Dr. Richard Dart joined the in 1992, after working at a poison center in Tucson, Arizona. Since then, the Denver-based Rocky Mountain Poison and Drug Safety, which includes the poison center and related research, grew from about 30 employees to 150, added a surveillance system to monitor prescription drug misuse, and led a clinical trial that changed how hospitals treat venomous snake bites.

The center’s staff, who are employed by Denver Health, answer calls from Colorado, Montana, Nevada and Hawaii.

Dart and the Rocky Mountain Poison Center have been leaders in expanding how centers contributed to health care and public safety, and quite a few younger toxicologists and poison center directors were trained there, said Dr. Alan Woolf, a professor of pediatrics at Harvard Medical School who has worked with poison centers since the 1980s.

Dart’s tenure coincided with technological advances that allowed poison centers to respond more quickly and to better use their call data, Woolf said. Before personal computers, they had to rely on microfiche records of the thousands of products people could ingest and kept call records on paper, limiting the ability to do research, he said.

“I think Rick can be very proud of the role he played over the last 30 years,” he said.

While most people know poison centers as resources to call if their child swallows something potentially dangerous, they also train toxicologists and produce research on what substances Americans are ingesting, intentionally or not.

One of the Rocky Mountain Poison Center’s biggest accomplishments during Dart’s tenure was helping to pull off a clinical trial for a new rattlesnake antivenom, which became the preferred option in the early 2000s, he said.

Studying antivenoms is difficult because any given hospital will only see a few rattlesnake bites each year, which the poison center overcame by involving 15 medical centers and ensuring those hospitals’ emergency room doctors knew to randomize whether patients received only the old antivenom, or the new one in addition. They quickly realized patients getting the new one had better outcomes.

“You have to make sure that when that patient comes, you’re ready,” Dart said. “Luck favors those who are prepared.”

Dart also oversaw Denver Health’s acquisition of the or RADARS, which tracks misuse of prescription drugs with data from poison centers, reports from about 200 law enforcement agencies and surveys of the general public and people entering addiction treatment.

The U.S. Food and Drug Administration requires drugmakers to conduct studies about misuse of their products, and most contract with RADARS to do that work, Dart said.

Purdue Pharma, the now-bankrupt maker of OxyContin, created RADARS in 2001, then sold it to Denver Health for $100 cash and $10 million worth of reports.

with advocacy groups including Public Citizen and Physicians for Responsible Opioid Prescribing, as well as some individuals who lost family members to overdoses, urging the FDA not to work with RADARS.

Advocacy groups, including Public Citizen and Physicians for Responsible Opioid Prescribing, have alleged that RADARS is too close to drug companies and provides scientific cover for their products. But Dart maintains that the system is entirely independent.

RADARS offered an early warning about misuse and addiction from prescription opioids, especially generic forms of oxycodone, Dart said. Purdue became one of the main villains of the opioid epidemic in the public mind because of their unethical sales techniques, but most people misused cheaper generic versions, he said.

“While Purdue did some very inappropriate things and are getting their just deserts, I think, OxyContin wasn’t the problem,” he said. “OxyContin never had more than a few percent of the market.”

In general, the data RADARS collected from people seeking treatment showed price, availability and purity matter most to those who use illicit drugs, which foreshadowed the shift from prescription opioids to heroin and fentanyl following a government crackdown on pill mills, Dart said.

They haven’t yet been able to answer how many people would have preferred to keep using prescription pills, if not for the crackdown, and how many switched to heroin or fentanyl because they offered a stronger effect for the same price or less, he said.

“There was this demand, and people are going to fill it,” Dart said.

It also tracked the rise of polydrug use. About half of people who reported using one recreational drug also said they used others when Denver Health purchased RADARS in 2006, but now 80% to 90% take two or more drugs, Dart said.

That suggests people aren’t especially particular about seeking one experience, he said — they just want to feel something different than they would without drugs.

“State government, federal government, they focus on one drug at a time,” he said. People who use drugs “just go to something else.”

Like many providers around the country, UCHealth sent Houk to , an Englewood-based medical device company that manufactures and sells instruments used for pain management and rehabilitation.

When insurance didn’t cover the , Zynex promised Houk that she could make 10 payments of $25 to cover the cost. What the Westminster patient didn’t know was that this would kick off a year of fighting with a company determined to bill Houk and her insurance providers as often as possible.

The company billed her old insurance. It billed her new insurance. And it sent her bills for more than $2,000 for the $250 device, when she was already paying it off in installments.

“The billing was relentless and terrifying,” Houk said in an interview.

Houk was one of numerous Coloradans caught up in what federal investigators say was a years-long scheme by Zynex to oversupply medical devices and overbill patients seeking opioid-free pain relief. A federal grand jury indicted two former top executives in January, accusing them of orchestrating the fraudulent practices that netted Zynex nearly $1 billion. The company last month avoided further prosecution by admitting to participating in a conspiracy to commit health care fraud, securities fraud, mail fraud and other violations.

Former Zynex employees, in interviews with The Denver Post, said they felt uncomfortable following directives that were unethical or outright illegal. The company routinely fell behind on paying vendors, even as leadership touted rapid growth and record revenue. Staff said they were instructed to continue sending devices and supplies to patients, even when they didn’t request them. Executives told workers not to tell Medicare and Medicaid patients that they would be on the hook for the devices if their insurance didn’t cover them.

“It felt like that was poor business practice to essentially lie to your patients and scam them and create a bad reputation for the company,” said Cori Latousek, a former Zynex employee.

More than a dozen patients told The Post they received supplies that they didn’t order and didn’t need. The scheme has prompted a host of lawsuits from insurance companies and shareholders who say they were duped by Zynex.

