Overdose deaths
By Shen Wu Tan
Drug overdoses killed an estimated 83,544 people during a 12-month period ending in July 2020, a record that coincides with the COVID-19 pandemic, which experts say has created a huge amount of stress and hampered treatment services.
That is almost a 25% increase from the year that ended in July 2019, when the Centers for Disease Control and Prevention reported 68,023 overdose deaths.
But the number of deaths last year could be closer to 86,000, the CDC said this week, citing the issue of underreporting caused by incomplete data.
Meanwhile, the number of calls to the national crisis hotline run by the Substance Abuse and Mental Health Services Administration rose last year by more than 700% from 2019, according to agency spokesman Christopher Garrett.
“During the pandemic, more people are experiencing anxiety. More people are experiencing depression. And one of the ways that people cope with depression and anxiety is taking drugs,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse. “And if you are addicted to opioids or to any drug, what you are seeing is an escalation, an increase in the consumption of drugs overall for people who are addicted or not. But for those who are addicted, an increasing consumption, and in those that are in recovery, there are increases in relapses of drug taking.
“What we have known all along is that among people who overdose one of the factors that is contributing is depression,” Dr. Volkow said. “And in many instances, we know some of these deaths are motivated by a conscious desire to basically overdose or by passively doing that.”
According to a state-by-state breakdown of CDC data, 22 jurisdictions reported a greater than 25% increase in drug overdose deaths from July 2019 to July 2020. The District saw the greatest rise in fatal drug overdoses with a nearly 57% increase. The city reported 483 deaths as of July 2020, up from 308 in 2019.
Two states, North Dakota and North Carolina, reported slight drops of about 2% in drug overdose deaths. Alaska reported no change.
William Stauffer, executive director of the Pennsylvania Recovery Organizations Alliance, said many people in long-term recovery have started using substances again and fewer are seeking help during the pandemic.
“What we started to see as the COVID-19 pandemic hit was a lot of social isolation, and in the recovery community, a lot of people depend on the support they get from in-person connections they get from other people in meetings,” he said. “In the recovery community, we have seen more people experiencing mental health struggles as they are experiencing elements of despair.”
Mr. Stauffer, who is also in long-term recovery, has spent more than 30 years helping others with substance use disorder.
“Alcohol use is up, overdose rates have increased,” he said, “and we know that stimulant use like methamphetamine is increasing.”
The disruption of treatment services during the pandemic could be one of the biggest contributors to a rise in drug overdose deaths, Dr. Volkow said.
Naloxone can quickly reverse opioid overdoses, but pandemic-related isolation protocols have left many people with no one to observe them or administer the medication. This has led to more overdose deaths at home, Dr. Volkow said.
Social distancing protocols made it difficult for people at the start of the pandemic to go to clinics for methadone, a medication to treat opioid addiction. As health systems became inundated with COVID-19 patients, it also became harder to obtain waivers for buprenorphine, a prescription drug used to treat heroin and methadone dependence.
The pandemic closed or limited hours for syringe service programs, which could affect access to care and treatment for substance use disorder, the CDC said. The supply of illicit drugs also might have been disrupted because of the pandemic. That increased risks of withdrawal and use of contaminated drugs or drugs to which they have a lower tolerance.
Additionally, people might be afraid to seek medical help for addiction, and bystanders of an overdose might be reluctant to administer naloxone or perform other lifesaving measures because of the fear of COVID-19 exposure, the health agency said.
“Patients have delayed their care, providers often rescheduled and postponed visits, and patients fearful of COVID avoided going outside. This has resulted in undertreated or untreated conditions. Sometimes this has led to more severe presentations in emergency rooms,” Mr. Garrett said.
To address some of these issues, clinics began to supply a month’s worth of methadone rather than requiring daily visits and began to offer waivers for buprenorphine through telehealth appointments, Dr. Volkow said.
Opioids and synthetic opioids appear to make up the bulk of drug overdose deaths, CDC data shows. Nearly 61,300 drug overdose deaths, about 73%, involved opioids. Synthetic opioids, excluding methadone, were involved in 58% of overdoses. Other drugs included psychostimulants such as amphetamine, in about 24% of cases, cocaine in nearly 23%, heroin in almost 17%, natural and semisynthetic opioids in 15%, and methadone in almost 4%.
As the nation tries to get COVID-19 under control, Dr. Volkow said she hopes drug overdose deaths go down this year and added that it could depend on how quickly the country acts.
“Right now, a major challenge is to implement vaccinations to as many people as possible, and that has been harder to achieve than we had initially expected,” she said, noting the complication of coronavirus variants. “People have lost their houses, have lost their jobs, and that is a level of stress that, even if you control for not being so worried that you are going to be infected, actually exacerbates your outcomes.”
“In 2021, I hope we are able to actually start to get better numbers than those in 2020, but this will happen only if we focus resources strategically to intervene to actually help those that are more vulnerable,” Dr. Volkow said.
Mr. Stauffer said he worries that the pandemic will have lingering, long-term effects, contributing to another decade of issues with substance abuse.
This last year has been more of a struggle for him personally than in the past, he said, even with 35 years of recovery under his belt.
Although the thought of using substances hasn’t crossed his mind, Mr. Stauffer said he has definitely had to put more focus on self-care.
Drug overdose deaths did decline in 2018, a first ever recorded. In December 2018, the CDC recorded 67,850 drug overdose deaths compared with nearly 70,700 at the end of 2017.
Decreases in deaths from heroin and prescription painkillers contributed to the slight drop, but growth in deaths involving fentanyl, cocaine and psychostimulants counteracted those.
The number of drug overdose deaths climbed in 2019. A total of 71,130 people died from drug overdoses over a 12-month period ending in December 2019, CDC data shows.
Overdose deaths have continually climbed since 1990, when 8,413 deaths were reported. In recent years, opioids, mostly synthetic opioids (other than methadone), have acted as the “main driver” of drug overdose deaths, the CDC says.
