an additional cause of death than decedents of other drug overdose categories. Of all deaths caused by prescription drug(s) (n =765), 590 (77.1%) were caused by opioid painkillers, 263 (34.4%) by tranquilizers, and 196 (25.6%) by antidepressants.

Conclusions:  The rate of prescription drug overdose death in New Mexico increased significantly over the 10-year study period. Comprehensive surveillance of drug overdose deaths is recommended to describe their occurrence in the context of both medical and diverted use of prescription drugs. Understanding decedent profiles and the potential risk factors for prescription drug overdose death is crucial for effective drug overdose prevention education among healthcare providers.

Lives are being saved everyday thanks to increased engagement and response by City staff and community providers offering outreach, overdose education, referrals to treatment, and naloxone on the streets of the neighborhood and at the Tenderloin Center.

The following dashboard shows the number of overdose reversals recorded by Emergency Medical Services (EMS) responders each week. Overdose reversals involve the administration of naloxone, a medication that can rapidly reverse an opioid overdose, and are performed by EMS or another responder prior to EMS arrival.

The chart compares the number of overdose reversals within the Tenderloin to the number of overdose reversals outside the Tenderloin. Combined, these two numbers represent all EMS overdose reversals citywide. Clicking on a column in the chart will filter the data for that week. Weeks are represented by an operational period (OP), which begins on Monday and ends the following Sunday.

Use the buttons at the top of the chart to toggle between viewing total overdose reversals and viewing overdose reversals within the Tenderloin by location type, such as on the street or in a private residence.

Naloxone is a medication that can rapidly reverse an opioid overdose. The Tenderloin Center and its Public Health Street Outreach team partners provide naloxone to people who use drugs and their peers to help prevent overdose deaths. These outreach teams include:

The dashboard below shows the number of doses of naloxone distributed by staff at the TLC and by Street Outreach teams. The card at the top shows the total doses distributed over time by both groups. The clustered bar chart shows the number of doses distributed by the TLC (in orange) and by Street Outreach teams (in blue) by week. Each week is represented by an Operational Period (OP), which begins on Monday and ends the following Sunday. Hover your mouse over one of the bars to see the total number of doses distributed by both groups for each Operational Period. The table shows the same information.

The City and its community partners provide naloxone to people who use drugs and their peers to help prevent overdose deaths. When a client requests a refill of naloxone at the TLC, they can report how they used previous doses. This includes the number of overdoses they helped to reverse with naloxone.

This data is incomplete. Not all overdose reversals are reported, and the TLC is one of many programs distributing naloxone. Nonetheless, this data helps reveal the lives saved by community members with additional doses of naloxone made available by the TLC.

NCHS released the next set of monthly provisional drug overdose death counts that provide data through December 2022. The monthly counts are released under the Vital Statistics Rapid Release program as an interactive data visualization and are available at -overdose-data.htm. 006ab0faaa

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