At the top of the pyramid stood a chief executive officer who marketed the company’s work as the antidote to the opioid epidemic. Thomas Sandgaard started a to help fund alternatives to painkillers and on the opioid crisis. He was also known for driving expensive sports cars, playing guitar around the office and promoting himself at every turn, former employees say.

Zynex served as a Colorado startup success story — a one-man operation turned public company with hundreds of millions of dollars in revenue. This is the story about how it all fell apart.

Sandgaard, a Castle Rock resident, remained in federal custody as of late February, according to the U.S. Marshall’s Office. His attorney, when contacted by The Post, said he was no longer working on the case. Anna Lucsok, Zynex’s former chief operating officer, who was also indicted, is free on bond. Her attorney, Bill Leone, said, “the allegations in this indictment are just that — allegations. We look forward to vindicating our client at trial.”

Zynex, in a statement, said the company, in its deal with the Justice Department, “took responsibility for past business practices implemented by former company executives.”

“Our new management team is committed to the highest standards of integrity and compliance in everything we do, so we can better serve patients who can truly benefit from our prescription medical devices,” the company said. “We have completely broken from the past and look forward to closing this chapter and making an important contribution to the health care needs of Americans living with chronic pain.”

Rapid growth fueled by ‘moral conundrums’

Sandgaard, a dual citizen of the U.S. and Denmark, founded Zynex in 1996 after a career in the semiconductor, telecommunications and medical equipment industries. He positioned the company’s products as a safe alternative to opioids through the development of electrotherapy technology that alleviates chronic pain.

In February 2019, the company went public. Sandgaard that would help expand the Zynex team.

Rapid growth followed — and industry watchers started taking note.

The company ranked 13th in revenue growth among all medical device companies in the U.S. and Canada on Deloitte’s 2020 Technology Fast 500. Jim Cramer, the popular host of “Mad Money” on CNBC, in 2021 .

Zynex, in the first quarter of 2023, reported 36% year-over-year revenue growth. Orders increased 61%. The following quarter, revenue jumped 22%.

At the end of 2024, Sandgaard said his company hit , and he expected to see 10% to 15% growth in 2025.

“The company is built by our employees,” the founder said in a .

Privately, though, many of those same employees grew concerned over how Zynex was making its money.

Latousek served as a territory manager in Seattle, targeting physical therapy, pain clinics and surgery centers for business. The sales pitch: non-opioid pain management.

She recalled leadership instructing her not to tell patients who received the devices that they automatically get enrolled for supplies, such as batteries and electrodes. Many patients, as a result, she said, received charges that they didn’t authorize.

“That felt really sketchy,” Latousek said. “I would always tell my patients to make sure they opted out.”

Most of the time, Medicare wouldn’t cover the stimulation device or the electrodes. When Zynex dealt with these patients, staff said they told them it cost $250 out of pocket.

But in the spring of 2021, leadership changed the directive. Going forward, the policy was to not tell Medicare patients the cost if their insurance didn’t cover it, former employees said.

“We’re pretty much locking in older vulnerable people on Social Security or fixed incomes who don’t have much money,” said one former Zynex worker, who spoke to The Post on the condition of anonymity because they feared career consequences for being associated with the company.

This led to constant “moral conundrums,” the former employee said. They recalled phone calls with elderly patients who said they couldn’t afford the device. Yet Zynex still found a way to send them the units, charging them $250.

When this employee brought up concerns from staff that they were taking advantage of people, they said they were let go.

“I never felt good,” the individual said. “Me getting fired was definitely a blessing.”

Former Zynex staffers said this occurrence was common: Workers who expressed concerns about the company’s practices would be fired or reassigned to different roles. As a result, few employees stayed for long, outside of top executives.

Meanwhile, Zynex was often late paying vendors, employees said. The company offered to pay half if it could receive some of the inventory — an arrangement that left workers feeling uncomfortable.

People in the buying department quickly grew alarmed that their supply orders for batteries and electrodes were so steady. Normally, in this business, there should be fluctuating inventory levels based on customer demand, employees said. But at Zynex, the numbers remained constant.

That was because they were shipping batteries and electrodes over and over to the same patients, these workers said they realized. Many people would return the packages to the warehouse with notes telling Zynex to stop sending them supplies.

Unwanted supplies, unexplained bills

More than a dozen patients told The Post that they received supplies from Zynex that they never ordered and didn’t need.

Josh Kahn, 39, underwent a spinal fusion in 2023, and his surgeon recommended an electrical nerve stimulation machine. The Denver resident got a prescription for the Zynex device.

The implement worked well, Kahn said, but every month he received batteries and electrodes that were unnecessary given his usage of the machine. He stuffed a drawer with all the supplies.

In January 2025, Kahn asked Zynex to discontinue the recurring orders. The company acknowledged his request.

But Kahn continued to get charged $45 a month for the device and supplies, according to the bills he provided to The Post.

“This is becoming a nuisance,” he told the company in an email.

Chris Basser, 49, used a Zynex machine for a back injury he sustained in 2021 after getting hit by a drunk driver. Medicaid covered everything, the Colorado Springs resident said, but he still received packs of six or nine batteries every three weeks.

He said he tried calling the company to cancel the orders, but nobody ever responded. He eventually gave up.

“I thought it was maybe a miscommunication,” Basser said. “I didn’t think of fraud.”

It didn’t seem to matter whether patients paid their bills. Zynex continued to demand payment.

For nearly four years, Zynex has been seeking $250 from Michael Raizen, despite the Denver resident negotiating a deal with the company to pay for his device.

“It’s like a bad rash,” Raizen’s wife, Gail DeVore, said. “No matter what you do, you can’t get rid of it.”

