Overdose Deaths Break Records in 2021 (Again)
Overdose Deaths Break Records in 2021 (Again)
Over the years, synthetic drugs have become cheaper, more accessible, and more potent—the exact opposite goals of America’s supply-side drug control strategy.
Drug overdose deaths have been on the rise since the 1970s, and have increased every single year but for a slight dip in 2018. During the pandemic, overdose deaths have surged to new heights: Deaths jumped almost 30 percent during 2020. That rise continued into 2021, increasing nearly 15 percent, according to new data from the Centers for Disease Control.
At this current rate, one American dies from an overdose every five minutes.
The majority of overdose deaths can be traced back to two culprits: the synthetic opioid fentanyl that’s illegally manufactured and increasingly showing up in all kinds of different drugs, from meth and cocaine to counterfeit pills. The other big culprit is synthetic stimulants like methamphetamine. Many deaths appear to be the result of combining meth and fentanyl in the form of speed balls.
“There’s an intertwined synthetics epidemic the likes of which we’ve never seen,” Dr. Dan Ciccarone told the New York Times. “We’ve never seen a powerful opioid such as fentanyl being mixed with such a potent methamphetamine.”
The Synthetic Takeover
In 2020 there were 58,000 deaths involving synthetic opioids (i.e. illicit fentanyl); in 2021, that number jumped by 23 percent to 71,000. In 2020, 25,000 deaths involved stimulants like methamphetamine; in 2021, that number jumped by 34 percent to 33,000. Deaths involving cocaine also jumped by 23 percent in 2021. It’s also worth noting that deaths from alcohol have also surged during the pandemic, to 99,017 in 2020 from 78,927 in 2019.
Overdoses involving both pharmaceutically manufactured opioids and heroin are astoundingly low by comparison. Preliminary data for 2021 show just 8,800 deaths involving heroin and 13,000 deaths involving pharmaceutical opioids. These numbers show just how dramatic the illicit drug supply has changed over the years. These relatively low figures also show the extent to which the epidemiology of the overdose crisis in America has mutated. (NOTE: There is also some cross-over and double-counting in the data. Counting these deaths are complicated by the fact that the majority of people have more than one drug in their system).
Over the years, synthetic drugs have become cheaper, more accessible, and more potent—the exact opposite goals of America’s supply-side drug control strategy. The strategy is geared toward disrupting illicit drug trafficking organizations and heavy policing at the border. All of this morbidity and mortailty has also ocurred during a relentless increase in the number of people incarcerated for drug offenses.
What you won’t see in most of the reporting about the new mortality data is the role incarceration itself plays as a driver of overdose deaths. People with opioid addiction are up to 129 times more likely to die of an overdose if the’ve been incarcerated. For the past several decades, American drug policy has been draconian and punitive, producing disparate outcomes for racial minorities. The steepest incarceration rates and steepest overdose death rates continue to fall on Black and Indigenous populations, even though they use less drugs than white people.
“Over-Prescribing” Is Not the Problem
America’s other approach to the overdose crisis has focused on suing Big Pharma and investigating doctors and pharmacies with the goal of reducing opioid prescribing. Experts, lawmakers, and public health officials at the Centers for Disease Control and Prevention thought that reducing the amount of opioids that doctors prescribe would result in fewer overdose deaths and fewer cases of opioid use disorder.
But that is not what happened: As the volume of opioids that doctors prescribe fell, the number of overdose deaths rose exponentially.
The figure below shows that opioid prescribing is back to what it was in 1993, before Purdue Pharma’s blockbuster drug OxyContin hit the market, and well before there was any notion of an “opioid epidemic.” The decision to drastically lower the pharmaceutical opioid market has not achieved its aims, and seems to have caused more problems than it solved.
Today, people in pain face tremendous difficulties finding doctors who will prescribe them opioids for pain relief. And despite CDC data clearly indicating the illicit drug supply as the No. 1 driver of overdose deaths, experts quoted in the media still argue that America is prescribing too many opioids. Some even blame wisdom tooth extractions as the main culprit in spreading addiction, as though a teenager has their wisdom teeth out and somehow progresses to use illicit fentanyl on the street. Sorry, there is just no way you can blame these obscene overdose numbers on wisdom tooth extractions.
On April 29, 2022, The Baltimore Sun published an editorial with the headline: “U.S. still overprescribing opioids for pain management, putting patients at risk.”
The editorial claims:
Most opioid prescriptions are completely unnecessary and excessive. In a recent study, researchers found that 91% of patients undergoing outpatient surgeries received opioid prescriptions. All of these prescriptions varied in the number of pills prescribed, with a range of 15 to 120 pills in any given prescription…. Compared to many other countries, the U.S. shows greater reliance on opioids for acute pain management.
This is an outdated perspective and completely misses the true drivers of mortality today. Recent data show that America now prescribes fewer opioids than Canada, Switzerland, Germany, Spain, Denmark, Australia, and Austria. Globally, America precribes the eighth most opioids, slightly more than Norway. And none of these countries, but for Canada, is experiencing anything close to America’s astronomical surge in overdose deaths. These comparisons across countries also miss the fact that in many parts of the world people have almost no access to pain relief at all where even cancer patients suffer in agony.
Reducing the supply of prescription opioids has not solved the overdose problem, and there are persuasive arguments out there that reducing prescribing has actually poured gasoline on the fire.
It’s a Dangerous Time to be a Drug User
People constantly ask me how things have gotten so bad. Why are so many more people overdosing? There is an equation invented by drug policy analysts to help us understand what’s happening: Total harm = Average harm per dose x The number of doses.
Basically, all the inputs in this equation have gone up, amounting to a much higher Total Harm. This is a function of the opioid market being taken over by potent synthetic fentanyls, as well as cheap and widely accessible methamphetamine. And importantly, both of these drugs require frequent dosing throughout the day for those who are addicted, so the total number of doses has dramatically risen, along with the average harm per dose. All this is a fancy way of saying the drug supply is more dangerous than it has ever been before.
New trends have made this even worse, like the rise of counterfeit pills. Young people who aren’t aware of the current drug market trends take pills that they think are of pharmaceutical origin, but really just contain fentanyl powder pressed into pill form. Fentanyl is even popping up in cocaine, putting recreational cocaine users at risk of an overdose death.
To be sure, the fentanyl on the street is very different from the fentanyl used in hospitals and prescribed by doctors. Deaths from pharmaceutical fentanyl are quite rare. The reason the street fentanyl is so dangerous is because people have no clue how potent the fentanyl is, and therefore they have no clue how to dose. And that’s given the user even knows fentanyl is there in the first place. Not knowing what drugs you’re taking or how much to take is a recipe for disaster. And this disaster is now ocurring at a scale we’ve never seen before.
Based on the current trends in American drug policy and based on the illicit drug supply dynamics, it doesn’t look like this problem is getting any better anytime soon. I’ll end on the fact that most of these overdose deaths are preventable. Every overdose death is a policy failure.
Note: This article contains important public health information and has been made freely available to all. If you appreciate this work, I encourage you to subscribe to Substance and support our project. As always, thanks for reading.
- Zach Siegel