Drug overdose deaths in US spike amid Covid-19 pandemic as country records largest numbers ever in a year
There have been substantial increases in drug overdose deaths across the US, primarily driven by rapid increases in overdose deaths involving synthetic opioids, likely illicitly manufactured fentanyl. An estimated 81,230 Americans have died from a drug overdose between June 2019 and May 2020, reveals analysis. This represents a worsening of the drug overdose epidemic in the US and this is the largest number of drug overdoses for a 12-month period ever recorded, according to the US Centers for Disease Control and Prevention (CDC).
After declining 4.1% from 2017 to 2018, the number of overdose deaths increased by 18.2% from the 12-months ending in June 2019 to the 12-months ending in May 2020. Drug overdose deaths during this time increased more than 20% in 25 states and the District of Columbia, 10% to 19% in 11 states and New York City, and 0% to 9% in 10 states. Only four states have reported a decrease in drug overdose deaths. The largest increase was recorded from March 2020 to May 2020, coinciding with the implementation of widespread mitigation measures for the Covid-19 pandemic.
"The recent increase in drug overdose mortality began in 2019 and continues into 2020, prior to the declaration of the Covid-19 national emergency in the US in March. The increases in drug overdose deaths appear to have accelerated during the Covid-19 pandemic," warn authors.
Provisional overdose death estimates indicate that the largest monthly increases in drug overdose deaths occurred in the 12-months ending in February 2020 (74,185 deaths) and the 12-months ending in March 2020 (75,696 deaths); the 12-months ending in March 2020 (75,696 deaths) to the 12-months ending in April 2020 (77,842 deaths); and from the 12-months ending in April 2020 (77,842 deaths) to the 12-months ending in May 2020 (81,230 deaths). These one-month increases of 2,146 deaths and 3,388 deaths respectively for the 12-month periods are the largest monthly increases documented since provisional 12-month estimates began to be calculated in January 2015, emphasize researchers.
"The disruption to daily life due to the Covid-19 pandemic has hit those with substance use disorder hard. As we continue the fight to end this pandemic, it’s important to not lose sight of different groups being affected in other ways. We need to take care of people suffering from unintended consequences,” stresses CDC Director Dr Robert Redfield.
Synthetic opioids are the primary driver of the increase in overdose deaths. Their use increased 38.4% from the 12-months ending in June 2019 compared with the 12-months ending in May 2020. Of the 38 jurisdictions with available synthetic opioid data, 37 reported increases in synthetic opioid overdose deaths for this period. Eighteen of these jurisdictions reported increases greater than 50%, 11 reported increases of 25% to 49%, 7 reported increases of 10% to 24%, 1 reported an increase of less than 10%. “State and local health department reports indicate that the increase in synthetic opioid-involved overdoses is primarily linked to illicitly manufactured fentanyl,” explains the agency.
Historically, deaths involving illicitly manufactured fentanyl have been concentrated in the 28 states east of the Mississippi River, where the heroin market has primarily been dominated by white powder heroin. However, the report shows that the largest increases in synthetic opioid deaths (98%) from the 12-months ending in June 2019 to the 12-months ending in May 2020 occurred in 10 western states. According to experts, this is consistent with large increases in illicitly manufactured fentanyl availability in western states and increases in fentanyl positivity in clinical toxicology drug tests in the west after the Covid-19 pandemic. “Increases in synthetic opioid overdose deaths were also substantial in other regions: 12 southern states and the District of Columbia (35.4%), 6 midwestern states (32.1%), and 8 northeastern states and New York City (21.1%),” they add.
Overdose deaths involving cocaine also increased by 26.5%. “Other data have shown that recent increases in overdose deaths involving cocaine are primarily related to overdose deaths that involved both cocaine and synthetic opioids (primarily illicitly manufactured fentanyl). These deaths are likely linked to co-use of cocaine among people injecting opioids such as illicitly manufactured fentanyl or heroin,” the findings state.
In contrast, overdose deaths involving psychostimulants, such as methamphetamine, have been increasing with and without synthetic opioid co-use and at a rate faster than overdose deaths involving cocaine. Provisional 12-month counts of overdose deaths involving psychostimulants in the US increased by 34.8% from the 12-months ending in June 2019 compared to the 12-months ending in May 2020. “The number of deaths involving psychostimulants now exceeds the number of cocaine-involved deaths. These increases are consistent with the increased availability of methamphetamine in the illicit drug supply and increases in methamphetamine-related treatment admissions,” note authors.
Recommendations
The findings coupled with the known disruption to public health, healthcare and social services as a result of the coronavirus pandemic and related mitigation measures highlight the need for essential services to remain accessible for those most at risk of overdose and the need to expand prevention and response activities, emphasizes the CDC.
Expanding the provision and use of naloxone and overdose prevention education; expanding access to and provision of treatment for substance use disorders; intervening early with individuals at the highest risk for overdose; and improving detection of overdose outbreaks due to fentanyl, novel psychoactive substances (such as fentanyl analogs), or other drugs to facilitate an effective response, are part of the guidelines issued by the agency.
The agency, for example, is advising healthcare providers to talk to patients about the changing illicit drug supply and risks for overdose and exposure to highly potent opioids such as illicitly manufactured fentanyl. The guidelines call for prescribing naloxone to people at risk for opioid overdoses, such as those with a prior history of overdose, those with opioid use disorder, and individuals using illicit opioids and other drugs that might be mixed with illicitly manufactured fentanyl. Naloxone can reverse the effects of opioids and can be life-saving when an opioid overdose occurs, say health experts.
Expanding locations in which overdose prevention education and take-home naloxone are provided — which include inpatient and outpatient treatment programs, primary care settings, retail pharmacies, counseling, and support groups, and other community-based settings — is another recommendation. "Counsel patients that multiple doses of naloxone may be needed for a single overdose event because of the potency of illicitly manufactured fentanyl and fentanyl analogs, 19 and that multiple doses of naloxone may be needed over time due to prolonged effects of opioids in some cases,” says the CDC
Unlike opioid use disorder treatment, there are no Food and Drug Administration (FDA)-approved medications to treat stimulant use disorders. “The most effective treatments for stimulant use disorders are psychosocial therapies such as motivational interviewing, contingency management, contingency management combined with community reinforcement approach, and contingency management combined with cognitive-behavioral therapy. These therapies have demonstrated effectiveness for stimulant use disorders,” suggests the advisory.