Sports cars, electric guitars and giant banners

Sandgaard served as the face of Zynex — and he wasn’t shy about letting everyone know.

The CEO showed up to the Englewood office in a sports car, and liked to walk around the office with his electric guitar, blasting music, ex-employees said. One former staffer recalled carrying around his amp and handing out T-shirts “like a little groupie.”

Sandgaard hung a large banner on the fourth floor, a spoof of a in which the Zynex founder is holding a machine gun in one hand, a bald eagle perched on his other arm. He’s standing on a fiery hill with a white Zynex flag behind him. Dollar bills flutter around his feet.

“He came off as a man incredibly full of himself,” the former staffer who felt like a groupie said, speaking on the condition of anonymity due to fears about future career consequences. “It felt very toxic male CEO.”

Complicating matters was the fusion of Sandgaard’s professional and personal lives.

He was in the midst of a divorce when he enlisted the services of a local psychologist, Dr. Raelynn Maloney. In 2014, the two started dating.

Despite the Zynex founder boasting about the company’s success, Maloney learned that Sandgaard and his firm had accrued significant debt and had exhausted lines of credit, she alleged in a 2025 lawsuit against him and the company.

Desperate, Sandgaard asked Maloney to help save Zynex, she said. The psychologist started attending high-level meetings as an unpaid consultant.

Without the ability to obtain financing, Sandgaard regularly asked Maloney for loans for himself and the company, she alleged. Maloney put up more than $1.1 million in personal assets as cash or collateral throughout 2023 so Sandgaard and Zynex could avoid bankruptcy, the complaint alleges.

Sandgaard eventually bought a house for Maloney and her daughters. She quit her private practice to join Zynex full-time, serving as the head of customer service, billing and parts of human resources, Maloney alleged.

In 2020, Sandgaard , and asked Maloney to help turn that organization around as well, she said.

Eventually, Sandgaard started to pull away from Maloney, she said in the lawsuit. He began seeking sexual experiences with their mutual friends, colleagues and former Zynex employees, she alleged. He sexually harassed his staff, Maloney said, and even put her in charge of handling several sexual harassment complaints made by employees.

“I guess you’re not going to have your fairytale ending,” Maloney said Sandgaard told her.

Maloney did not respond to messages seeking comment. Her lawsuit remains open.

Sandgaard, in court filings, called the complaint a “vengeful recounting of events regarding her romantic breakup.” The lawsuit, his lawyers wrote, “is nothing but a punitive attempt to punish her ex-partner and seek financial relief for the benefits she can no longer reap from their relationship.”

Zynex begins to crumble

The facade eventually started to crumble when insurance providers began to catch on to the scheme.

In December 2024, , the health insurer for service members, suspended payments to Zynex “based upon credible allegations of fraud and its audit of Zynex’s billing,” according to Sandgaard and Lucsok’s indictment. That move represented a huge blow to the company’s business, as TRICARE accounted for a quarter of its revenue.

Other payors also stopped reimbursing Zynex.

, in September 2025, said it had paid out more than $3 million in bodily injury claims to Zynex based on “false and fraudulent records,” the insurer alleged in a federal lawsuit filed in New York.

Zynex, the insurer said, “abused Allstate’s claimants’ insurance coverage by billing for (durable medical equipment) that” Zynex “had no legal right to collect.”

Sandgaard and Lucsok concealed TRICARE’s suspension until March 2025, federal prosecutors said. After the news came out, Zynex’s stock dropped by 51% in one day, dipping to $3.41 per share from $7.

Two days after the disclosure, Sandgaard sold $4.8 million of his stock, even though the company could not afford to buy it back, the indictment states.

Records show Sandgaard and the company as a whole suffered from serious financial woes.

Between 2015 and 2025, the Zynex founder personally racked up more than $321,000 in unpaid taxes to the , court records show.

In December, Zynex filed for Chapter 11 bankruptcy protection, listing assets of more than $45 million and debts exceeding $86 million. Among the creditors: U.S. Bank (owed $61.75 million), TRICARE (owed $2.77 million) and the Polsinelli law firm (owed $1.14 million). Maloney is also listed with an “undetermined” claim.

On Jan. 14, a federal grand jury in Rhode Island on charges of conspiracy to commit mail, health care and securities fraud, among other counts.

Federal prosecutors alleged what patients, Zynex employees and insurance providers had been saying for years: The company was billing for and sending people devices and supplies that they didn’t request and didn’t need.

The company collected more than $873 million for its products, including more than $600 million for supplies, “the vast majority of which were the result of fraud,” the government alleged.

Between them, Sandgaard and Lucsok used their sizable earnings to pay for a private jet, a Lamborghini, the McLaren sports car, cosmetic procedures, real estate and the British soccer club, investigators said.

“This case represents a troubling abuse of patients seeking care, as well as the federal health care benefit system,” U.S. Attorney Charles C. Calenda said in a statement announcing the charges.

On Feb. 17, the Justice Department announced Zynex to avoid prosecution, admitting to the long-running scheme. Zynex also agreed to pay up to $12.5 million in fines and forfeit all unpaid claims.

Sandgaard and Zynex also face numerous lawsuits from insurers, patients and shareholders, who say they were duped by the Colorado company.

For patients who used Zynex devices and employees who worked for the Englewood company, the indictment represented an unsurprising turn of events, while also serving as validation that their suspicions were not wrong after all.

“What they were doing was shoveling as much money into their own coffers as possible,” said Houk, the patient who kept getting billed. “It was utterly relentless. A lot of people got hurt by this.”

