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The US is in the midst of a drug overdose epidemic as a fresh report claimed that the number of people who died from an overdose in 2020 rose by almost 30% year-on-year to more than 93,000, and experts said that the isolation and mental health pressures caused by the pandemic may have triggered this rise.
In a statistical report published last week, the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics said that the predicted number of drug overdose deaths in 2020 was 93,331, a 29.4% rise nationwide.
In some states, including Kentucky, Vermont, and South Carolina, the number of overdose deaths in 2020 was up more than 50% compared to the preceding year.
An opioid crisis has long raged throughout the United States, and overall, 69,710 people were estimated to have died from opioid overdoses last year, of which 57,550 deaths were attributed to synthetic opioids.
Synthetic opioids such as fentanyl, a highly potent painkiller first developed in 1959 by Johnson & Johnson subsidiary Janssen Pharmaceuticals that is estimated to be anywhere from 80 to 100 times stronger than morphine, are now commonly available at street level and are wreaking havoc in many states.
Street use of fentanyl began to spike in northeastern US states such as New Hampshire and Massachusetts back in 2013, and since then, the drug has spread westwards.
US President Joe Biden has pledged to end the opioid crisis, but the latest CDC data suggests that the government has a long way to go to ensure that those with substance use disorders get the help they need.
Rapid Rise in Overdose Deaths Not Surprising
The onset of the COVID-19 pandemic and the related lockdown and quarantine measures have been linked with a growing mental health crisis in many parts of the world.
As a result, Jim Scarpace, the executive director at addiction treatment provider Gateway Foundation, said that he was not surprised to see overdose deaths spike last year.
“I wasn’t surprised. We’ve been seeing this occur over the course of the year in the United States, especially since March of 2020 when isolation and quarantine started to occur due to COVID-19. We know substance use disorder, it’s a physiological disease, it’s a psychological disease, and it’s a social disease, and the social impact of COVID has really, in a lot of ways, negatively influenced and increased the progression of substance use disorder for individuals who struggle with it”, Scarpace said.
Many people who are now coming forward to get addiction treatment were in more progressive stages of their substance use disorder, Scarpace said, adding that a large number of patients also had severe mental health disorders such as anxiety and depression.
This sentiment was shared by Dr. Lawrence Weinstein, the chief medical officer at the American Addiction Centers (AAC), who said that the lockdown measures brought on by the COVID-19 pandemic created the conditions that would lead many to turn to narcotic drugs.
“At AAC, we’ve seen at least a 20% increase in people reaching out for help. The reason for this increase as well as the increase in deaths, in my opinion, is because circumstances and mandates related to the pandemic created the perfect storm, where nearly all of the factors that increase substance use and relapse rates took place at the same time”, Weinstein said.
Alongside the limitations on freedom of movement, the economic instability created by the COVID-19 pandemic was likely to have led to increased substance use and growing relapse rates, Weinstein remarked.
Both Scarpace and Weinstein also noted the continued stigmatization of drug and alcohol addiction in the United States that was preventing people from coming forward and getting help.
Weinstein said that this stigma was “one of the most significant barriers to treatment” for many years, and Scarpace criticized those who consider addiction to be a behavioral, rather than a medical, condition.
“All we know about this disorder, and we’ve actually known since the 1950s when the American Medical Association put out an article that started with alcohol and then went onto to other drugs saying that ‘this is a disease of the brain, not a moral failing, not a character flaw, not a weakness.’ But unfortunately, here we are in 2021, several decades since the 1950s when that study came out, and people still believe in some ways that it is not a medical condition like other medical conditions like cancer or heart disease”, the latter said.
Despite this lasting societal stigma, which was also seen last year during then-President Donald Trump’s attack on Hunter Biden’s drug addiction, Scarpace said that law enforcement agencies in some states were helping those caught in the criminal justice system get treatment.
Going forward, the Gateway Foundation executive director said that journalists and media outlets also had a responsibility to destigmatize the language surrounding substance use disorders, in order to help those with drug and alcohol issues feel comfortable in admitting they need help.
Fentanyl Fears
Fentanyl is seen to be the deadliest drug in circulation in the United States at the present time, and James DeFrancesco, a senior lecturer of chemistry at Loyola University Chicago, said that fentanyl was not an overly difficult drug to make, adding that the substance can provide great profits for the dealers that sell it.
