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Drug overdose deaths rose sharply during the first year of the pandemic, partly due to a more dangerous illegal drug supply. Drazen Zigic / Getty Images
  • A new report from the CDC estimates 93,331 people died from a drug overdose in 2020 in the United States.
  • That’s nearly a 30 percent increase from the previous year, and a far higher number than the previous peak of roughly 72,000 deaths in 2017.
  • Experts say that opioids, particularly illegally manufactured fentanyl, significantly contributed to the rise in overdose deaths during the pandemic.

Drug overdose deaths in the United States increased by almost 30 percent during 2020 over the previous year, the Centers for Disease Control and Prevention (CDC) reported at the beginning of July.

The agency estimates that 93,331 people died from a drug overdose last year in the United States, far more than the previous 12-month peak of about 72,000 deaths in 2017.

Opioids, in particular illegally manufactured fentanyl, were the main driver behind the rise in overdose deaths during the pandemic. This continues a several-year trend.

“Synthetic opioids other than methadone, a category that includes illicitly manufactured fentanyl and its analogues, were specifically involved in 62 percent of these overdose deaths,” Regina LaBelle, acting director of the Office of National Drug Control Policy (ONDCP), said in a written statement.

Fentanyl, which is up to 100 times more potent than morphine, has contaminated other illegal drugs, which experts say has made the drug supply more dangerous.

“Fentanyl, one of the main opioids driving our overdose crisis, is now spreading rapidly into other drug supplies, and many of the overdose deaths that involve cocaine and methamphetamines now also involve fentanyl,” said Brendan Saloner, PhD, a professor of Health Policy and Management at the Johns Hopkins School of Public Health, during a podcast from The Commonwealth Fund.

Saloner said fentanyl, which has previously been common in the Midwest, Northeast, and mid-Atlantic, is now showing up more often in states west of the Mississippi.

In many cases, people may not realize the illegal drug they are using contains fentanyl.

“Many doctors are advising their patients, and harm reduction programs are telling people, no matter what you think you’re using, fentanyl can be out there,” Saloner said.

In the past, the opioid crisis has often been depicted as mainly affecting white Americans living in rural parts of the country.

Saloner said the picture is actually more complicated than that, and added that during the pandemic, overdose deaths also increased in other groups.

“With fentanyl now spreading into other drugs of use, I think that’s [why] we’re seeing the rise in overdose deaths among Black and Latinx populations,” Saloner said. “And one other group that I would just draw attention to are Native Americans, who have also been incredibly hard-hit by the overdose crisis.”

In addition to the contamination of illegal drugs with fentanyl, the pandemic — with its lockdowns and disruptions of employment and social connections — has worsened the opioid crisis in the United States.

“During the second half of 2019, before the pandemic hit, drug overdose deaths were trending up. So, after a slight decrease in 2018, we were seeing a rise again,” said Jesse Baumgartner, a research associate with The Commonwealth Fund, during the foundation’s podcast.

“While [overdose deaths] were going up right about in March [2020],” he added, “when the pandemic really started to hit the United States, they really exploded.”

Jan Losby, PhD, MSW, branch chief of the division of overdose prevention at the CDC, said during a webinar of the National Institute for Health Care Management (NIHCM) Foundation that there are many potential reasons for this rise in overdose deaths during the pandemic.

“[Many people] were struggling to maintain access to essential harm reduction treatment and recovery support services, [were] initiating or increasing substance use to cope with the stressors and social isolation created, and [were] using illicit drugs while alone more frequently,” she said.

Economic disruptions caused by the pandemic also contributed to overdose deaths.

“Homelessness, which was a crisis before COVID, is a major risk factor for overdose, because when people are unhoused, the way that they use drugs is just a lot riskier,” Saloner said.

Saloner said the Biden administration has already taken steps to address the worsening opioid epidemic, including focusing on harm reduction and trying to get more states to expand Medicaid.

In 2009, Medicaid accounted for 21 percent of the $24 billion U.S. health insurers spent on substance use disorder treatments, according to the agency’s website.

Harm reduction programs focus on helping people reduce the risks associated with substance use and substance use disorder. This includes needle exchange programs and methadone maintenance programs.

Tom Hill, MSW, senior policy adviser at the ONDCP, said in the NIHCM Foundation webinar that these types of programs can reach people who might not find their way into addiction treatment otherwise.

“It’s a way of engaging people into healthcare and treatment often for the first time,” he said. “And often a very low threshold manner of entry — not a lot of requirements — and a way to treat people without judgment, without shame.”

In recent testimony to Congress, ONDCP acting director LaBelle said the administration is taking other steps to help people at risk of dying from a drug overdose.

“The administration [is] making it easier for physicians and other medical practitioners to treat patients with opioid use disorder with the standard of care,” she said.

Also, “we have allowed federal funds to be used for fentanyl test strips; and we have ended a decade-long moratorium on methadone vans, so treatment can be brought to underserved communities.”

As seen with the COVID-19 pandemic, federal support is essential for tackling this kind of large-scale health crisis.

But Saloner thinks a lot of the key action over the coming months and years will happen at the state and local levels.

“One state that I’m really excited about is Missouri, which has a medication-first approach to treatment,” he said. “[Missouri has] created a whole system where they will support people in recovery. Even if they’re not ready to start counseling, they can still get medication.”

Some health insurers are also taking steps to help people access treatment.

Dr. Gregory Harris, senior medical director of behavioral health at Blue Cross Blue Shield of Massachusetts, said during the NIHCM Foundation webinar that the insurer has reduced the need for prior authorizations for detox admissions, and eliminated the deductible and copay for methadone.

This has made these treatments more accessible to members.

“What we find is for our members who are actually engaged, the admissions rate and costs have really dropped, and the more engaged they are with medication-assisted treatment, the better they do,” Harris said.

Many other efforts are underway at the national, state, and local levels to reduce the rising number of overdose deaths.

There’s still much work to be done, but experts see a glimmer of hope in the progress so far.

“People who have died from the opioid crisis did not need to die, and there are things that can be done,” Saloner said. “We don’t need to be paralyzed around this. There is a better future.”