Naloxone, sold under the brand name Narcan, counters the effect of opioids so that a person who is overdosing doesn’t stop breathing. For the last decade, Colorado has had “standing orders” that allow anyone to buy it without a prescription.

In 2023, the , sparking additional public discussion about the option to carry the lifesaving drug.

Colorado residents bought 743.7 doses of naloxone for every 1 million residents in the first year after it became legal over the counter in September 2023, . That was more than 80% higher than the national average of 396 units per million people, and behind only Oregon.

In Colorado and nationwide, , then dropped rapidly. Across the country, pharmacies dispensed almost 18 units of naloxone for every one unit purchased over the counter, and state-funded programs distributed 30 units for every one unit bought at retail.

Over-the-counter naloxone costs about $40 for a two-pack of the single-use spray. While Medicaid covers it in Colorado, commercial plans may charge co-pays.

Doctors also commonly prescribe naloxone to patients who receive opioids for pain following an injury or surgery. Depending on the size of the co-pay that their insurance charges, prescribed doses can be cheaper than those purchased over the counter. Patients may be more likely to follow through if they don’t have to remember to pick up an over-the-counter product while the pharmacy fills their painkiller prescription.

“Over-the-counter naloxone is an avenue to get naloxone into communities, but it pales compared to naloxone filled in pharmacies or distributed” by nonprofits, said Rachael Duncan, a pharmacist and associate director of the Naloxone Project.

While over-the-counter purchases may account for a relatively small share of naloxone distribution, they are an important way to allow lower-risk people to contribute while letting harm-reduction groups focus on those most likely to respond to an overdose, said Lisa Raville, executive director of the Harm Reduction Action Center in Denver.

People who use drugs respond to a disproportionate share of overdoses, both because they’re often nearby and because they don’t feel comfortable calling 911, she said.

“We had a whole bunch of moms coming to us wanting naloxone, and we didn’t have it to give them,” Raville said. The center only has enough to give the antidote to the highest-risk people, who also use drugs.

Studies estimated 80% to 90% of overdose reversals involve a rescuer who also uses drugs, rather than a first responder or another type of bystander, .

Raville is concerned that access could take a hit in the coming years, though, if Colorado can’t find a sustainable funding source.

In 2022, the legislature appropriated $20 million for the Opioid Antagonist Bulk Purchase Fund, commonly called the naloxone bulk fund, but most of it came from federal pandemic recovery funds that expire at the end of 2026. The fund purchases naloxone at cheaper rates and delivers it to organizations that distribute it to end users.

Projections show the bulk fund will have enough money to continue purchasing and distributing naloxone for organizations working with the highest risk groups through December 2026, said Paul Bishop, spokesman for the Colorado Department of Public Health and Environment.

The fund , which also have a clear distribution plan and can track how many kits they gave out, he said. In the fiscal year that ended in June, the bulk fund distributed about 411,000 doses to 390 organizations, .

The goals of getting naloxone into the hands of anyone willing to carry it and focusing on people most likely to use it can be in tension if groups don’t have enough funds to do both, Duncan said. But naloxone’s long shelf-life somewhat mitigates that: doses that go to people who may not need to use them for years aren’t wasted, she said.

The Naloxone Project doesn’t receive donations from the bulk fund and relies on private fundraising to supply hospitals and first responders with doses patients can take home.

Most hospitals already offer naloxone to anyone treated for an opioid overdose and to new mothers deemed high-risk, because overdoses are essentially tied with suicide as the top cause of death during the postpartum period, Duncan said.

While they can’t know if patients use those doses once they go home, overdoses among new mothers dropped from 20 in 2022 to eight in 2023 – a 60% decline, she said. During the same period, overdoses among women of childbearing age in general declined 15%, from 321 to 278.

While they can’t be certain that naloxone distribution caused the greater drop among new mothers, the trend is encouraging, Duncan said. She and her colleagues started crying when they saw the numbers, because it had been so long since overdoses moved in the right direction, she said.

“To see this actually change is wild,” she said.

Offering naloxone on opt-out basis

Montrose Regional Health is piloting a program to offer naloxone to all pregnant patients during the first prenatal visit, and when they take their babies home.

Most decide to take it after learning they could use it years later if they happen to encounter someone in the throes of an overdose, said Jennifer Ackerman, director of women’s services at the hospital. Some say they’d like to have it on hand at work, or in case their older children experiment with drugs, she said.

“It’s kind of an opt-out instead of an opt-in,” she said. “It also takes away the bias” of deciding who might be at risk.

Offering it to high-risk people when they were about to be discharged from the labor and delivery unit produced “hit and miss” results, Ackerman said. Parents receive a great deal of information at discharge time and may not see naloxone as a priority, and providers don’t always have a full picture of risk in a household, she said.

Children’s Hospital Colorado is also piloting a broader distribution plan, offering naloxone to all families with babies in the neonatal intensive care unit as well as high-risk parents of healthy babies.

Ideally, hospitals would be able to offer it on an opt-out basis to anyone giving birth, since overdose risk increases during the postpartum period and babies put everything in their mouths once they’re mobile, said Dr. Stephanie Bourque, a neonatologist.

The hospital improved its screening in recent years to make the questions sound nonjudgmental, but not everyone will disclose substance use struggles even then, and parents may not know if other family members are using opioids, Bourque said.

“We weren’t doing a great job identifying who was at risk,” she said.

While most parents may not need to reverse an overdose, teaching all families prevents tragedies, in the same way that all parents learn about safe sleep and infant CPR, even though sudden infant death syndrome never affected most babies, Bourque said.

“This is just as normal as learning to put your baby on their back to sleep,” she said.

