U.S. overdose deaths increased in early 2019, largely due to opioids and stimulants, according to a Centers for Disease Control and Prevention (CDC) Vital Signs report. And recent data indicate that the COVID-19 pandemic is worsening drug overdose trends.
Illicitly manufactured fentanyl (IMF) drugs, heroin, cocaine, or methamphetamine were involved in nearly 85% of drug overdose deaths in the 24 states and the District of Columbia that reported data in the CDC's State Unintentional Drug Overdose Reporting System (SUDORS). Two or more of these drugs were involved in half of deaths that occurred January to June 2019. The American Medical Association published an issue brief that stated its concern with the growing number of reports from national, state and local sources of increases in opioid- and other drug-related mortality, especially from IMF.
The CDC analysis of unintentional drug overdose deaths showed that over 80% involved opioids and stimulants. Opioids are a class of drugs that are used to reduce pain and include morphine, heroin, oxycodone, and fentanyl. Stimulants increase alertness, attention, and energy and include cocaine, amphetamine, and methamphetamine.
Roughly 80% of 16,236 drug overdose deaths in the 25 jurisdictions in the study were due to one or more opioids, and of those deaths, 75% involved an IMF. Using both opioids and stimulants raises the risk of fatal overdose and is associated with worse medical, mental health, and substance abuse treatment outcomes. IMFs are especially dangerous because they are very potent relative to other opioids and more likely to cause an unexpected overdose, particularly when injected.
Opioid overdose deaths were most common among white males (>66%) and most of that group were non-Hispanic white (75%). Most overdose deaths involving opioids—with and without stimulants—occurred among younger people, ages 25 to 44 years. In contrast, almost 56% of overdose deaths involving stimulants without opioids were among people aged 45 to 64 years.
Methamphetamine was involved in approximately one half of stimulant overdose deaths without opioids. The report notes seven years of substantial increases in the methamphetamine supply with increases accompanied by jumps in methamphetamine-related treatment admissions and overdose deaths.
Drug overdoses and COVID-19
Data indicate that the COVID-19 pandemic is worsening drug overdose trends and deaths. Recent reports detail an 18% jump in suspected overdoses, based on data from a federal initiative that collects statistics. In some jurisdictions, dispatch calls for overdoses have increased more than 50%, according to the initiative.
Meanwhile, a July Millennium Health report detailing an analysis of 500,000 urine drug testing samples collected since March of 2020 noted a 32% increase in urine samples testing positive for non-prescribed fentanyl, about a 20% increase for methamphetamine, a 12% increase for heroin, and a 10% increase for cocaine. However, during the COVID-19 pandemic, urine drug testing decreased nationally in association with stay-home orders; therefore, the true incidence of drug use during this time is unknown.
Some reasons why overdoses have increased is that the pandemic has disrupted illegal supply chains, driving drug users to buy new substances and from suppliers they do not know. Social distancing has meant that people take dangerous drugs or dangerous doses alone, with no one to call emergency services or administer naloxone, a drug that can reverse the effects of an opioid overdose when administered in time. Many treatment centers have closed or scaled back, according to recent reports. These extra challenges created by the pandemic have intensified the need for effective overdose prevention strategies and interventions.
Preventing drug overdoses
The CDC report suggests several measures to combat the rise in overdose deaths, using insights from the data. More than three out of five overdose deaths involved at least one potential opportunity to help a person at risk to get treatment services before the overdose happened, or to use life-saving actions when an overdose occurred.
Expanding outreach programs and offering treatment services to people at risk could reduce the number of overdose deaths. Significant risk factors for death from overdose include recent release from an institution (e.g., jail, prison, inpatient rehabilitation facility), previous overdose or substance use disorder treatment, and mental health diagnosis, according to the report.
CDC treatment guidelines call upon healthcare practitioners who prescribe opioids for chronic pain to assess their patients' risk of opioid-related harm and use urine drug testing to monitor treatment. This testing can detect whether patients are taking their prescribed drugs, and whether they may also be taking non-prescribed drugs that may trigger an overdose. Healthcare practitioners should also refer patients who are at risk of harm to mental health, social services, and substance use disorder treatment.
The 2019 data also showed that a bystander was present in nearly 40% of overdose deaths. The CDC website urges bystanders who suspect an overdose to remain with the distressed person and to get them emergency care. Additionally, the CDC suggests that individuals learn about naloxone and its proper use, and that communities expand naloxone distribution programs and dispensing from pharmacies. Meanwhile, the CDC website also suggests that patients who take high-dose opioids, have a substance use disorder, or have other risk factors for opioid overdose ask their healthcare practitioners or pharmacists for a naloxone prescription. Their families should be educated on naloxone too, as a potential life-saving measure.