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COVID-19
October 20, 2020

Drug Overdose Deaths Head Toward Record Number in 2020, CDC Warns

Author Affiliations
  • 1Consulting Editor, JAMA Health Forum and JAMA
JAMA Health Forum. 2020;1(10):e201318. doi:10.1001/jamahealthforum.2020.1318

Even as the rising number of US coronavirus disease 2019 (COVID-19) deaths dominates the spotlight, another national public health crisis—overdose deaths from use of illicit drugs—shows no sign of abating.

An estimated 19 416 individuals died of a drug overdose in the United States in the first 3 months of 2020 compared with 16 682 in the same 3-month period in 2019, according to preliminary data released last week by the US Centers for Disease Control and Prevention’s (CDC’s) National Center for Health Statistics. The agency also estimates that 75 500 overdose deaths occurred in the 12-month period between March 2019 and March 2020, an increase of approximately 10%.

If this increased rate for drug overdose deaths holds, the United States is on track to reach a new all-time record for overdose fatalities within a calendar year. Most states experienced increases in the rate of overdose deaths during the first quarter of 2020 compared with the same period in 2019, with 7 states (plus the District of Columbia) experiencing increases ranging from 25% to 50% from March 2019 to March 2020.

Stresses related to the COVID-19 pandemic, such as economic strains, as well as COVID-19–related isolation and other factors hindering treatment and support for people with substance use issues, may have contributed to the current rise in overdose deaths.

Other than a small decline in 2018, overdose fatalities have increased dramatically for 3 decades, with a record number of 71 966 estimated deaths in 2019. According to the CDC, opioids—especially synthetic ones (other than methadone)—are currently the chief drivers of drug overdose fatalities.

This rise in opioid overdose deaths has occurred in 3 waves. The first involved prescription opioids (natural and semisynthetic opioids and methadone) beginning in 1999 or earlier, following increased prescribing of opioids in the 1990s. A second wave began in 2010, featuring rapid increases in overdose deaths involving heroin, followed by a third wave of significant increases in fatalities starting in 2013 that was fueled by synthetic opioids (especially illicitly manufactured fentanyl).

The latest rise in fatal drug overdoses may have been boosted by factors related to the COVID-19 pandemic. According to findings from a CDC survey of US adults, 13% of respondents said in late June that they had started or increased substance use to cope with pandemic-related stress or emotions. Groups that were more likely to do so included young adults (nearly a quarter of those aged 18 to 24 years), Hispanic (21.9%) and Black (18.4%) respondents, essential workers (24.7%), and unpaid caregivers for adults (32.9%).

At the same time, accounts in the news media suggest that individuals struggling with past or current substance abuse may face pandemic-related hurdles to getting help. According to a report by Kaiser Health News, drug rehabilitation programs, including in Florida, Illinois, Indiana, Minnesota, and Pennsylvania, have been forced to close down or limit their operations because of COVID-19 cases among patients or staff or financial difficulties stemming from the pandemic.

Such programs commonly involve shared spaces for group therapy, and people struggling with substance use often have heightened vulnerability to coronavirus infection because of other health conditions. Moreover, as Nora Volkow, MD, director of the National Institute on Drug Abuse, has noted, individuals who regularly use certain illicit drugs, such as opioids and methamphetamines, “may also be vulnerable due to those drugs’ effects on respiratory and pulmonary health.”

However, there have been efforts to extend treatment and support to people struggling with substance use by adapting guidelines and easing restrictions in response to the difficulties posed by COVID-19, including increasing use of telemedicine. To make it easier for patients with opioid use disorder to access buprenorphine and methadone, the Substance Abuse and Mental Health Services Administration (SAMHSA) and Drug Enforcement Administration have issued new guidance that provides more flexibility for clinicians to evaluate and prescribe remotely.

In parallel with these adaptations to the pandemic, community support programs for substance use disorders (such as Narcotics Anonymous) have moved meetings online to allow people in treatment or recovery to meet virtually. To assist such efforts, SAMHSA developed a tip sheet listing virtual recovery resources that offer online support, as well as advice to help local recovery programs create virtual meetings.

“In an infectious disease outbreak, when social distancing and self-quarantine are needed to limit and control the spread of the disease, continued social connectedness to maintain recovery [is] critically important,” SAMHSA notes. “Virtual resources can and should be used during this time.”

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