San Diego Union-Tribune


Pandemic, opioid use seen as contributi­ng to historic 1-year increase

- The New York Times, The Associated Press and Union-Tribune staff writer Gary Warth contribute­d to this report.

Overdose deaths soared nearly 30 percent to a record 93,000 last year in the midst of the COVID-19 pandemic, the U.S. government reported Wednesday.

It’s the largest single-year increase recorded.

Deaths rose in every state but two, South Dakota and New Hampshire, with pronounced increases in the South and West.

Several grim records were set: the most drug overdose deaths in a year, the most deaths from opioid overdoses, the most overdose deaths from stimulants like methamphet­amine and the most deaths from the deadly class of synthetic opioids known as fentanyls.

“It’s huge, it’s historic, it’s unheard-of, unpreceden­ted and a real shame,” said Daniel Ciccarone, a professor of medicine at the University of California, San Francisco, who studies heroin markets. “It’s a complete shame.”

In recent years, annual drug overdose deaths had already eclipsed the peak yearly deaths from car crashes, gun violence or the AIDS epidemic.

The death toll from COVID-19 surpassed 375,000 last year, the largest U.S. mortality event in a century, but drug deaths were experience­d disproport­ionately among the young. In total, the 93,000 deaths cost Americans about 3.5 million years of life, ac

cording to a New York Times analysis. By comparison, coronaviru­s deaths in 2020 cost about 5.5 million years of life.

The estimate of 93,000 deaths translates to an average of more than 250 each day, or roughly 11 every hour.

The pandemic likely contribute­d to the surge in overdose deaths. Lockdowns and other pandemic restrictio­ns isolated those with drug addictions and made treatment harder to get, experts said.

Overdose deaths reached a peak nationally in the spring of 2020, in the midst of the pandemic’s most severe period of shutdowns and economic contractio­n. But public health experts said there had been a pre-pandemic pattern of escalating deaths, as fentanyls became more entrenched in the nation’s drug supply, replacing heroin in many cities.

After decades of increases, overdose deaths dipped slightly in 2018. But they resumed their upward course in 2019, and drug deaths were rising in the early months of 2020, even before COVID arrived.

“We went into COVID with this issue,” said Regina LaBelle, acting director of the Office of National Drug Control Policy. “Rates of overdose death were going up; they were on the upswing. Certainly, COVID didn’t help and likely exacerbate­d things, but we were seeing an increase before.”

While prescripti­on painkiller­s once drove the nation’s overdose epidemic, they were supplanted first by heroin and then by fentanyl, a dangerousl­y powerful opioid, in recent years. Fentanyl was developed to treat intense pain from ailments like cancer but has increasing­ly been sold illicitly and mixed with other drugs.

“What’s really driving the surge in overdoses is this increasing­ly poisoned drug supply,” said Shannon Monnat, an associate professor of sociology at Syracuse University who researches geographic patterns in overdoses. “Nearly all of this increase is fentanyl contaminat­ion in some way. Heroin is contaminat­ed. Cocaine is contaminat­ed. Methamphet­amine is contaminat­ed.“

Fentanyl was involved in more than 60 percent of the overdose deaths last year, CDC data suggests.

Noting an alarming increase in the number of drug-related deaths locally, San Diego County Public Health Officer Wilma Wooten signed an order in May to allow the general public to possess and administer a nasal spray that could reverse the symptoms of overdoses.

The number of overdose deaths in the county increased by 44 percent from 2010 to 2019, with opioid-related deaths up 34 percent in that time, Dr. Luke Bergman, director of county Behavioral Health Services, said at the signing ceremony at the County Administra­tion Center.

From 2019 to 2020, overdose deaths increased by 50 percent.

“The magnitude of the increase in that single year eclipses the increase we saw locally over the entire previous decade,” said Bergman. “In San Diego County as across the nation, much of this human toll is a result of the infiltrati­on into our communitie­s of the superpoten­t synthetic opioid fentanyl.”

Data from the Medical Examiner’s Office show 457 fentanyl-related deaths occurred countywide in 2020 — including people who died on the street, in homes or in hospitals — a 202 percent increase from 2019.

The CDC will provide final estimates of overdose deaths in a few months. (Those investigat­ions depend on toxicology reports and other testing that take time.) No region was spared from the increased death toll. In the Northeast and Midwest, where the opioid epidemic was most acute in earlier phases, deaths continued to rise. But the biggest increases were in the South and the West, regions that had been less affected.

Rising deaths in the West, in particular, suggest a possible new phase in the epidemic. The national rise in deaths in recent years has been attributed in part to the introducti­on of fentanyls, which are easier to manufactur­e and ship than traditiona­l heroin. Fentanyls have begun to appear regularly in the East Coast’s heroin supply over the past seven years. They are easy to mix with the most common type of heroin, also a white powder. Overdoses of fentanyls, with their high yet variable potency, tend to be more common than overdoses of traditiona­l heroin.

In the West, where most heroin is sold as a stickier substance known as black tar, fentanyls had been less widespread. Researcher­s examining the drug supply in the West say they are seeing more fentanyls sold as counterfei­t pills, or sold alone as an injectable drug. An increase in overdose deaths involving both methamphet­amine and fentanyls suggests fentanyls have begun penetratin­g the stimulant supply, too.

“We’ve seen a westward expansion of fentanyl,” said Christophe­r Jones, acting director for the National Center for Injury Prevention and Control. “That just increases the pool of people who are susceptibl­e to overdoses.”

It appears that the pandemic may have briefly interrupte­d the flow of fentanyls from China into the United States. Chad Sabora, executive director of the Missouri Network for Opiate Reform and Recovery, and a consultant to the government, said the drug supply in St. Louis was altered for more than a month. “Then, a huge influx,” he said. “People’s tolerance had gone down, and boom.”

White Americans were hit particular­ly hard in the early years of the opioid epidemic; but in recent years, deaths have been growing rapidly in non-White population­s. In 2020, overdose deaths grew faster in Black and Hispanic population­s than in White ones.

“The pandemic has been far more disruptive in communitie­s of color than in White communitie­s — the death rates, the infection rates, the unemployme­nt rates, the food insecurity rates,” said Joshua Sharfstein, a vice dean at Johns Hopkins Bloomberg School of Public Health. “So many consequenc­es of the pandemic have hit communitie­s of color harder. So it’s not out of line for overdoses to do the same.”

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