More Americans died of drug overdoses in 2021 than any previous year, a grim milestone in an epidemic that has now claimed 1 million lives in the 21st century, according to federal data released Wednesday.
More than 100,000 Americans died of drug overdoses in 2021, up 15% from the previous year, according to an estimate released by the National Center for Health Statistics. The tally of 107,622 reflects challenges exacerbated by the coronavirus pandemic: lost access to treatment, social isolation and more potent drug supplies.
More than 80,000 people have died using opioids, including prescription painkillers and fentanyl, a deadly drug 100 times more potent than morphine and increasingly found in other medications. Deaths from methamphetamine and cocaine have also increased.
Since the turn of the 21st century, an epidemic of overdose led by prescription painkillers and followed by waves of heroin, fentanyl and methamphetamine has killed more than a million people, roughly the population of San Jose, according to provisional data.
And there is no clear end in sight, experts say.
“2022 is likely to be as horrific as 2021, if not worse,” said Keith Humphreys, an addiction and drug policy researcher at Stanford University.
Nora Volkow, director of the National Institute on Drug Abuse, said the country is emerging from the pandemic with a “significant increase” in depression, anxiety, loneliness and suicidal thoughts, “and it’s not going to go away.”
“I think the next few years will be difficult,” she said.
Officials warn they are responding to more and more overdoses as the pandemic lingers. Pennsylvania Attorney General Josh Shapiro’s office seized 1.8 million doses of fentanyl in the first three months of 2022, more of the powerful synthetic opioid than in all of 2021.
Nationwide overdose deaths have reached levels not seen in the first half of the pandemic, rising 30% from 2019 to 2020. The pandemic has strained finances, mental health, housing and more for many, while overshadowing the drug crisis. There are fears that an expected spike in coronavirus cases this fall could once again restrict access to treatment and medicine.
COVID-19 has claimed as many lives in two years as the opioid epidemic in two decades. However, the victims of the drug epidemic are predominantly young. Between 2015 and 2019, young Americans lost an estimated 1.2 million years of life to drug overdoses, according to a study published in JAMA Pediatrics in January.
Rural areas have been particularly devastated by the overdose crisis during the pandemic, as residents struggle to access remote and limited treatment options. Alaska saw the largest increase in overdose deaths in 2021, about 75%, according to federal data. The National Center for Health Statistics is part of the Centers for Disease Control and Prevention.
In California, where more than 10,000 people died from overdoses in 2021, psychostimulants such as methamphetamine accounted for about half of overdose deaths and led to 15% more deaths than the previous year, according to an analysis of Washington Post data. Overdoses of opioids, including fentanyl, jumped more than 27% in the state.
Between 2018 and 2020, drug addicts in San Francisco switched from injecting heroin tar to fentanyl after noticing improved health and reduced stigma, according to research co-authored by epidemiologist Alex Kral at RTI International which studied California’s drug supply. Kral said that as drug use has evolved, the data explaining the changes has lagged, leaving researchers and health experts somewhat blind to the various drugs users use more often in tandem.
Experts have increasingly warned of a methamphetamine wave. In 2021, almost 33,000 people died from psychostimulants, less than half of the deaths caused by opioids. Combining an opiate with a stimulant – commonly known as a “speedball” – has become increasingly popular, said Daniel Ciccarone, a professor at the University of California, San Francisco who studies drugs.
While the supply of more potent drugs will continue to lead to deaths, Ciccarone predicted that the rising rate of overdoses will level off or perhaps decline over the next year due to a confluence of events: pandemic mitigation, with the government stepping up its response and pharmaceutical companies paying billions to help alleviate the crisis. Yet the number of people using drugs is also on the rise, Ciccarone added.
“There is something to be said for the request,” he said. “Why is America so hungry for drugs? Why does it seem to be increasing from generation to generation? Does it have anything to do with our economic inequalities and other disparities?”
The patchy nature of this modern scourge may be due in part to how fentanyl has seeped into the drug supply. It first dominated the Midwest and New England but spread across the country, Humphreys said, suggesting it and other synthetic drugs could chase less potent drugs over the next decade. . Fentanyl, increasingly found in counterfeit pills bought online and made in labs, is easier to produce than herbal drugs, he said.
“There might not be a lot of heroin in 10 years because it’s all fentanyl,” Humphreys said. “What are you doing in a world where nobody needs a farm to make drugs anymore? »
Humphreys, who estimated there could be another million overdose deaths over the next decade if policy does not change, said there was no silver bullet to deal with the crisis multi-faceted. But one of the most effective ways to reduce overdoses, he said, is better access to naloxone, the drug to reverse opioid overdoses.
“I think of naloxone like fire extinguishers,” he said. “Usually they sit on a wall and they’re not needed. But when there’s a fire, nothing beats a fire extinguisher.”
In a first, the Biden administration presented the National Drug Control Strategy to Congress last month to lay out a roadmap to tackle untreated addiction and drug trafficking. The plan calls for an expansion of naloxone, drug test strips and syringe programs.
While the plan takes the right steps to mitigate the damage of the crisis, the damage is done, said Kasia Malinowska-Sempruch, director of global drug policy at Open Society Foundations. The upward trend in deaths will continue until insights trickle down to real-world policy regarding the hardest hit communities.
As part of his strategy to curb the flow of fentanyl into the country, President Joe Biden asked Congress in his budget for a $300 million increase in funding for U.S. Customs and Border Protection and an increase in $300 million for the DEA.
Another challenge for the administration is to ensure that resources reach those who need them most, as the stigma of drugs has alienated some users.
Although treatment has intensified, it remains inaccessible to most of those it could help. Nearly 15% of people 12 or older needed substance abuse treatment in 2020, while 1.4% received it, according to the Substance Abuse and Mental Health Services Administration.
Additionally, Malinowska-Sempruch said, Biden’s plan does not recommend some solutions that could help meet drug users where they are, such as decriminalizing personal possession and creating supervised injection sites, where trained monitors monitor users to intervene and counter overdoses.
“It’s going to take a while before it can get better,” Malinowska-Sempruch said, “and it’s going to continue to cost lives.”
Meanwhile, the Biden administration has ushered in “a new era of drug policy,” according to Rahul Gupta, director of the Office of National Drug Control Policy, who highlighted actions to make overdoses preventable, such as the distribution of naloxone.
“It is unacceptable that we lose a life to an overdose every five minutes 24 hours a day,” Gupta said.