WASHINGTON — According to preliminary new data released Wednesday by the Centers for Disease Control and Prevention, drug overdose deaths continued to rise to record levels in 2021, nearing 108,000.
The nearly 15 percent increase followed a much stronger rise of nearly 30 percent in 2020, an unrelenting crisis that has consumed federal and state drug policy officials. The number of drug overdose deaths has been increasing every year, but since the 1970s.
A growing number of deaths have resulted from overdoses of fentanyl, a class of potent synthetic opioids often mixed with other drugs, and methamphetamine, a synthetic stimulant. State health officials battling an influx of both drugs said many of the deaths appeared to have resulted from the combination of the two.
Drug overdoses, which long ago surpassed the country’s peak deaths from AIDS, car accidents and firearms, killed about a quarter as many Americans as Covid-19 last year.
Deaths involving synthetic opioids – largely fentanyl – rose from 58,000 to 71,000 from 71,000, while deaths from stimulants such as methamphetamine, which have become cheaper and more lethal in recent years, rose from 25,000 to 33,000. Because fentanyl is a white powder, it can be easily combined with other drugs, including opioids like heroin, and stimulants like meth and cocaine, and can be stamped into counterfeit anti-anxiety pills like Xanax. Such mixtures can be fatal if drug users are unaware they are taking fentanyl or are unsure of the dose.
Deaths from both classes of drugs have risen in recent years.
But there’s mounting evidence that mixing stimulants and opioids — in combinations known as “speedballs” and “goofballs” — is also becoming more common. Dan Ciccarone, a professor of family and community medicine at the University of California, San Francisco, who studies drug markets, has just begun a multi-year study on the combination of opioids and meth.
“There’s an intertwined synthetic epidemic like we’ve never seen before,” he said. “We’ve never seen a potent opioid like fentanyl mixed with such a potent methamphetamine.”
The opioid crisis
From potent drugs to illicit synthetics, opioids are fueling a deadly drug crisis in America.
The numbers released on Wednesday are considered preliminary and could change as the government assesses more death data. But they added more definition to a crisis that has escalated sharply during the pandemic.
The White House has in recent weeks announced President Biden’s first national drug-fighting strategy, and a plan to combat meth use unveiled last week by its drug czar, Dr. Rahul Gupta, the first physician to oversee the White House Office of National Drug Control Policy. According to the National Institutes of Health, the number of meth overdose deaths nearly tripled in people ages 18 to 64 between 2015 and 2019.
Mr. Biden is the first president to embrace harm reduction, an approach criticized by some for enabling drug users, but hailed by addiction experts as a way of keeping drug users alive while providing access to treatment and support.
Rather than urging abstinence, the approach aims to reduce the risk of death or contracting infectious diseases by providing sterile equipment — for example, changing needles — or tools to monitor medications for the presence of fentanyl. Comics that can detect fentanyl have become increasingly valuable resources for local health officials, and some states have recently moved to decriminalize them, even as others resist.
The causes of the continued increase in overdoses are complex and difficult to untangle, experts say. But state health officials and some addiction experts said the spike in drug overdoses, which began before the pandemic, could not be attributed solely to the disruptions that accompanied it, or to a large increase in the number of Americans taking drugs.
Social isolation and economic disruption, which were widespread during the pandemic, tend to trigger drug relapses and may have contributed to increasing drug overdoses. Shutdowns in early 2020 also forced some addiction treatment providers to temporarily close their doors. But the pandemic alone does not explain the recent trend.
Policy changes made during the pandemic may have helped prevent more deaths. Regina LaBelle, an addiction policy expert at Georgetown University, said early research found that relaxing the rules to allow for home methadone treatment was beneficial, along with an increase in telemedicine treatment.
“The difference in what we see now is not how many people use it,” said Dr. Anne Zink, the chief health officer in Alaska, said data released Wednesday.
Instead, she said, fentanyl supplies had skyrocketed, in shipments that were difficult to track and penetrated even the most isolated parts of the state. Of the 140 deaths from fentanyl overdose the state recorded in 2021, more than 60 percent also involved meth and nearly 30 percent were heroin.
Fentanyl, which is made in a lab, can be cheaper and easier to produce and distribute than heroin, making it more attractive to dealers and traffickers. But because it’s strong and sold in different formulations, small differences in amount could mean the difference between a drug user’s usual dose and one that turns out to be lethal. It is particularly dangerous when used unknowingly by drug users who do not normally use opioids. The spread of fentanyl in an ever-growing portion of the nation’s drug supply has baffled even states with strong addiction treatment services.
Often synthesized in Mexico from precursor chemicals made in China, fentanyl penetrated the heroin markets of the Northeast and Midwest long ago. But recent data shows that it has also gained a strong foothold in the south and west.
“The economics of fentanyl just pushed the other drugs out of the market,” said Dr. Joshua Sharfstein, a vice dean of the Bloomberg School of Public Health at Johns Hopkins University. “It’s just so cheap to buy fentanyl and flip it and put it in whatever.”
A recent investigation into illicit pills seized by drug enforcement authorities found that a significant portion of what’s marketed as OxyContin, Xanax or the Hyperactivity Disorder drug Adderall now contains fentanyl. The proliferation of these counterfeit pills may explain a recent surge in overdose deaths among teens, who are less likely to inject drugs than older people.
Pat Allen, the director of the Oregon Health Authority, said that, as was the case in other states with rising overdose deaths, the clear difference in 2021 was fentanyl’s ubiquity. Children over the age of 12 are at high risk of being given counterfeit pills containing fentanyl, and high school students overdose thinking they are opioid pain relievers or anti-anxiety drugs. The state was in the process of sending naloxone toolkits to schools, similar to a program it has used in fast-food restaurants, where people overdosed in bathrooms.
mr. Allen said he’s seen an alarming phenomenon among those who overdose: they view fentanyl’s risk as low, even though the actual risk is “seriously higher.”
“We’ve had an addiction problem in Oregon that we’ve known about for a long time,” he said. “This takes away that existing addiction problem and makes it much more dangerous.”
By 2021, overdoses were one of the leading causes of death in the United States, comparable to the number of people who died from diabetes and Alzheimer’s disease, and about a quarter of the number of people who died from Covid-19, the third leading cause of death, according to the CDC
In Vermont, 93 percent of opioid deaths in 2021 were related to fentanyl, according to Kelly Dougherty, the state’s deputy health commissioner.
“In the early stages of the pandemic, we attributed the increase to disruption of life,” she said. But now, she added, another explanation seems clear: “What’s really the main cause is the presence of fentanyl in the drug stock.”
The state’s famed “hub and spoke” model of addiction treatment and the aggressive use of drug treatment programs, she said, were not enough to cope with the ease and speed with which people overdose on fentanyl.
“You can have the most robust treatment system,” she said, “and not everyone will use it when they might have to, or before they overdose.”
And fentanyl is in counterfeit pills, Ms. Dougherty said, also in OxyContin.
She said officials in Vermont had included new public messages about fentanyl.
“Guess it’s everywhere,” she said.