When Covid raged, so did the country’s other epidemic.
According to preliminary statistics released Wednesday by the Centers for Disease Control and Prevention, deaths from drug overdose rose nearly 30 percent in 2020 to a record 93,000. Deaths rose in all but two states, with significant increases in the south and west.
Drug Overdose Deaths in the United States
Source: Centers for Disease Control and Prevention
Several dismal records have been set: most drug overdose deaths in a year; most deaths from opioid overdoses; most deaths from overdose of stimulants such as methamphetamine; most deaths from the deadly class of synthetic opioids known as fentanyls.
“It’s huge, it’s historic, it’s unheard of, unprecedented, and a real shame,” said Daniel Ciccarone, a professor of medicine at the University of California at San Francisco who studies heroin markets. “It’s an absolute shame.”
In recent years, annual drug overdose deaths had already dwarfed the highest annual deaths from car accidents, gun violence or the AIDS epidemic.
The death toll from Covid-19 topped 375,000 last year, the largest American mortality event in a century, but drug deaths were disproportionately high among young people. In total, the 93,000 deaths cost Americans about 3.5 million years of life, according to an analysis by the New York Times. For comparison: The deaths from the coronavirus in 2020 were responsible for around 5.5 million years of life.
The pandemic itself has undoubtedly contributed to the surge in overdose deaths, with disruptions in contact and treatment facilities and increased social isolation. The death toll from overdose peaked nationwide in spring 2020, amid the worst period of shutdowns and the economic downturn from the pandemic. However, public health experts said there had been a pattern of escalating deaths prior to the pandemic as fentanyles became entrenched in the country’s drug supply, replacing heroin in many cities, and finding their way into other drugs such as meth.
After decades of uninterrupted growth, overdose deaths fell slightly in 2018. But they resumed their upward trend in 2019, and drug deaths rose in the first few months of 2020, even before Covid hit.
Change in drug deaths from 2019
“We went into Covid with this problem,” said Regina LaBelle, the acting director of the Office of National Drug Control Policy. “The number of deaths from overdose has increased; they were on the upswing. Certainly Covid didn’t help and probably made things worse, but we saw an increase before. ”
President Biden nominated a permanent director for the post Tuesday, sometimes called a drug czar. The candidate, Dr. Rahul Gupta, doctor and chief medical and health officer for the March of Dimes, was the former public health commissioner in West Virginia, a state with one of the sharpest increases in drug deaths in the past year.
José Benitez, executive director of Prevention Point Philadelphia, said the continued mixing of heroin and other drugs with fentanylene had driven overdose rates there. But he also took note of the effects of the pandemic. His group, which provides services to drug users, saw appointments decrease by about 20 percent. Some of their funds have been diverted to support Covid services. He also said that Covid’s public health warnings about social distancing ran counter to advice for opioid users. When using drugs, they are encouraged to use them around other people so that someone can resuscitate them if they overdose. “The messages were mixed at best,” he said.
Mr Benitez said the past year has been tough for his employees. It wasn’t uncommon for two clients to die every week. “I was a social worker during the AIDS era,” he says. “This is almost a repetition of it in many ways.”
The C.D.C. will provide final estimates in a few months (overdose studies will depend on toxicological reports and other tests that may take time). No region was spared the increased death toll. Deaths continued to rise in the Northeast and Midwest, where the opioid epidemic was most acute in earlier stages. However, the greatest increases were in the south and west, regions that were less affected.
In particular, rising deaths in the West indicate a possible new phase of the epidemic. The nationwide increase in deaths in recent years has been partly attributed to the introduction of fentanylene, which is easier to make and ship than traditional heroin. Fentanyles have made regular appearances in the East Coast heroin supply for the past seven years, where they were easily mixed with the most common type of heroin, including a white powder. Fentanylene overdoses, with their high but variable potency, tend to be more common than traditional heroin overdoses.
In the west, where most heroin is sold as a stickier substance known as black tar, fentanyls were less common. Researchers studying drug supply in the West say they see more fentanyles being sold as counterfeit pills or as an injectable drug alone. An increase in deaths from meth and fentanylene overdose suggests that fentanyls may have penetrated stimulant supplies as well.
It appears that the pandemic temporarily cut off the flow of fentanylene from China to the United States. Chad Sabora, executive director of the Missouri Network for Opiate Reform and Recovery and government advisor, said drug supplies in St. Louis had been changed for more than a month. “Then a huge influx,” he said. “People’s tolerance had fallen and was booming.”
White Americans were hit particularly hard in the early years of the opioid epidemic, but deaths in non-white populations have risen rapidly in recent years. In 2020, overdose deaths grew faster in black and Hispanic populations than in whites.
The trend could reflect the growing reach of fentanyls, which are now often found in combination with stimulants like cocaine and meth. You reach groups that were less dependent on prescription pain medication earlier in the epidemic. The pressures of the Covid pandemic have also disproportionately affected blacks, Latinos and Native Americans, with the potential to affect patterns of drug use.
“The pandemic was far more disruptive in colored communities than in white communities – death rates, infection rates, unemployment rates, food insecurity rates,” said Joshuah Sharfstein, vice dean of public health practice at Johns Hopkins University. “So much of the aftermath of the pandemic has hit colored communities harder. So it’s not uncommon for overdoses to do the same. ”
Politicians, public health officials and clinicians have been fighting the opioid epidemic for years. In 2018, Congress passed a package of laws aimed at lowering the death toll by limiting the overuse of prescription drugs and improving access to drug addiction treatment. And earlier this year, Congress allocated an additional $ 1.5 billion to fight the epidemic.
The pandemic brought some changes in addiction policies that may have saved lives. Temporary changes have made it easier for people who have signed up for methadone treatment to take doses home rather than going to a clinic every day. Ms. LaBelle said more people remained enrolled in drug treatment as a result. Regulators also made it easier for people to get medical help through telemedicine, another policy that can be extended beyond the Covid emergency. For the first time, federal funds (from the latest economic stimulus package) can be used to buy needles and syringes for exchange programs, as well as fentanyl rapid test strips that can be used to check whether drugs contain fentanyl.
These new initiatives, and the substantial new funding available to fight the epidemic, could help, several scientists said. But Ms. LaBelle warned that the improvements could come slowly. “I hope that in a year some of the regulatory reviews have been extended,” she said. “I think it will be another five to ten years before we see more of the fruits of our labor.”