July 17, 2020

New CDC data shows America's number of fatal drug overdoses hit a record high last year, reversing progress made in 2018—and public health experts fear the situation will only get worse amid the country's coronavirus epidemic.

How Covid-19 is impacting the opioid crisis (and 5 ways providers can help)

Fatal drug overdoses resurge, hitting a record high

Driven largely by the United States' opioid epidemic, the number of Americans who died from a drug-related overdose surged to 70,699 in 2017, marking the country's previous peak in such deaths. However, that number declined by 4.6% in 2018 when compared with 2017—the first decline in drug overdose death that the country had seen in almost 30 years.

Public health experts at the time touted the progress and credited the decline to efforts intended to address the U.S. opioid epidemic. According to the White House's Office of National Drug Control Policy, the federal government had invested more than $21 billion over four years in efforts targeting the opioid crisis.

But the new CDC data shows the progress seen in 2018 essentially was erased in 2019, as the number of U.S. overdose fatalities increased by 4.6% and reached a new high of 70,980 deaths. According to the data, 37 states and the District of Columbia reported an increase in or a stable number of drug-related overdose deaths in 2019 when compared with 2018. South Dakota reported the biggest increase, at 54%.

More than half of the nation's overdose deaths last year involved synthetic opioids such as fentanyl, with deaths related to synthetic opioid overdoses accounting for 36,500 of the 70,980 deaths that occurred in 2019. In addition, Bob Anderson, chief of mortality statistics at CDC's National Center for Health Statistics, noted that the number of overdose deaths involving cocaine and methamphetamine increased from 34.7% of the nation's total number of overdose deaths in 2017 to 45.4% in 2019. "A substantial portion of those are combination drugs, where fentanyl is being mixed with meth or cocaine," he said.

The data is preliminary and could be adjusted before CDC finalizes the numbers later this year. However, Anderson said, "It seems that 2019 is the new high for drug overdose deaths." He explained, "[The] [d]ata is still provisional at this point, but the increase in the last few months of 2019 was steep enough to push it over the top by a little more than 200 deaths."

Data suggest 2020 could be worse—particularly because of Covid-19

Separate data suggests that America already is seeing increases in its number of drug-related overdose deaths in 2020 when compared with 2019. For example, an analysis released by the White House last month found that overdose deaths were up by 11.4% from January to April of this year when compared with the same period in 2019.

It that trend continues, the United States in 2020 will see its sharpest increase in annual overdose deaths since 2016, the New York Times reports—and some public health experts have expressed concerns that America's coronavirus epidemic could exacerbate the issue.

As the Times reports, researchers in the past have found strong associations between economic recessions and increases in drug misuse and overdoses, and those associations could appear now, amid the economic downturn spurred by the coronavirus epidemic.

"People are feeling a lot more despair, anxiety, and rootlessness," and that can "lea[d] to more problematic drug use and more risk of overdose," said Brendan Saloner, a substance use disorder researcher at the Johns Hopkins Bloomberg School of Public Health.

Nora Volkow, director of the National Institute on Drug Abuse, said the new coronavirus epidemic is particularly concerning because "[w]e have two things colliding: the stress of the uncertainty of what's going to happen with [Covid-19], and also the uncertainty of what's going to happen to you, (with high levels of) unemployment, or if you are studying, what will happen to your education. And then the social distancing and isolation that makes the whole process much worse."

Social isolation also can make it more difficult for people with substance use disorders to manage their conditions and increases the likelihood that a person who overdoses won't be around others who could help that person get needed medical care, health experts have said.

At the start of America's coronavirus epidemic, many outpatient treatment facilities for substance use disorders had to suspend their in-person services, which limited patients' access to care. In addition, some needle-exchange programs and programs that distribute the opioid overdose-reversal drug naloxone have been struggling to operate. Since the start of the coronavirus epidemic, about 43% of syringe service programs surveyed by the North American Syringe Exchange Network reported a decrease in services, STAT News reports.

"Way too many residential programs just shut their doors and left patients with no safety net," said Percy Menzies, president of Assisted Recovery Centers of America, an outpatient treatment center for alcohol- and drug-related substance use disorders.

Further, as the country continues to navigate its worsening coronavirus epidemic, a lack of funding could cause some substance use disorder treatment facilities to remain closed, the Washington Post reports.

According to STAT News, during the Great Recession, states from fiscal years 2009 to 2012 cut at least $4.35 billion from their budgets for mental and behavioral health services, which typically include services aimed at addressing substance use disorders. And STAT News reports that a handful of states already are slated to reduce their funding for mental and behavioral health services in the next fiscal year due to economic losses attributable to the coronavirus epidemic. Oregon is preparing to cut $69 million from its budget for behavioral health services in 2021, for instance, and Colorado, Florida, New Jersey, and Utah already have made similar cuts.  

Stephen Loyd—a medical director of substance use disorder treatment facilities in Florida, Kentucky, and Tennessee—said funding cuts are "taking an already at-risk population and really cutting the legs off from under them." Loyd added, "If you don't have money to treat these folks, there's really only a couple of places they can wind up. One is, unfortunately, dead."

Natalia Derevyanny—a spokesperson for the medical examiner's office in Cook County, Illinois—said America's opioid epidemic "never stopped," but it's been overshadowed by the new coronavirus. "If it weren't for [Covid-19], these opioid deaths are all we'd be talking about right now."

Alex Kral, an epidemiologist at RTI International, said ensuring people with substance use disorders can access treatment during the coronavirus epidemic will be key to preventing drug-related overdose deaths.

"We may not have a vaccine for [Covid-19], but we actually have very effective treatments for opioid use disorder. We have medication and proven interventions. It doesn't have to play out the way we fear it will" (Ehley, Politico, 7/15; Johnson, AP/ABC News, 7/15; Johnson, The Hill, 7/15; Katz et al., New York Times, 7/15; Sokolow, STAT News, 7/16; Wan/Long, Washington Post, 7/1).

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