“The economics of fentanyl are ridiculous. If you are going to produce heroin, you have to get the plant, so you need land, you need resources, and it’s very very resource intensive. And then you need people who go out there and harvest, and then you need to take what you extract from the plant, which is opium, and extract out the morphine and then do the chemical conversion into the heroin, and then you have to move that heroin and find distribution channels for that. With fentanyl, you walk into the laboratory, you have all the starting materials, and at the end of a relatively short time period, you’ve got the end product”, DeFrancesco said.
Police in the United States have said that they are finding traces of fentanyl in seizures of drugs such as heroin and cocaine, and Lawrence Weinstein of the AAC said that the addition of the super-strength opioid was posing great risks for users.
“We’ve known for a while that fentanyl has been making its way into the country and becoming more and more prevalent, but the fact that nearly 75% of overdose deaths last year were due to synthetic opioids, primarily fentanyl, that it was involved in 70% of cocaine overdose deaths and a further 50% of methamphetamine overdose deaths is a worrying surprise”, Weinstein said.
In a statement, the state of New York’s Office of Addiction Services and Supports (OASAS) said that raising public awareness of the possibility that fentanyl could be in the drugs they are consuming was of vital importance.
“The presence of fentanyl in illicit substances such as heroin, methamphetamine, cocaine, ecstasy, and others continues to be a major contributor to overdoses and fatalities. OASAS is actively running public awareness campaigns to ensure the public learns of the dangers of fentanyl and is aware of overdose prevention measures”, the statement read.
OASAS has also worked to ensure that all individuals on medication to combat their opioid use disorder had uninterrupted access throughout the pandemic, the organization said.
This line was echoed by the New York State Department of Health, which said in a comment that it had expedited the approval procedures for drug treatment providers that offered services via telephone.
Despite these measures, the CDC estimated that overdose deaths in upstate New York rose by 32.3% year-on-year in 2020, and by 36.9% in New York City, and health officials confirmed that there was also an increase in the use of naloxone, the medication used to treat an individual who is in the midst of an opioid overdose.
“New York, like many states, has experienced an increase in opioid overdoses, as indicated by increases in naloxone administrations, emergency department visits, hospitalizations and deaths during the COVID-19 pandemic”, the Department of Health said.
Next Steps for Biden Administration
A little over a month before the CDC published its drug overdose death data, the Food and Drug Administration approved a new nasal spray that delivers 8 milligrams of naloxone in one go. Before this, nasal sprays could only deliver a maximum of 4 milligrams.
The Biden administration has also issued new federal guidelines that will allow more medical practitioners to deliver buprenorphine, a drug that can reduce opioid relapses and deaths from overdoses.
Steps have also been taken to give law enforcement agencies more power to prosecute those dealing fentanyl, as Congress in April passed an extension of the opioid enforcement tool, a sweeping set of laws that allows federal agents to crack down on narcotics that are chemically similar to fentanyl.
James DeFrancesco of Loyola University Chicago said that law enforcement agencies had previously attempted to outlaw one chemical compound at a time, which gave producers time to craft derivatives of fentanyl that were slightly different to the batches that came before it.
“The other trick in making these other compounds is that law enforcement typically goes after substances one molecule at a time, or one structure at a time. So, the people dealing on the black market or on the streets are looking for compounds that don’t technically fit with what the law is looking for. Law enforcement has responded by making laws that are a little bit broader, these analog laws that cover more chemical structures, so it’s a cat and mouse game”, the academic said.
Reversing the concerning trend in drug overdose deaths will require a “multi-pronged effort” between different federal agencies and departments, Lawrence Weinstein of the AAC said.
“For example, increased access to mental health and addiction treatment can considerably affect the number of people with substance use disorders and the number of overdose deaths. The fewer barriers to treatment that exist, the more people can utilize services that can prevent an overdose from taking place at all. Eliminating the influx of fentanyl in the country can also reduce substance abuse rates and overdose deaths”, he said.
Jim Scarpace of Gateway Foundation said that the Biden administration’s biggest priority should be ensuring that federal and state funds used to combat this issue are funneled into addiction treatment and prevention programs, rather than into the criminal justice system.
“First and foremost we definitely need to make sure that monies associated with addressing addiction and substance use disorder go into prevention and recovery. A lot of times historically in the past those monies were not put in those areas”, he said.
Any further measures introduced by the Biden administration to reduce the number of people dying annually as a result of overdoses will have to be taken urgently to address the rapidly growing scope and scale of the United States’ opioid crisis.
The number of people who died from an opioid overdose in 2020 was seven times the figure registered in 1999, and roughly 900,000 people have lost their lives as a result of drug overdoses in this period.
