The nation’s drug overdose epidemic worsened in 2021 with deaths surpassing 100,000 during the second year of the COVID-19 pandemic, according to the Centers for Disease Control and Prevention.
The CDC’s National Center for Health Statistics figures released Wednesday show a record 107,622 drug overdose deaths during 2021, a 14.9% increase from 93,655 overdose deaths the previous year.
While the provisional numbers are subject to change as medical examiners finish death investigations and report all cases nationwide, experts say the figures underscore the powerful and dangerous reach of predominately illicit drugs and drug combinations.
While prescription painkillers and heroin drove the nation’s overdose epidemic last decade, the powerful synthetic opioid fentanyl is now responsible for most overdose deaths. Overdose deaths from fentanyl accelerated to 71,238 last year from 57,834 in 2020, according to the CDC.
Illicit versions of fentanyl have increasingly been manufactured in clandestine labs overseas, sold on the black market and mixed with other street drugs. The street version is different than legal fentanyl, a powerful pain medicine vetted by the Food and Drug Administration and prescribed in medical settings to treat intense pain flares in cancer patients.
Illicit fentanyl has been the driving cause of the current wave of overdose deaths, said Dr. Nora Volkow, director of the National Institute on Drug Abuse.
“The synthetic opioid fentanyl has injected itself throughout our entire country,” Volkow said. “It’s everywhere.”
Stimulants such as methamphetamine were detected in 32,856 overdose deaths and cocaine in 24,538 deaths. In many cases, more than one drug is found in a fatal mixture of substances,
Experts say illicitly manufactured fentanyl is often mixed with cocaine, methamphetamine or even counterfeit prescription opioids sold on the street.
People who intend to purchase non-opioid street drugs might have no idea they are getting a toxic combination cut with with fentanyl. And for a person who has built no tolerance for opioids, whether prescription pain pills, heroin or street fentanyl, taking street drugs cut with fentanyl can be fatal.
“We’re finding that people are overdosing because they’ve had no exposure to opioids that powerful,” said Chris Delcher, a University of Kentucky professor and director of the Institute for Pharmaceutical Outcomes & Policy. “We like to categorize our deaths to a single drug or a single cause of death. What’s happening right now on the street is this incredible experiment in combinations of drugs.”
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The Biden administration’s drug control strategy includes expanding access to the overdose reversal drug naloxone, fentanyl test strips and sterile needles. These techniques, known as harm reduction, aim to both prevent overdoses and reduce disease transmission.
The Biden plan cited the importance of “syringe services” programs that provide access to and disposal of clean needles and injection equipment and links to substance use disorder treatment. The plan calls for increasing the number of syringe services programs in counties with high overdose rates and expanding the use of fentanyl test strips. Studies have shown drug users who deployed test strips that detected fentanyl were more likely to switch to safer methods such as taking a smaller amount or avoiding the drug.
The Biden plan also aims to increase access to medications such as buprenorphine for people seeking treatment for opioid addiction.
It is the first time an administration has named harm reduction techniques as part of a national drug control policy, said Daliah Heller, vice president of drug use initiatives for Vital Strategies, a global public health nonprofit organization.
“The federal government can really play a leading role in pushing states to expand access to programs on the ground,” Heller said.
Biden’s plan cited research that shows drug users who have access to needle-exchange programs are more likely to seek drug treatment, and these programs help reduce transmission of HIV and Hepatitis C among drug users.
Still, 11 states prohibit the operation of needle exchange programs. Republican Senators Marco Rubio, a Republican from Florida, and Joe Manchin, a Democrat from West Virginia, have introduced legislation that would prohibit spending federal dollars to buy needles or “other paraphernalia” for use at syringe services centers.
Delcher, of the University of Kentucky, said operating a successful syringe services center is challenging even when states allow such programs. Some health care providers might be reluctant or unavailable to serve people at such centers. And these centers need to build trust and rapport among drug users they intend to help.
“Even when you manage to establish a program like that, it still does not mean it will be used effectively,” Delcher said. “There’s still that stigma. There are still those health care providers who wouldn’t want to be part of that. So changing laws is not the only answer.”
Ken Alltucker is on Twitter at @kalltucker, or can be emailed at firstname.lastname@example.org