The increase came as no surprise to addiction specialists, drug counselors and policy experts who have watched the steady rise in deaths throughout the pandemic. But that did not make the statistics any less horrifying.
“Every one of those people, somebody loved them,” said Keith Humphreys, a psychiatry professor at Stanford University and an expert on addiction and drug policy. “It’s terrifying. It’s the biggest increase in overdose deaths in the history of the United States, it’s the worst overdose crisis in the history of the United States, and we’re not making progress. It’s really overwhelming.”
The estimated number of overdose deaths reached 93,331 in 2020, according to the new data. Annual final numbers usually differ little from provisional figures like those released Wednesday. More than 900,000 people have died of overdoses since the U.S. drug epidemic began in about 1999, according to the Centers for Disease Control and Prevention. The National Center for Health Statistics is part of the CDC.
Opioids, primarily illegal fentanyl, continued to drive the death toll, as they have for years. Overdose deaths involving opioids reached 69,710 in 2020, up from 50,963 in 2019, according to the data. Deaths from methamphetamine and cocaine also rose.
Nora Volkow, head of the National Institute on Drug Abuse, said in an interview that fentanyl has so thoroughly infiltrated the illegal drug supply that 70 percent of cocaine overdose deaths and 50 percent of methamphetamine overdose deaths also involved fentanyl.
In many cases, she said, users are unaware that their drugs are laced with the powerful painkiller, which can halt breathing even if a minute amount is ingested. In other cases, users knowingly take multiple drugs.
“Most of the deaths are from multiple drugs,” she said.
But unlike past years, 2020 brought the added complications of a worldwide viral pandemic. Health-care resources were stretched and redirected toward the emergency. Anti-addiction medication was more difficult to obtain. Stress increased dramatically. Users were more isolated, leading to additional overdoses because other people were not nearby to summon first responders or administer the opioid antidote naloxone, experts said.
“The pandemic has led to increased substance use across the board, as people have sought to manage stress, isolation, boredom, anxiety, depression, unemployment, relationship and child care issues, and housing instability,” Kimberly Sue, medical director of the National Harm Reduction Coalition, an advocacy group that tries to prevent overdose deaths, said in an email.
Sue, an addiction specialist at Yale University, also said the pandemic limited drug users’ access to anti-addiction medication such as buprenorphine and methadone, in addition to naloxone.
With covid-19 having killed more than 300,000 people last year, “we took our eye off the opioid epidemic,” said Tami Mark, a senior fellow at the think tank RTI International. “When we weren’t looking, it got horribly worse.”
Humphreys said Congress too often has treated drug addiction as a short-term issue rather than a chronic problem like cancer and other diseases.
“We keep thinking it’s a short-term thing, and we just need one oomph to get past it. It’s not like that,” he said.
The most populous state, California, saw an increase in fatalities of 45.9 percent from December 2019 to December 2020, according to the new data. In Vermont, deaths rose by 57.6 percent, the largest increase in the country, followed closely by Kentucky at 53.7 percent.
Nationally, the number of overdose deaths was more than double the estimated number of motor vehicle fatalities. Those rose slightly to 42,617, despite shutdowns forced by the pandemic.
A modest dip in fatalities between 2017 and 2018 led Alex Azar, the Trump administration’s secretary of Health and Human Services, to proclaim progress against the drug crisis. But fatalities soon surged again before rocketing upward last year.
“I’m just heartbroken,” National Institutes of Health Director Francis Collins said in an interview. “We have another public health crisis, of major proportions. It’s not infectious, but is spreading across our county and taking far too many lives.”
Drug overdose fatalities have been increasing for much of the past quarter-century, a period when they became one of the leading causes of death in the United States and helped fuel small declines in overall life expectancy — a dismal sign for a developed nation with one of the most sophisticated health-care systems in the world.
There are some signs that the Biden administration and Congress are preparing to renew efforts to address what was the nation’s most serious public health crisis before the pandemic. President Biden on Tuesday nominated former West Virginia public health official Rahul Gupta to be his drug czar. Gupta has cited the shift from in-person care during the pandemic as one of the contributors to increased addiction-related public health problems.
The Senate Caucus on International Narcotics Control will hold a hearing next week on how to move forward against the drug crisis.
The White House has insisted that battling the overdose epidemic is an “urgent priority,” laying out a first-year slate of goals that include boosting harm reduction efforts and strengthening recovery supports. Biden’s proposed budget also calls for investing $41 billion in national drug program agencies — about $670 million more than the enacted fiscal 2021 level — with increased funding for evidence-based treatment and prevention services.
Volkow said the country must continue to remove obstacles that make it difficult for users to gain access to addiction medications such as methadone, buprenorphine and monthly injections of naltrexone.
During the pandemic, for example, users were allowed a four-week supply of methadone, which typically must be obtained in daily doses at clinics. In April, the Biden administration eased restrictions that had limited prescribing of buprenorphine by doctors and other health-care practitioners.
It’s time for the government to “provide medications for opioid use disorder for everyone who needs them, with no restrictions on cost or availability,” Volkow said.
Dan Diamond contributed to this report.