‘People don’t have to die’

Naloxone spray is easy to use, though people who aren’t experienced with drugs may inadvertently give too much because they think the person overdosing needs to wake up, Raville said. As long as the person is breathing, they aren’t in immediate danger, she said.

The experience can be scary, though, for people who haven’t seen an overdose before. Ideally, anyone willing to respond would get trained in advance, so they can give rescue breathing during the three minutes it can take for the naloxone to reach the brain and partially block the opioids, Raville said. The bulk fund offers a each month.

“It’s a miracle drug. You can’t mess it up,” she said. “The only issue is that you can’t really use it on yourself.”

Colorado has generally supported naloxone access; back in 2015, all members of the legislature voted in favor of allowing doctors to write standing orders so individuals who wanted to carry it didn’t need an individual prescription, Raville said.

Now, people are comfortable enough with it that parents pack it for their kids to take to college, just in case they or a friend decides to mix pills and alcohol, she said.

“People don’t have to die of overdoses,” she said.

Colorado agents alone seized more than 665,000 potentially deadly pills and 2.41 kilograms of fentanyl powder, the equivalent of 1.2 million lethal doses, DEA Rocky Mountain Field Division Special Agent in Charge David Olesky said.

The division’s other three states — Utah, Montana and Wyoming — seized another 387,000 pills and 1.04 kilograms of powder, about 520,000 lethal doses, according to the DEA.

Fentanyl is a deadly synthetic opioid that¶¶Ňőap pressed into counterfeit pills or mixed into heroin, cocaine and other street drugs. Federal officials believe 76,516 people died from drug overdoses between May 2024 and April 2025, according to the .

While that¶¶Ňőap a 24.5% decline nationally from the 12 months prior, Olesky said that overdoses in Denver remain “on record pace.”

“Most folks would never choose to do fentanyl,” Olesky said. “We really refer to the deaths that are happening around the country as poisonings because folks don’t know what they’re taking.”

As of Sept. 14, the date the was last updated, the city had seen a 22.1% increase in overdose deaths from that time in 2024.

Olesky described the October initiative, , as “comprehensive, blunt force,” where agents focused on cases with more immediate impacts “on a national and international level to disrupt the fentanyl supply chain.”

The ramped-up enforcement operations in October were unrelated to recent strikes on drug boats near Venezuela, Rocky Mountain Field Division spokesperson Steffan Tubbs said in an email to The Denver Post.

“Fentanyl Free America represents DEA’s unwavering commitment to save American lives and end the fentanyl crisis,” DEA Administrator Terrance Cole said in a statement. “DEA is striking harder and evolving faster to dismantle the foreign terrorists fueling this crisis, while empowering all our partners to join the fight to prevent fentanyl-related tragedies.”

The operation does not include the recent discovery of 1.7 million counterfeit fentanyl pills in a Douglas County storage unit, the largest DEA seizure in Colorado history and the sixth-largest on U.S. record.

In the last two years, the amount of fentanyl pills seized by the DEA containing potentially lethal doses dropped by nearly 50%, according to data from the agency. Just under 30% of pills tested by the DEA in the 2025 fiscal year contained a “potential lethal dose” of fentanyl, 2 milligrams or more, Olesky said.

“It¶¶Ňőap a good sign that potency is down, but when it¶¶Ňőap three out of 10 pills still with a lethal dose, it¶¶Ňőap still playing Russian Roulette with your life,” Olesky said. “…One pill can kill, but one conversation can save.”

Since 2021, nearly 325,000 Americans have died from synthetic opioids, according to the DEA.

Resources for families are available online at .

CHARLESTON, W.Va. (AP) — A federal appeals court on Tuesday overturned a landmark decision in West Virginia that had rejected attempts by an opioid-ravaged area to be compensated by U.S. drug distributors for a influx of prescription pain pills into the region.

The 4th U.S. Circuit Court of Appeals in Richmond, Virginia, ruled that a lower court judge erred when he said West Virginia’s public nuisance law did not apply to the lawsuit involving the distribution of opioids.

“West Virginia law permits abatement of a public nuisance to include a requirement that a defendant pay money to fund efforts to eliminate the resulting harm to the public,” the 4th Circuit wrote. “West Virginia has long characterized abatement as an equitable remedy.”

The ruling sends the case back to U.S. District Court in Charleston for “further proceedings consistent with the principles expressed in this opinion.”

Thousands of state and local governments have sued over the toll of opioids. The suits relied heavily on claims that the companies by failing to monitor where the powerful prescriptions were ending up. Most of the lawsuits were settled as part of a series of nationwide deals that could be worth more than $50 billion. But there wasn’t a decisive trend in the outcomes of those that have gone to trial.

In July 2022, of three major U.S. drug distributors who were accused by Cabell County and the city of Huntington of causing a public health crisis by distributing 81 million pills over eight years in the county. AmerisourceBergen Drug Co., Cardinal Health Inc. and McKesson Corp. also were accused of ignoring the signs that Cabell County was being ravaged by addiction.

Faber said West Virginia’s Supreme Court had only applied public nuisance law in the context of conduct that interferes with public property or resources. He said to extend the law to cover the marketing and sale of opioids “is inconsistent with the history and traditional notions of nuisance.”

Last year the federal appeals court to the state Supreme Court, which states: “Under West Virginia’s common law, can conditions caused by the distribution of a controlled substance constitute a public nuisance and, if so, what are the elements of such a public nuisance claim?”

The state justices declined to answer. That 3-2 opinion in May returned the case to the federal appears court.

“We hold that West Virginia’s highest court would not exclude as a matter of law any common law claim for public nuisance caused by the distribution of a controlled substance,” the 4th Circuit wrote Tuesday. “Therefore, we necessarily conclude that the district court erred when it held that a public nuisance claim based on the distribution of opioids was per se legally insufficient under West Virginia law.”

