More Lethal Drugs Caused US Overdose Deaths to Spike Dramatically

“The question is: When will it end?” one expert asked.

More than 100,000 Americans died of drug overdoses in the 12-month period ending in April 2021, according to a federal report released on Wednesday. That’s more than double the number of such deaths in 2015, and it’s a 28.5% increase from the same time period a year earlier.

The National Center for Health Statistics report finds that opioids are the leading cause of overdose deaths; they are linked to the illicit fentanyl replacing heroin in illegal drug markets nationwide. Opioids are now responsible for three-quarters of drug overdose deaths. But deaths from methamphetamine and cocaine, both stimulant drugs, also increased, according to the report, which measured deaths in the 12 months from April 2021 to April 2020.

"As we continue to make strides to defeat the COVID-19 pandemic, we cannot overlook this epidemic of loss, which has touched families and communities across the country," President Joe Biden, in a statement on the report.

Drug overdose deaths nationwide have increased dramatically, though it’s been almost masked by the toll of the coronavirus pandemic, said experts, who have called the US to change its approach to illegal drug use.

“We are living amid an extraordinary, tragic epidemic of drug overdose deaths where everything is going in the wrong direction,” said Dan Ciccarone, a medical epidemiologist at the University of California, San Francisco. “The only question is: When will it end?”

There are at least two explanations for the increase. One is the pandemic. The CDC reported only five months ago that more than 93,000 overdose deaths took place in 2020, itself a record. The newer NCHS report marks an acceleration in overdose deaths after April 2020 once pandemic restrictions took hold. Public health experts have long feared that the pandemic made drug overdose deaths more likely last year, with isolated people using drugs alone and more often amid nationwide reports of surging anxiety and depression.

Disruptions to all aspects of life during the pandemic, including reduced access to drug treatment and harm reduction services, which provide overdose-reversing medications to people, certainly made things worse, said Georgetown University’s Regina LaBelle, the former acting director of the US Office of National Drug Control Policy.

But an increasingly lethal drug supply offers a second significant reason for the increase in overdose deaths, she suggested.

Once-regional US markets for illicit drugs, such as fentanyl in the East and methamphetamine in the West, appear to have spread nationwide in the last five years, Ciccarone said, which has exposed more people to more potent, more dangerous, substances. “We basically outlawed making these drugs here and outsourced their production to a smaller country, Mexico, which has become very good at making more potent, more dangerous versions of drugs to get to our market,” he said.

Methamphetamine sold in the US is now stronger than it used to be. It's often made by cartel chemists in Mexico, according to the Drug Enforcement Administration. Fentanyl is some 30 to 40 times more potent by weight than heroin, and it has largely replaced that drug in many illicit markets. Notably, fentanyl has increasingly turned up in counterfeit pain pills following efforts to crack down on the overprescription of painkillers in the middle of the decade. Counterfeit pills figured in overdose deaths such as Prince’s in 2016, and that of Major League Baseball pitcher Tyler Skaggs in 2019.

“We are way overdue for real-time warnings to people about dangerous illicit drugs for sale,” Ciccarone said.

The latest increase comes after more than half a million people have died as a result of drug overdoses in the last decade. This calamity frustrates experts because solutions exist — but they often don’t receive enough support.

Effective drug treatment programs are only available to a fraction of the people with drug use dependencies, for example, and programs offering health services are scattered among local health departments nationwide, many struggling for funding and resources.

“There is a great deal more we can do to increase access to harm reduction services such as syringe services programs that distribute naloxone, fentanyl test strips, and provide compassionate care to people who use drugs,” LaBelle said.

In a news conference following the release of the report, Biden administration officials called for Congress to pass the Build Back Better bill devoted to increased social service spending nationwide. They cited its increased funding on reducing drug overdoses, in particular making the overdose-reversing drug Naloxone more available everywhere.

"We have to acknowledge what this is. It is a crisis," said HHS secretary Xavier Becerra, speaking at the briefing, and noting the numbers added up to one person dying of an overdose every 5 minutes.

Drug overdoses are now the leading cause of death for people released from prison. LaBelle said that to reduce these deaths, Congress should allow incarcerated people to have access to opioid use disorder medication through Medicaid. During LaBelle’s tenure at the Biden administration, the Office of National Drug Control Policy released a strategy that prioritized harm reduction, a first for the White House “drug czar” office. She called for an endorsement of that strategy in next year’s federal budget.

“We need to massively scale up harm reduction services to get help to people most at risk for overdose,” LaBelle said.


This post has been updated with a statement from President Joe Biden and comments from administration officials.

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