health

The pandemic has had a dramatic effect on drug overdoses

The COVID-19 pandemic has overtaken the health news cycle this year. And though the novel coronavirus remains a major public health threat, other substantial health issues that affect Americans—like the opioid epidemic—haven’t gone away and many of them have gotten worse in light of the pandemic.

New data from the Centers for Disease Control (CDC) paints a concerning picture of the opioid crisis as it was just before—and then for a few months after—the pandemic began. The preliminary data found that more than 81,000 people died of an overdose in the 12-month period that ended this May—the largest number ever recorded. This represents an 18.2 percent year-over-year increase in overdose deaths.

“We’ve been seeing a steady increase,” Deb Houry, director of the CDC’s National Center for Injury Prevention and Control, told Popular Science. Synthetic opioids like fentanyl and carfentanyl accounted for the majority of overdoses, Houry says. These potent substances are being mixed with a wide variety of other drugs.

Historically, Houry says, the greatest concern surrounding synthetic opioids was that they might be contaminating other opioids, such as heroin. Since they are many times stronger, it is much easier to overdose—especially since many people who take drugs contaminated with fentanyl or other synthetic opioids don’t realize what they’re taking. “I think we need to broaden that to realize that cocaine and other stimulants and psychoactive drugs can be contaminated with illicit fentanyl,” Houry says.

The new CDC data shows that overdose deaths involving cocaine increased by 26.5 percent from the 2018-2019 year—in large part because of co-use of cocaine and synthetic opioids. Amphetamines and other psychostimulant overdoses are also on the rise.

The early months of the pandemic (March to May 2020) saw the greatest increase in overdose deaths. “Early in the pandemic, there was disruption to treatment services,” says Houry. “We’re also hearing about disruptions to the drug market.”

There are no specific numbers yet for the rest of 2020, but Houry expects the trend of increased overdose deaths to continue.

Even before the pandemic began, says Jeremy Faust, an emergency medicine doctor at Brigham and Women’s Hospital in Boston, drug overdose deaths were on the rise. “There’s a few reasons unintentional overdose deaths can go up in a period of time,” he says: One is increased use, but contaminated supply and changes to healthcare access are important too.

The stresses of the pandemic, changes in the drug market that might mean people who use drugs are getting them from unfamiliar sources, and—especially in the early days of the pandemic—interruption to services are all likely contributors to the uptake in overdose deaths.

This spike has likely hit one key population very hard, Faust and his coauthors identified in a recent study: adults between 25 and 44 years old. The leading cause of death in this age group for the past several years is unintentional drug overdoses. Between March 1 and July 31 of this year, nearly 12,000 more people in this age group died than the number of deaths anticipated for the cohort (just over 64,000). A little less than half of that 12,000 can be accounted for 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 not identified.

Faust suspects that additional deaths by drug overdose make up at least a percentage of this overage. “If you want to explain this excess mortality, you have to look at the usual suspects,” he says. For this population, that’s unintentional overdose, he says.

These statistics all point to the continuing importance of addressing the opioid epidemic, both Houry and Faust note—especially now.

Reducing harm is a key piece of this puzzle, which means making sure that people who use drugs have access to health and social services, says Tara Marie Watson, a 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 added to the ongoing public health crisis that is the opioid overdose crisis.”

It’s key that during this time, health support systems for addiction and drug use remain in place, she says. “It’s important that people are not shut out from having these kinds of services and supports, especially during lockdown.”