The Epidemic Preceding the Pandemic: Opioid Overdoses Surge Again
Though a new year brings with it the hope for a better future, the COVID-19 pandemic inflicted incalculable pain and loss over the past year. That pain and loss came in a variety of forms, including a rise in drug overdoses. The opioid epidemic, already on a virulent upswing immediately prior to the pandemic, continued to swell.
As recently as early 2019, there was reason for optimism. Based on provisional data, reported drug overdoses declined overall from November 2017 through February 2019. They began rising again from the February lows, but even by November 2019, reported overdose deaths were still below the November 2017 peak. However, 2020 brought with it an astonishing increase in drug overdose deaths. The reported number of provisional drug overdose deaths is up one-fifth between June 2019 and June 2020, the latest data available.
Overdose Deaths By Type, Jan. 2015-June 2020
Source: Social Capital Project analyses of CDC's Provisional Drug Overdose Death Counts as of January 3, 2021. January 2015 to June 2020.
A breakdown of drug overdoses by type shows that only some kinds of drugs account for the recent rise. Prescription opioid and heroin overdose deaths continued to decline, but deaths from synthetic opioids like fentanyl and non-opioid drug overdoses, including cocaine and psychostimulants with abuse potential, continued growing unabated.
Synthetic opioid overdoses are the most dangerous category; even during the relatively optimistic period around 2018 when overall drug deaths declined, synthetic opioid deaths rose, albeit at a slower pace. They began rising again more ferociously, starting in mid-2019 and continuing through the COVID-19 pandemic.
In addition to overdose deaths, the data from CDC’s Drug Overdose Surveillance and Epidemiology System demonstrates rising emergency department visits for drug overdoses, including from opioids and more specifically heroin, beginning in the spring of 2019.
Non-Fatal Cases By Type, Jan. 2019-Feb. 2020
Source: Social Capital Project analyses of CDC's Drug Overdose Surveillance and Epidemiology (DOSE) System. 12 months ending in January 2019 to February 2020.
The recent rise in overdose deaths began prior to COVID-19, and this makes an aggressive causal inference impossible; as Charles Lehman of the Institute for Family Studies points out, we cannot know for certain how much of the 2020 rise in overdoses was a continuation of existing trends, rather than a consequence of the rising health crisis and economic fallout due to COVID-19.
However, there are reasonable arguments for COVID-19 contributing to overdose deaths. The requirements to reduce virus spread—social distancing, quarantining, limiting capacity—combined with strained health resources and precarious economic conditions, fed stressful conditions that made illicit drug use and overdose all the more likely and recovery all the more difficult.
Seeking treatment for opioid addiction has been even more challenging because of the pandemic, likely increasing risk of relapse. This was particularly clear in the early months of the pandemic, when in-person visits were still a requirement for treatment despite the risk of contracting the virus. Federal rules have since been suspended, relaxing the need for in-person visits to receive treatment during the pandemic, but the scale-back of services and the lack of face-to-face interaction has affected recovery for many addicts that rely on frequent contact and close relationships to sustain sobriety.
The Social Capital Project last discussed deaths of despair in the beginning of 2020, and at that time expressed hopefulness given that the age-adjusted drug overdose death rate in 2018 had declined enough to offset the rise in rates of suicide and alcoholic liver disease and cirrhosis that year. In 2019, however, deaths of despair rose again, as the drug overdose death rate returned to its 2017 level and alcoholic liver disease and cirrhosis continued to rise. Fortunately, the age-adjusted suicide rate ticked down in 2019 for the first time since 2005.
Deaths Of Despair By Component, 1999-2019
Source: Social Capital Project analyses of CDC data using Case and Deaton definitions: https://www.brookings.edu/wp-content/uploads/2017/03/casedeaton_sp17_dataappendix.pdf.
We do not yet have complete data on deaths of despair for 2020; however, the early data on drug overdoses suggests they are likely to rise. While the trends for drug overdoses, suicide, and alcohol-related deaths will remain difficult to disentangle from the effects of the pandemic, there is reason to hope that any increased risk factors for deaths of despair resulting from the pandemic’s toll may be short-lived.
As Lehman highlights, the pandemic’s effect on suicide deaths is not straightforward, despite surveys suggesting suicidal ideation increased during the pandemic. It is also possible that coping behaviors like increased alcohol consumption may fall once the pandemic subsides, which may reduce contributions to alcohol-related disease deaths that take years to manifest. However, even if this cautious optimism is justified, and the most worrying changes of 2020 are reversed as COVID-19 abates, the opioid crisis will remain with us well beyond the pandemic.