Alex Cochran sat in her car for an hour, weeping, unable to drag herself inside her apartment. Her dad had just told her that her older brother Jason, 44, was dead from a drug overdose.
The family would later learn that a drug he’d used had also contained fentanyl, a cheap synthetic opioid that has made a national drug problem even deadlier. Fentanyl, which is 50 to 100 times more potent than morphine, increasingly shows up in everything from heroin to cocaine, with heart-stopping results.
Jason had struggled with drug addiction since he was in his late teens, but his death shocked his family, who’d seen him just weeks before. He seemed then like the healthy, sober Jason they adored — the funny, witty, super-outgoing guy who’d help anyone and loved everyone.
They thought he was drug-free, said Cochran, a Deseret News illustrator who talked about her brother’s death after she was asked to create art for a story about the massive increase in overdose deaths that has become part of America’s pandemic story.
The numbers are people, she said. Loved. Missed. Mourned.
The numbers are also record-breaking. The provisional data released by the Centers for Disease Control and Prevention this week indicate 100,306 U.S. drug overdose deaths from May 2020 through April 2021 — a 28.5% increase compared to the same period the year before and the first time U.S. overdose deaths topped 100,000 in a 12-month period.
A huge portion of those deaths were, like Jason’s, related to opioid use. The new report estimated opioid deaths increased to 75,673 in the 12-month period ending in April 2021 from 56,064 the year before. Most of the deaths came from synthetic opioids — mainly fentanyl — and a category called psychostimulants that includes methamphetamine. Cocaine use and natural and semi-synthetic opioids, including pain medication, also led to a higher number of deaths than before.
Bryce Pardo, a drug policy researcher at Rand Corporation, said the “huge increase” in overdose deaths involving synthetic opioids is “largely due to the illegally manufactured fentanyl. It’s coming from Mexico now. That’s kind of spilling into other drug use patterns and behaviors.”
He said that a cocaine overdose, for instance, may show fentanyl mixed in. It’s not clear if those who overdosed used more than one drug or if dealers are accidentally or deliberately adding fentanyl before their products hit the streets.
Christina Zidow, chief operating officer of Odyssey House, an addiction treatment center in Salt Lake City, said many of the clients at her organization’s harm-reduction clinic have reported running across fentanyl even in non-opioids.
Another phenomenon that’s contributing, especially out West, to the rise of overdose deaths is the sale of counterfeit pills made to look like genuine pharmaceutical products like oxycodone or Xanax that don’t contain the actual drug, but instead a few milligrams of fentanyl.
“That’s also a concern that we’re seeing given that that puts people at really, really great risk of overdose, because they may not be aware that they’re taking a fake product,” Pardo told the Deseret News.
Pardo said a major reason 2020 brought an increase in drug overdose deaths is probably that so many people were home so much because of the COVID-19 pandemic.
Nationally, substance use increased, including alcohol and drugs. Surveys showed alcohol consumption was up, as well as the use of cannabis.
“We’ve seen a steady, steady demand for treatment throughout COVID,” said Zidow, who is also a licensed clinical social worker. “I think one of the compounding effects is the mental health impacts from COVID. We know that we’re seeing increases in rates of depression and rates of anxiety. And that leads to substance use as a coping strategy.”
Some people were coping with loss of a job. Boredom may have played a role, too, Pardo and Zidow separately said. Both noted that flexibility that comes with working from home let some people stay unseen and may have made it easier to hide substance use.
Meanwhile, as the need grew, people had less access to medical care, including treatment for addictions.
“Limiting access to healthy interventions and medical care has absolutely compounded the situation,” said Zidow. “We’ve seen a lot of folks who certainly needed residential care early on in the pandemic, but were afraid to come into a residential setting because of COVID. And a lot of parents who were afraid to send their youths into residential settings.”
The one positive she noted was that telehealth was more readily available, which likely helped some people cope and get care. But overall, “users are notoriously under-served, and the pandemic made it worse.”
Zidow said she hopes people will show compassion as they consider the complexities of substance use and how hard it is to quit. She added that the pandemic has been traumatic for everyone and people should recognize that addiction is often a result of layers of trauma and a lack of resilience. It can arise from mental health issues. Or medical treatment.
A great deal of work now goes into harm reduction — efforts to make drug use safer —not just in the United States, but globally. Both Zidow and Pardo reject the idea that providing tools like Naloxone, which can reverse an overdose, or allowing people to test for fentanyl to make drugs safer just encourages more drug use.
“Drugs not being safe has not stopped drug use,” Zidow said. “The harm-reduction strategy is about how can we make this not a death sentence. So that when you’re ready to stop using — and hopefully you’re ready soon — you’re still alive to go through the process. And the people who love you can still go through that process with you because you’re alive.”
Zidow points out that the beginning of drug use, especially opioids, is about feeling better in some way. Some search for a high, but often the individual is trying to find relief for physical or emotional pain.
“By the time someone becomes addicted to an opioid, that ongoing need is really about avoiding the horrendous illness that comes with withdrawal symptoms. That’s why it’s critical to have medication-assisted therapies,” she said.
Many addicts would like to stop using. But those who’ve watched someone else go through withdrawal with all its misery, or who lack access to medical assistance in recovery or who already tried to quit and failed know that quitting an addiction means overcoming daunting hurdles.
There’s a “tremendous amount of physical pain involved,” Zidow added.
She said there are therapies available to help with withdrawal of some drugs and others are being developed, including testing of one that may help methamphetamine users overcome addiction.
Pardo said the Biden administration has proposed spending on an overdose prevention strategy to tackle the barriers so that drug users can access medications to help them withdraw. The administration and others are also looking at making fentanyl test strips more available so that fentanyl adulteration can be detected.
He understands why some are concerned that harm reduction could encourage use, But as a researcher, Pardo said he recognizes society has to make choices. People may be ready and willing to quit, but not have access to medication therapy that will help them succeed.
“Expanding access to medication therapies and health care coverage will help those people into some sort of stable system where they can start putting the pieces of their life back together,” he said.
“Morally speaking, you need to give people a fighting chance to enter recovery, because an overdose victim can never recover. They’re never gonna get their life back,” Pardo added. “So if that’s the trade-off you’re willing to make, then you’ll continue to see overdose deaths, tens of thousands of Americans. I'm willing to make that trade-off, given that these are people in the prime of their life. The majority who are dying are between the ages of 30 and 60.”
Cochran said her parents tried hard to save Jason when he was younger and none of them ever stopped loving him or rooting for him. They won’t stop missing him, either, she said.
The CDC overdose data can be found on a dashboard that looks at numbers in different jurisdictions, by class of drugs, by the specific drugs and more.