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January 5, 2021

CDC Warns of Surge in Drug Overdose Deaths During COVID-19

Author Affiliations
  • 1Consulting Editor, JAMA Health Forum and JAMA
JAMA Health Forum. 2021;2(1):e210001. doi:10.1001/jamahealthforum.2021.0001

Spurred by a spike in drug overdose deaths over the past year, the Centers for Disease Control and Prevention (CDC) is warning public health departments, health care professionals, and first responders of “a concerning acceleration of the increase in drug overdose deaths” coinciding with the emergence of the coronavirus disease 2019 (COVID-19) pandemic.

In a recent CDC Health Alert Network advisory, the agency noted that approximately 81 230 drug overdose deaths occurred in the United States in the 12 months ending May 2020, the highest number ever documented in a 1-year period, the agency said. Although such deaths were already on the rise in the months before the emergence of COVID-19, the latest evidence suggests an acceleration during the pandemic, with the largest increase documented from March 2020 to May 2020, a time when widespread mitigation measures were implemented.

“The disruption to daily life due to the COVID-19 pandemic has hit those with substance use disorder hard,” said CDC Director Robert Redfield, MD, in a statement. “As we continue the fight to end this pandemic, it’s important to not lose sight of different groups being affected in other ways. We need to take care of people suffering from unintended consequences.”

The surge in deaths was primarily driven by a rapid rise in overdose deaths caused by synthetic opioids (other than methadone), most likely illicitly produced fentanyl, the CDC said. Such deaths increased more than 38% from the 12-month period ending in June 2019 to the 12-month period ending in May 2020.

Of 38 jurisdictions with available synthetic opioid data, 37 reported increases in synthetic opioid overdose deaths, and nearly half (18) reported increases greater than 50%. The largest percentage increases in deaths caused by synthetic opioids overdoses occurred in western states, with 10 western states reporting more than a 98% increase in such deaths.

“This is consistent with large increases in illicitly manufactured fentanyl availability in western states and increases in fentanyl positivity in clinical toxicology drugs tests in the West” after the United States declared COVID-19 a national emergency on March 13, 2020, the CDC noted. Other regions experiencing large increases in synthetic opioid overdose deaths included a dozen southern states and the District of Columbia, a half-dozen midwestern states, and 8 northeastern states and New York City.

Overdose deaths involving cocaine use increased 26.5% during the same 1-year period. Based on earlier research, the CDC noted, these deaths were likely linked to use of cocaine together with illicitly manufactured fentanyl or heroin or use of cocaine contaminated with these opioids.

The researchers noted an even larger spike in deaths involving overdoses of “psychostimulants with abuse potential,” such as methamphetamine, increasing 34.8% in the same time period. Overdose deaths involving methamphetamine and other psychostimulants have been increasing both with and without concurrent use of synthetic opioids.

“These increases are consistent with the increased availability of methamphetamine in the illicit drug supply and increases in methamphetamine-related treatment admissions,” the advisory noted.

To address the surge in fatal drug overdoses, the CDC recommends expanding the distribution and use of the anti-overdose drug naloxone, as well as educational efforts targeting overdose prevention.

For clinicians and health care organizations, the advisory cited strategies to prevent overdose deaths. These strategies include talking with patients about the risks for overdose and the dangers associated with exposure to powerful opioids, such as illicitly produced fentanyl; prescribing naloxone to individuals at risk for opioid overdose (such as individuals with opioid use disorder and those with a history of overdose); and counseling patients that multiple naloxone doses may be required for a single overdose episode because of the potency of illegally produced fentanyl.

Locations that offer education about preventing overdoses and provide take-home naloxone—such as inpatient and outpatient treatment programs, primary care settings, pharmacies, and counseling and support groups—should also be expanded, the CDC said, an action that may be especially important in rural areas.

In addition, the advisory urges public health departments and community-based organizations to boost awareness about the importance of preparing bystanders to have naloxone on hand and use it during an overdose, among other measures. It also recommended actions by public health departments, medical examiners and coroners, and laboratories to improve detection of overdose outbreaks resulting from fentanyl, novel psychoactive substances such as fentanyl analogs, and other drugs.

The new data on fatal overdoses, in the context of the pandemic’s disruption to public health, health care, and social services and related mitigation measures, “highlight the need for essential services to remain accessible for those most at risk of overdose and the need to expand prevention and response activities,” the advisory said.

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Article Information

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Stephenson J. JAMA Health Forum.

Corresponding Author: Joan Stephenson, PhD, Consulting Editor, JAMA Health Forum (Joan.Stephenson@jamanetwork.org).

Conflict of Interest Disclosures: None reported.

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