The COVID-19 pandemic has caught up with the health news cycle this year. And while the new coronavirus remains a major public health threat, other substantial health problems affecting Americans – such as the opioid epidemic – have not gone away and many of them have gotten worse in the face of the pandemic.
New data from the Centers for Disease Control (CDC) paints a worrying picture of the opioid crisis as it happened just before – and a few months after – the pandemic started. The preliminary data showed that more than 81,000 people died of overdose in the 12-month period ending in May – the largest number ever recorded. This represents an 18.2 percent year-on-year increase in overdose deaths.
“We’ve seen a steady increase,” Deb Houry, director of the CDC’s National Center for Injury Prevention and Control, told Popular Science. Synthetic opioids such as fentanyl and carfentanyl were responsible for most of the overdoses, Houry says. These powerful substances are mixed with a wide variety of other drugs.
Historically, Houry says, the main concern around synthetic opioids has been that they could contaminate other opioids, such as heroin. Because they are many times stronger, it is much easier to overdose – especially since many people who use drugs contaminated with fentanyl or other synthetic opioids do not realize what they are taking. “I think we need to broaden that to realize that cocaine and other stimulants and psychoactive drugs could be contaminated with illegal fentanyl,” Houry says.
The new CDC data shows that the number of cocaine overdose deaths has increased by 26.5 percent from the year 2018-2019, largely due to the concomitant use of cocaine and synthetic opioids. Amphetamines and other psychostimulant overdoses are also on the rise.
The number of overdose deaths was highest in the first months of the pandemic (March to May 2020). “At the beginning of the pandemic, there was a disruption to treatment services,” Houry says. “We also hear about drug market disruptions.”
There are no specific figures for the rest of 2020 yet, but Houry expects the trend of increased overdose deaths to continue.
Even before the pandemic started, said Jeremy Faust, an emergency care physician at Brigham and Women’s Hospital in Boston, overdose deaths were on the rise. “There are a few reasons why accidental overdose deaths may increase over time,” he says: one of which is increased use, but contaminated supply and changes in access to healthcare are also important.
The tensions of the pandemic, changes in the drug market that could lead people using drugs to get them from unknown sources, and – especially in the early days of the pandemic – disruption of services likely all contribute to the number of deaths from overdoses.
This spike probably hit a major population very hard, Faust and his co-authors identified in a recent study: adults between 25 and 44 years old. The leading cause of death in this age group in recent years has been accidental drug overdose. Between March 1 and July 31 of this year, nearly 12,000 more people in this age group died than the number of deaths expected for the cohort (just over 64,000). Just under half of those 12,000 can be explained by known COVID-19 deaths, although the researchers note that COVID-19 may have been the cause of some of the other deaths, even if it was not identified.
Faust suspects that additional drug overdose deaths account for at least a percentage of this excess. “If you want to explain this over-mortality, you have to look at the usual suspects,” he says. For this population, that’s an accidental overdose, he says.
These statistics all point to the continuing importance of tackling the opioid epidemic, both Houry and Faust, especially now.
Harm reduction is an important part of this puzzle, which means that people who use drugs should have access to health and social services, said Tara Marie Watson, drug policy researcher at the Center for Addiction and Mental Health in Toronto. In neighboring Canada, as in the United States, Watson says, the COVID-19 pandemic has “only contributed to the ongoing public health crisis, namely the opioid overdose crisis.”
It’s critical that health support systems for addiction and drug use continue to exist during this time, she says. “It’s important that people are not excluded from this type of service and support, especially during lockdown.”