Confirming fears among public health officials, overdose deaths in the US sharply worsened again during the pandemic, killing more than 107,000 people last year, according to preliminary CDC estimates released Wednesday.
Overdose deaths in the US have been on the rise for over two decades, taking the lives of more than 1 million people since 2000. The increase in 2021, though, is 15% higher than the previous year, setting a new record, according to the CDC’s National Center for Health Statistics.
“It is unacceptable that we are losing a life to overdose every five minutes around the clock,” Rahul Gupta, US drug czar and head of the White House Office of National Drug Control Policy, said in a statement sent to BuzzFeed News.
The mounting deaths explain why the Biden administration is moving away from the longtime “War on Drugs” approach to deterring drug use through criminalization and toward wider availability of treatment programs and harm reduction measures, such as making the overdose-reversing drug naloxone more widely available, Gupta said.
The latest sharp increase and wave of deaths appears driven by increased supplies of the dangerous opioid fentanyl into the illicit drug market, along with more people using drugs alone while isolating during the pandemic, leaving them unable to get help when overdosing.
“The pandemic has just poured fuel on the fire of the overdose epidemic,” said medical anthropologist Dan Ciccarone of the University of California, San Francisco. “We are in an overdose epidemic that has been getting worse for 22 years, and is so bad that it has cut US life expectancy, even before the pandemic, which is incredible. We’ve never seen anything like this before in history.”
The spread of illicit fentanyl westward from the East Coast in particular, he noted, has added to surging death numbers. Now often sold in counterfeit pain pills (like the ones that killed Prince, and Los Angeles Angels pitcher Tyler Skaggs), fentanyl is an opioid 30 to 50 times more potent than heroin. By itself, illicit forms of the drug killed more than 71,000 people in 2021, two-thirds of all drug overdose deaths. That number equals the total drug overdose deaths in the US only three years ago.
Most worrisome, fentanyl is thought to be reaching more casual drug users — people who normally avoid heroin and aren’t used to high opioid doses — through those counterfeit pain pills and in combination with cocaine and other drugs (although not cannabis, at least so far). The drug’s increase in the illicit market is largely driven by Mexican criminal cartels that find the synthetic drug both easier to make and to smuggle compared to heroin, according to the Drug Enforcement Administration. (Deaths from genuine pain pills held steady, at around 13,000 last year, and heroin deaths have actually declined slightly, to around 9,000 a year, as supplies of the drug have dried up.)
Based on drug seizure data, Ciccarone and his colleagues estimate that the illicit drug market in the US has been flooded with 80 million counterfeit pain pills containing fentanyl. “That’s a terrifying number given the potency of fentanyl,” Ciccarone said. “These are higher quality counterfeits now that you can’t tell from the real thing. Kids need to know this.”
In the current wave, overdose deaths are also increasing from illicit stimulants, particularly cocaine and methamphetamines, as well as depressants like opioids. Usually the two classes of drugs aren’t mixed, but that rule of thumb seems to have faded in recent years. The ONDCP last week announced a plan to address the increase in methamphetamine deaths that included expanding efforts to crack down on illegal sales of pill presses and educating users about fentanyl contamination of meth. Methamphetamine appears to be spreading east in the US, Ciccarone noted, in counterpoint to fentanyl.
With public health resources strained by the pandemic, getting into effective treatment programs remains difficult for many people. About 1 in 5 people who want drug treatment can’t afford it, even if they can find a good program, according to the National Survey on Drug Use and Health.
The pandemic has spurred innovation in substance use disorder treatment such as prescribing medication by telehealth, and allowing people to take methadone prescriptions home instead of lining up every morning for a daily dose, without causing any harm, said Nora Volkow, director of the National Institute on Drug Abuse. Public health officials are moving to incorporate those practices more widely, and into prisons and jails, along with counseling.
However, Volkow isn’t optimistic that such measures by themselves, even with the pandemic moving to a less isolating era, will be enough to keep overdose deaths from rising again next year.
“There will be a ceiling at some point, but I don’t know when that will be,” she said. “I think we are going to see [another] increase in the next year, because the dealers have a big incentive, actually, to sell these drugs. It’s a very unfortunate situation.”