During arguments earlier this year before the state Supreme Court over the certified question, Steve Ruby, an attorney for the companies, called “radical” the plaintiffs’ arguments to extend the public nuisance law to opioid manufacturers. If allowed, he said, that would “create an avalanche of activist litigation.”

The appeals court previously noted that the West Virginia Mass Litigation Panel, which works to resolve complex cases in state court, has concluded in several instances that opioid distribution “can form the basis of a public nuisance claim under West Virginia common law.”

In his 2022 decision, Faber also said the plaintiffs offered no evidence that the defendants distributed controlled substances to any entity that didn’t hold a proper registration from the U.S. Drug Enforcement Administration or the state Board of Pharmacy. The defendants also had suspicious monitoring systems in place as required by the Controlled Substances Act, he said.

But the 4th Circuit Court found Tuesday that the lower court “misconstrued the distributors’ duties” under the Controlled Substances Act.

The plaintiffs had sought more than $2.5 billion that would have gone toward over 15 years.

In 2021 in Cabell County, an Ohio River county of 93,000 residents, there were 1,059 emergency responses to suspected overdoses — significantly higher than each of the previous three years — with at least 162 deaths.

The new grant comes as Colorado saw more than 300 fewer people die from drug overdoses in 2024, marking a 15.6% drop from 2023’s total, according to preliminary data released by earlier this month. The CDC projected that 1,701 people died from drug overdoses in the state in 2024.

The state saw an even steeper decrease in deaths — 31% — among those that involved synthetic opioids such as fentanyl, according to Weiser’s office. Officials credited the availability of naloxone, which has the brand name Narcan, for helping to blunt the health crisis.

Used appropriately, it can reverse the effects of an opioid overdose.

“Every life lost to an opioid overdose is one too many,” Weiser said in a news release. “This funding puts a proven tool in the hands of the people who need it most. We are using every resource available to protect communities, prevent overdoses, and support recovery.”

Denver also saw in the number of people who died from a drug overdose in 2024 compared to 2023. The city reported that 483 people died from an overdose last year, compared to 598 in 2023. That decrease followed a 32% surge in drug overdose deaths in Denver in 2023, as the overdose crisis peaked.

In both years, more than half the deaths involved fentanyl, methamphetamine, or a combination of the two.

However, recent numbers don’t portray a continued decline. In the first four months of 2025, Denver saw a year-over-year increase in the number of people who died from a drug overdose compared to 2024. City officials reported that 201 people died from a drug overdose from Jan. 1 to April 28, compared to 168 in the same period in 2024.

The will administer the new naloxone grant. The money comes from more than $132 million it has received through nationwide settlements with drug manufacturers and distributors, according to Weiser’s office.

The medication has proven extremely effective in stopping opioid overdoses, a leading cause of death among young people. The Lakewood Democrat personalized her letter, which was shared with The Denver Post ahead of it being sent to Kennedy, by invoking the traumatic experience her mother went through battling a decades-long addiction to pain pills after suffering a back injury.

“In one year alone, my mom overdosed more than 20 times and even overdosed three times in a single day. But she is one of the lucky ones,” Pettersen wrote. “Time and time again, she was administered naloxone, and eventually, she was finally able to receive the treatment she needed.”

The congresswoman asked for a meeting or a phone call with the Cabinet secretary to “discuss how to best help people survive this epidemic and get into recovery.”

The Trump administration is in the midst of proposing cuts to HHS’s funding and planning layoffs at the massive health agency as part of a larger effort to dramatically downsize the federal government. In 2023, there were nearly 1,300 overdose deaths due to opioids in Colorado, .

Specifically, Pettersen asked Kennedy to spare the potential elimination of the Overdose Prevention program and the First Responder Training program under the Substance Abuse and Mental Health Services Administration as part of the administration’s fiscal year 2026 budget request.

“As you know, both of these programs expand access to the life-saving drug, naloxone,” she wrote.

Her letter referenced as a young man to make her point.

“As an individual in recovery yourself, I trust that you are as committed as I am to addressing the opioid crisis head on,” Pettersen wrote.

She also invited him to visit Colorado’s 7th Congressional District to observe frontline workers administering naloxone, also known by its brand name Narcan.

Pettersen’s letter acknowledges some recent good news on the drug addiction and overdose front, with the U.S. Centers for Disease Control and Prevention predicting a nearly 24% decline in drug overdose deaths in the country for the 12 months ending in September 2024, compared to the previous year.

“Provisional data shows about 87,000 drug overdose deaths from October 2023 to September 2024, down from around 114,000 the previous year,” the . “This is the fewest overdose deaths in any 12-month period since June 2020.”

But Pettersen told Kennedy that “the substance use disorder crisis is far from over, and American lives are at stake.”

“This past August, my mom celebrated her seventh year in recovery, and I couldn’t be prouder of her. She serves as a powerful example of what is possible when people gain access to the treatment and services they need,” Pettersen wrote. “But the truth is, my mom wouldn’t be here if there hadn’t been naloxone on site each time she overdosed.”

House Bill 1326, which passed in 2022, lowered the threshold for felony charges to one gram from four grams of any drugs containing fentanyl. It also made selling a dose of fentanyl that killed someone a class-one felony, carrying a penalty of up to 32 years in prison — but prosecutors only filed nine cases in the first 10 months after the law changed.

Lawmakers included a provision requiring the state’s Behavioral Health Administration to commission a study about whether the change helped reduce overall overdose deaths or increase the number of people receiving medication to treat opioid addiction. Fentanyl was a factor in close to three out of every five Colorado overdoses in 2023.

