New drug combinations, limited emergency resources in some rural communities, and overdoses in jails and prisons have contributed to rising fentanyl deaths in Oklahoma. 

Data from the state Bureau of Narcotics shows that 748 people in Oklahoma died of overdoses related to fentanyl in 2023, an increase of 21% over the previous year. Fentanyl overdose deaths in Oklahoma have grown by more than 1,300% between 2019 and 2023, according to state data. 

Fentanyl has proliferated so quickly because it’s cheaper to make than other drugs and can be mass-produced in a few hours, said Mark Woodward, a spokesperson for the Oklahoma Bureau of Narcotics. 

State officials are concerned about reports across the country of fentanyl being mixed with xylazine and nitazenes, which can increase the drug’s potency and extend a user’s high, he said.

“New chemicals are popping up every day that can boost the strength of the drugs on the streets, and that means more profit,” Woodward said. 

Many people ingest other drugs that they don’t realize are laced with fentanyl, and they become addicted, said Amanda Hammack, director of addiction and recovery services at behavioral health provider CREOKS Health Services.  

About 70% of fentanyl deaths in 2023 also involved methamphetamine or another drug, according to Oklahoma Bureau of Narcotics data. Those deaths include situations where a person intentionally took multiple drugs and cases where they ingested one drug mixed with fentanyl, according to the agency. 

While the urban areas of Tulsa and Oklahoma City had the most fentanyl-related deaths, rural parts of the state had some of the highest fatal overdose rates over the past several years. 

In 2022 and 2023, Pawnee County in northeastern Oklahoma had fentanyl-related death rates that were about twice the statewide death rates for fentanyl. 

The Oklahoma Department of Mental Health and Substance Abuse identified Pawnee County as a priority area and partnered with Oklahoma State University to focus drug prevention efforts there, said OSU Community Wellness assistant director Chuck Lester. 

About 15,900 people live in the county, which Lester said means that just a few overdose deaths can make the difference between an average and relatively high death rate. 

But death rates for all drugs have been consistently higher in Pawnee County than the rest of the state over the past several years, state health department data shows. Methamphetamine was the leading cause of drug deaths in Pawnee County between 2018 and 2022, followed by fentanyl. 

Oklahoma State University’s prevention services team works with local entities like the Pawnee Nation to provide education. They also distribute naloxone and lock boxes to store medication safely. But Lester said a lack of hospitals in some rural communities presents a challenge in emergencies. 

The Pawnee Municipal Hospital closed in 2007. The Cleveland Area Hospital, which is a 23-minute drive from the city of Pawnee, is the only hospital in the county. 

Muskogee-based nonprofit Neighbors Building Neighborhoods provides education on alcohol, tobacco and opioid misuse in Muskogee, McIntosh, Haskell, Pittsburgh and Wagoner counties in eastern Oklahoma. All five counties are rural, but Muskogee County had the highest average fentanyl-related death rate in the group from 2019 to 2023. 

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Neighbors Building Neighborhoods focused on the cluster of rural counties because of the lack of nearby resources, said Lindsey Roberts, the organization’s director of prevention programs. While Muskogee has several hospitals, she said other parts of the county are further from emergency healthcare. 

“Life-saving measures have to be held close, and if you’re rural and you don’t have access to the healthcare or hospitals close by, it absolutely makes a huge difference in being able to save those lives,” Roberts said. 

Cuts to Medicaid being considered in Congress could have profound effects for healthcare facilities across the state, said Rich Rasmussen, the president of the Oklahoma Hospital Association. He said some rural hospitals will lose financial stability and might have to cut departments like behavioral health services or close. 

“The only real response they will have is to provide an antidote to the overdose in the emergency room,” Rasmussen said. “That’s what you’ll be left with.” 

Drug overdoses continue in state custody 

Data from the Oklahoma Department of Corrections shows that deaths involving alcohol or drugs have gradually increased since 2014. There were 30 related deaths in 2023. Staff at prisons across the state have also responded to 530 non-fatal overdoses over the past two years, an agency spokeswoman said. 

The state Medical Examiner’s Office has analyzed 23 overdose deaths so far that occurred in jails and prisons in 2024. Of those, 12 involved fentanyl. At least two detainees at the Oklahoma County Detention Center died of fentanyl-related overdoses. 

About a third of the charges filed against detainees in the facility in mid-January were drug-related, said Mark Opgrande, a spokesman for the jail. 

Detention officers carry naloxone with them, and extra boxes are located throughout the facility, Opgrande said. Staff are trained on identifying potential overdoses and handing off inmates to medical professionals, said Mark Winchester, the jail’s medical director.

Employees have started giving detainees medical assessments as they’re booked into the jail to determine sooner if they need to go to a hospital, Opgrande said. He said detecting fentanyl coming into the jail hasn’t been easy because even a tiny amount can be lethal. 

Some detainees have been criminally charged for smuggling drugs into the county jail. Two men were charged with murder for the fentanyl-related overdose of another detainee in January. Sometimes the guards are also involved with bringing in contraband. 

“The goal is the processes get better and better and better,” Opgrande said. “But it is a fight. It’s always a fight, because there’s always new drugs on the market. There’s stronger drugs.”