U.S. overdose deaths hit record 107,000 in 2021

More Americans died of drug overdoses in 2021 than any previous year, a grim milestone in an epidemic that has claimed 1 million lives in the 21st century, according to federal data released Wednesday.

About 107,000 Americans died of drug overdoses in 2021, up 15 percent from the previous year, according to figures released Wednesday by the National Center for Health Statistics. The sobering tally reflects challenges exacerbated by the pandemic: lost access to treatment, social isolation and a more potent drug supply.

More than 80,000 people died from opioids, including prescription pain pills and fentanyl, a deadly drug 100 times as powerful as morphine and increasingly present in other drugs. Deaths from methamphetamine and cocaine also rose.

Since the start of the 21st century, an overdose epidemic led by prescription pain pills and followed by waves of heroin, fentanyl and meth has killed more than 1 million people, or roughly the population of San Jose, Calif., according to the provisional data.

And experts say there’s no clear end in sight.

“2022 will probably be as horrible as 2021 was, quite possibly worse,” said Keith Humphreys, an addiction and drug policy researcher at Stanford University.

Overdose deaths jumped to previously unseen levels in the first half of the pandemic, rising 30 percent from 2019 to 2020. The coronavirus pandemic strained finances, mental health, housing and more for many, all the while overshadowing the drug crisis. There’s concern that a predicted spike in cases this fall again could curtail access to treatment and medication.

The victims of the drug epidemic are overwhelmingly young. Between 2015 and 2019, young Americans lost an estimated 1.2 million years of life from drug overdoses, according to a study published in JAMA in January.

Rural areas have been especially devastated by the crisis during the pandemic, as residents struggle to reach remote, limited treatment options. Alaska experienced the biggest increase in overdose deaths in 2021, roughly 75 percent, according to the federal data.

The uneven nature of this modern plague may in part because of how fentanyl has seeped into the drug supply. It first dominated the West and New England before spreading, Humphreys said, suggesting that it and other synthetic drugs could drive out less potent drugs in the next decade. Fentanyl, increasingly found in counterfeit pills bought online and made in labs, is easier to produce than plant-based drugs, he said.

“There may not be much heroin around in 10 years because everything is fentanyl,” Humphreys said. “What do you do in a world where no one needs a farm anymore to make drugs?”

Humphreys, who has estimated that there could be another million overdose deaths in the next decade if policy doesn’t change, said there’s no silver bullet to addressing the multifaceted crisis. But one of the most sound ways to reduce overdoses, he said, is greater access to naloxone, the medication to reverse opioid overdoses.

“I think of naloxone like I do fire extinguishers,” he said. “Generally, they sit on a wall and they’re not needed. But when there’s a fire, there’s nothing like a fire extinguisher.”

In a first, the Biden administration presented a National Drug Control Strategy to Congress last month to lay out a road map for addressing untreated addiction and drug trafficking. The plan calls for an expansion of naloxone, drug test strips and syringe distribution programs.

While the plan takes the right steps toward mitigating the damages of the crisis, the harm is done, said Kasia Malinowska-sempruch, director of drug policy at the global programs at Open Society Foundations. The upward trend of deaths will continue until the ideas trickle down to actual policy over the hardest-hit communities.

As part of his strategy to curb the flow of fentanyl into the country, Biden asked Congress in his budget for a $300 million bump in funding for the Customs and Border Protection agency and an increase of $300 million for the Drug Enforcement Administration.

The DEA issued a rare public warning last year over the alarming amount of fake pills bought online and laced with potentially lethal amounts of fentanyl.

Another wrinkle for the administration is ensuring the resources reach those who most need them, as the stigma of drugs has alienated some users.

While treatment has scaled up, it remains inaccessible to most of those it could help. Nearly 15 percent of people age 12 or older needed substance use treatment in 2020, but just 1.4 percent received it, according to the Substance Abuse and Mental Health Services Administration.

“It is unacceptable that we are losing a life to overdose every five minutes,” White House drug czar Rahul Gupta said.