The overall death rate from all overdoses remained essentially unchanged in the first 16 months after the law changed, by researchers at the University of Colorado School of Medicine and Kaiser Permanente Colorado.

Overdose deaths among Black Coloradans were higher than expected in four of the examined months, but other states that hadn’t changed their laws also saw more Black residents die during that time.

Dr. Joshua Barocas, the lead researcher, said Colorado’s overdose deaths moved in line with nationwide trends and projections from before the law changed.

“It didn’t reverse the trends,” he said.

U.S. Rep. Brittany Pettersen, a Democrat who was one of the bill’s sponsors when she served in the state Senate, said supporters didn’t expect to see a major decline in overdose deaths after the bill passed.

Law enforcement wanted another tool to pursue drug dealers, but the requirement that jails offer addiction-treatment medication and new funding for harm reduction were far more important, she said.

“We were working with police and impacted community members to walk that line and find a balance,” she said.

Some parts of the law hadn’t taken full effect during the period the researchers examined, including a requirement that jails offer the three major medications for opioid addiction treatment: buprenorphine, methadone and naltrexone.

Buprenorphine and methadone are milder opioids, which prevent people who are addicted from enduring painful withdrawal symptoms. Naltrexone blocks the pleasant effects of opioids, so people won’t want to misuse them.

The Behavioral Health Administration said in a statement that it would continue to monitor the effects of all changes in the law.

“It may be too early to fully assess the impacts of HB22-1326,” the agency’s statement said.

The data ended before overdose deaths started to drop last year. Nationwide, overdose deaths have fallen 26% from their peak in June 2023, meaning about 30,000 people survived last year who would have died if overdoses continued at their prior pace, .

Colorado hasn’t yet finalized its 2024 death data, but overdoses were on track to drop year-over-year.

The state’s overdose deaths slowly trended up over the last two decades, then spiked during the pandemic, which followed shortly after fentanyl arrived in the state’s drug supply. At the peak in 2021, 1,881 people died of overdoses, 912 of which involved fentanyl. While the total number of overdoses stabilized in 2022 and 2023, the share attributed to fentanyl grew.

No one knows if the nationwide decrease is because fewer people are using illicit drugs, the supply has become slightly safer, those who use drugs are taking more precautions, or some combination of the three. Some researchers theorize that the number of people vulnerable to overdose is down because so many died over the last few years.

People with opioid addiction were about equally likely to start either buprenorphine or methadone for treatment after the law changed as they were before, according to the report. They may have been less likely to stick with methadone treatment, though the authors cautioned that reporting standards for methadone clinics changed at that time, which could have influenced the results.

Barocas said he believes the drop is real, and worries that people were afraid to stand in line for methadone, knowing they would face higher penalties if caught with fentanyl. The percentage of methadone patients in treatment for six months dropped by half in the year after the law changed, with fewer than one in five sticking with treatment by the end.

“That’s my fear, that this acted as a deterrent to medication,” he said.

Then-House Speaker Alec Garnett, a Democrat and one of the bill’s sponsors, said at the time that he had to accept tougher penalties to gather enough votes to pass the treatment and harm reduction provisions. He declined to speak about the bill’s impacts through representatives for his current employer, UCHealth.

The third sponsor, then-Sen. John Cooke, a Republican, didn’t respond to phone messages.

The researchers will continue to look deeper into the data, to see how the law change affected different groups of people who use drugs, Barocas said. Interviews with law enforcement and people working in the addiction space suggest they don’t hold out much hope that any benefits will show up later, which is consistent with decades of research on punitive drug policies, he said.

“Colorado is no different than anywhere else that has been studied,” he said.

The deal, agreed to by Purdue Pharma, the Sackler family members who own the company and lawyers representing state governments — including Colorado — and thousands of victims of the opioid crisis, represents an increase of more than $1 billion over a that was rejected last year by the U.S. Supreme Court.

The Sacklers agreed to pay up to $6.5 billion, Purdue to pay $900 million, for a total of $7.4 billion.

It¶¶Ňőap among the largest settlements reached over the past several years in a series of lawsuits by local, state, Native American tribal governments and others seeking to hold companies responsible for a deadly epidemic. Aside from the Purdue deal, others worth around $50 billion have been announced — and most of the money is required to be used .

The deal still needs court approval, and some of the details are yet to be ironed out.

Joining Attorney General James in securing the settlement in principle are the attorneys general of California, Colorado, Connecticut, Delaware, Florida, Illinois, Massachusetts, Oregon, Pennsylvania, Tennessee, Texas, Vermont, Virginia, and West Virginia.

“The first lawsuit I filed to hold a drug maker accountable for creating and fueling the opioid crisis was against Purdue Pharma and the Sacklers in July 2019,” Colorado Attorney General Phil Weiser said in a statement. “That¶¶Ňőap because Purdue and the Sacklers profited off fueling a devastating opioid crisis that has greatly harmed communities and families across Colorado. After years of litigation, the Sacklers and their company are finally being held accountable for their wrongful conduct, and the funds we are securing will go to communities responding to the opioid crisis and working to prevent addiction and overdoses.”

Under the new proposal, members of the Sackler family who own Purdue would contribute up to $7.4 billion over 15 years and give up ownership of Purdue, which would become a new entity with its board appointed by states and others who sued the company. A portion of the money is also to go to victims of the opioid crisis or their survivors.

The family’s contribution will be higher than the $6 billion agreed to under the previous version. blocked the agreement last year because it protected members of the wealthy family from civil lawsuits over OxyContin — even though the family members themselves were not in bankruptcy. The new agreement protects family members from lawsuits only from entities that agree to the settlement.

