There was a giant jump in U.S. overdose drug deaths in 2020. Is the pandemic to blame?

CDC says COVID-19 may have contributed to the nearly 30% increase, but numbers have been climbing for years

Drug overdose deaths climbed dramatically in 2020, up nearly 30% to more than 93,000 from the 72,000 in 2019. And experts say even more people would have died without nationwide efforts to curb the public health crisis, including making Naloxone readily available without a prescription.

The Centers for Disease Control and Prevention’s National Center for Health Statistics released the latest bad news Wednesday, based on official estimates. The data is “provisional” because not all overdose deaths may be included. Finalized numbers lag by months, but those estimates strongly indicate trends and are based on actual, but incomplete data.

According to the CDC, the largest category was opioid-related overdose deaths, which climbed from nearly 51,000 in 2019 to almost 70,000 a year later. Deaths from synthetic opioids — mainly fentanyl — and psychostimulants including methamphetamine also increased, as did deaths involving cocaine and from natural and “semi-synthetic opioids,” many of which are prescription pain medications.

In its summary, the center included the number of deaths from drug overdoses that happened from Dec. 1, 2019, through the end of November 2020. The deaths were reported by the jurisdictions where the individuals died.

According to the center’s new data visualization map, Wyoming had the most drastic increase in overdose deaths, at 69.2%. South Dakota was at the other end, with a decrease of 21%. Case numbers are lower than reality, the map said, because the entire year is not yet included in numbers.

Overdoses are the leading cause of injury-related deaths in the United States, according to the CDC.

Growing problem pre-COVID-19

The Trust for America’s Health reported mid-pandemic that drug overdose death rates were rising even before COVID-19 appeared and the situation was getting worse as the pandemic unfolded. In December last year, the group called on policymakers to put “renewed focus on preventing deaths of despair.”

Even before the new estimates, 2019 overdose rates were “extremely alarming and the result of insufficient prioritization and investment in the well-being and health of Americans for decades,” John Auerbach, the group’s president and CEO, said at the time.

In 1999, there were 6.1 drug overdose deaths per 100,000 people. In two decades, the trust said the rate had more than tripled to 2019’s 21.6 deaths per 100,000 people, and called on federal, state and local officials to back evidenced-based policies and programs.

When it became clear that overdose deaths involving opioids and cocaine were increasing during the pandemic, then-CDC director Dr. Robert Redfield said that “the disruption to daily life due to the COVID-19 pandemic has hit those with substance use disorder hard. As we continue to fight to end this pandemic, it’s important to not lose sight of different groups being affected in other ways. We need to take care of people suffering from unintended consequences.”

The “rise in opioid overdose deaths has occurred in 3 waves,” according to Joan Stephenson, a consulting editor, in the Journal of the American Medical Association’s Health Forum. By the 1990s, prescription opioids were increasingly being prescribed. A second wave started in 2010, marked by more and more deaths from heroin use. The third increase began around 2013, “fueled by synthetic opioids (especially illicitly manufactured fentanyl).”

Stephenson said the pandemic may have created factors that will boost what could turn out to be a fourth wave — perhaps driven by people using substances to cope during the pandemic, but also people who already had substance use disorders and found themselves unable to secure the help they’d been getting prior to the pandemic.

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Harm-prevention strategies

The CDC has adopted strategies, providing money, tools and guidance to help states track numbers, conduct research and try to prevent both substance abuse and deaths in families. The effort includes public health strategy includes targeted prescription drug monitoring programs, regulation and licensing and training of health care providers, among others.

Public health officials team with a diverse cast of partners, from the doctor in private practice to community health systems, from law enforcement officials to lawmakers. Public health education campaigns are a key component of prevention efforts, which also include improving how drugs — especially opioids — are prescribed and expanding the public understanding of risks associated with both prescription and nonprescription drugs.

The CDC launched a partnership it calls “Overdose Data to Action,” providing funding to 66 jurisdictions — most of them states — to beef up collection of high-quality data on overdoses, fatal or not, in a timely fashion. The effort also includes prescription drug monitoring programs, helping people connect to care and promoting innovation to tackle drug overdoses.

One of the most high-profile efforts to combat overdose deaths in many parts of the country has been making Naloxone available to those who might have occasion to administer the drug if someone is overdosing. Naloxone has been credited with saving untold thousands of lives. Utah Naloxone said last August that it had helped save more than 4,000 Utahns, for example.

A National Institute on Drug Abuse policy brief says Naloxone grabs onto the body’s opioid receptors and either reverses or blocks the effects of opioids. One approach being studied is prescribing Naloxone when opioids are prescribed, in case of problems. Nearly all states have passed laws that say a bystander, friend or relative has legal immunity for the rescue-drug’s use.

Issues surrounding drug use and community approaches vary. In March 2020 the Deseret News reported that Vancouver, Canada, was testing a vending machine that would sell drugs to heroin addicts in hopes of cutting down on crime and overdose deaths and help addicts get clean.

“I think the Canadians are working from the principle that the drug supply has become so tainted and is so dangerous for their citizens that they would rather start by keeping them alive and working from there,” said Peter Davidson, an associate professor of medicine at the University of California San Diego. “They are coming at it from the view that this is a public health emergency and we have to solve the immediate crisis. Then we will work out what to do next.”

A 2018 article in the New England Journal of Medicine said that the CDC has in recent years classified about 15% of deaths caused by drug overdose as suicide.