Overdose deaths rise, driven by illegal opioids and the pandemic

Drug overdoses in the United States appear to be worsening, in part due to the coronavirus pandemic.

In 2016, the opioid crisis rose to near the top of the national agenda. Both President Trump and Hillary Clinton pledged to tackle the crisis.

Yet, the problem has been less of a factor in the 2020 campaign, even though the evidence suggests it has gotten worse.

Preliminary Centers for Disease Control and Prevention data show that overdose deaths rose about 5.6% in 2019 to 71,148. The increase follows a decline of 4.1% in overdose deaths in 2018.

The apparent increase in 2019 likely resulted from changes in the illegal drug market. Private-sector and government efforts to limit abuse of prescription opioids succeeded in lowering overdose deaths in 2018, said Kenneth Leonard, director of Clinical and Research Institute on Addictions at the University of Buffalo. But now, the use of illegal opioids is likely driving overall deaths back up.

"This may be the result of heroin, fentanyl, and methamphetamines becoming more available in areas of the country that have been largely spared until recently," Leonard said.

"We saw a shift starting a few years ago when drug dealers began selling very potent fentanyl products that are relatively cheap to produce," said Dr. Wilson Compton, deputy director at the federal National Institute on Drug Abuse. The potency of fentanyl makes it easier to smuggle because only small amounts are needed to achieve a high. But the potency also makes fentanyl more lethal.

The pandemic also seems to have worsened the problem. The Overdose Detection Mapping Application Program, a federal initiative that collects data from ambulance teams, hospitals, and police, found that overdose deaths jumped 18% in March from the previous March. April and May saw even sharper increases, of 29% and 42%, respectively.

The pandemic interfered with addicts' ability to get daily medication and attend support groups.

"Many patients receive medication and counseling at methadone clinics," said Sebastian Seiguer, CEO of emocha, a telehealth platform that helps addicts improve medication adherence. "They have to go in person to the clinic. But during the pandemic, you don’t want patients going to the clinic every day. So, those patients did not have the benefit of the routine that keeps them in counseling and on their medication."

Seiguer noted that many addicts lead isolated lives, so attending support groups is crucial to avoiding relapse.

"You have patients attending multiple support groups every day," he said. "Those groups did not easily transition to a virtual setting."

What may also be leading to a rise in overdose is the stress that the pandemic is putting on addicts.

"At the individual level, there is substantial stress that has resulted from the pandemic. Substance users are at higher risk for contracting COVID, and many have preexisting conditions that would make their prognosis worse," said Leonard. "The economic stress of unemployment, and under-employment through furloughs or reduced hours, also increase the likelihood of relapse."