There’s been mediation seeking a new deal since the court¶¶Ňőap ruling was delivered. If one is not reached, it could against Sackler family members.

The new settlement could bring to a close a chapter in a long legal saga over the toll of an that some experts assert began after the blockbuster painkiller OxyContin hit the market in 1996. Since then, opioids have been linked to hundreds of thousands of deaths in the U.S. The deadliest stretch has been since 2020, when has been found as a factor in more than 70,000 deaths annually.

Members of the Sackler family been and have seen their name removed from around the world because of their role in the privately held company. They’ve continued to deny claims of any wrongdoing.

Collectively, family members have been estimated to be worth billions more than they’d contribute in the settlement, but much of the wealth is in offshore accounts and might be impossible to access through lawsuits.

Purdue sought bankruptcy protection in 2019 as it faced thousands of lawsuits over the opioid crisis. Among the claims are that the company targeted doctors with a message that the addiction risk to the powerful painkillers was low.

In an October 2024 filing, one branch of the family pledged to defend itself in any cases that are allowed to move ahead, saying that the legal theory at the heart of the lawsuits — that Purdue and Sackler family members created a “public nuisance” — “is utterly devoid of merits.”

Still, experts and health officials cautioned, the data is preliminary and only covers the first six months of this year — and Colorado’s number of overdose deaths still remain well above pre-pandemic levels.

“Any improvement is good news,” said Rob Valuck, the executive director of the . “It certainly beats (a plateau) or going up, and it¶¶Ňőap something we desperately need. The two big messages I have are: The things we’re doing are working, and we still have a long way to go.”

Fatal overdoses in Denver dropped 11%, to 303 deaths, between January and July compared to the same period last year when the death toll was 341, according to data from the . Statewide, the fatal overdose rate per 100,000 residents declined 8% and the total number of deaths fell nearly 5% during the first six months of this year compared to 2023.

Final figures for this year won’t be available until the spring. But if those trends hold for the rest of 2024, it would mark a shift of years of increases or stubbornly high plateaus.

Statewide, as fentanyl replaced heroin as the dominant opioid in the drug supply, fatal from 912 in 2016 to 1,881 in 2021, and they’ve held at high levels since. Deaths in Denver flattened in 2022 only to surge by nearly a third, to 598 deaths, in 2023,

“It is encouraging to see overdose death rates dropping. It¶¶Ňőap not something we’ve seen for five years,” said Tristan Sanders, the director of community and behavioral health for Denver’s . “It’s nice to see the data go the way we want it to for once.”

But Sanders, like others, said the data was still preliminary and that overdoses still remained too high. Sanders cautioned that the national data showing declines still indicated that deaths remained high among minority groups, whose rates have surged amid the fentanyl crisis.

Nationally, fatal overdoses fell more than 14% between June 2023 and June 2024, “a stunning and rapid reversal of drug overdose mortality numbers,” .

Colorado officials urged particular caution about comparing the state’s data to national trends. While deaths from overdoses dropped nationally through June 2024, they effectively remained flat here: 1,820 Coloradans fatally overdosed between July 2023 and June 2024, compared to 1,837 over the same time period the year before, a 1% decrease.

More promisingly, though, Colorado’s data showed more significant declines in fatal overdoses caused by fentanyl and opioids more broadly.

“While there remains a 3-4 month lag in the complete registration and processing of this data, and the numbers for 2024 may change as the data are finalized in the coming months, we are hopeful this suggests the beginning of a downward trend, particularly in overdose deaths involving opioids and fentanyl specifically,” Vanessa Bernal, spokeswoman for the , said in an email.

Experts said a number of factors could help explain the declines:

• The state has distributed millions of dollars worth of naloxone, an opioid overdose antidote, to pharmacies, schools, hospitals, advocacy groups and individual citizens in recent years
• Efforts to expand treatment options — including by expanding Medicaid to cover substance-use care — appear to be breaking through
• Tens of millions of dollars in settlement money from companies involved in the opioid crisis has begun to flow to a variety of entities across the state and will continue to do so for nearly two decades

“We’ve worked really hard over the last decade to expand access. It’s not where it needs to be, but in Colorado, we went from an 85% treatment gap to now in the mid-to-upper 50s range,” Valuck said, referring to the proportion of people who need or want substance-use treatment but are unable to get it. “It¶¶Ňőap not great, but it’s a heck of a lot better than when it was 85%.”

indicate Colorado tripled its rate of naloxone distribution between 2019 and 2023, while improving its distribution of buprenorphine — a key medication used to treat opioid addiction — and curbing distribution of legitimate opioids from pharmacies.

Earlier this month, ‘s top official also announced that the agency had detected a decrease in the potency of fentanyl pills for the first time since 2021.

Perhaps most fundamentally, the public — and drug users themselves — are also likely more familiar with the potency and presence of fentanyl, which is far stronger than heroin or legitimate opioid pills. It has also spread to all corners of the drug supply, contaminating methamphetamine, cocaine and other substances — endangering drug users unaware of its presence or unfamiliar with fentanyl’s unique potency.

Health departments, schools, law enforcement agencies and the state of Colorado itself have launched education programs about fentanyl. The state also set aside money to buy and distribute strips to test drugs for the presence of fentanyl.

But the declines may also be explained by a grim effect of years of high overdose deaths.

“It could also be the adverse selection of people who were at the highest risk of experiencing a fatal overdose have already died,” said Tyler Coyle, an addiction medicine doctor who recently served as the president of the . “Which sucks. And now we’re analyzing a population of people who are still using in settings where it could be hazardous, but for whatever reason they aren’t experiencing the same outcome.”

The Associated Press contributed to this report.