The country first surpassed 100,000 annual deaths in April, and overdose deaths have persisted at staggeringly high levels since.
An estimated 104,288 people died of drug overdoses in the 12-month period ending September 2021. In September 2015, the annual death toll was about 52,000.
The pandemic accelerated trends that were already heading in the wrong direction, and experts say that reversing course will require concentrated efforts — and it will take time, both strategically and ideologically.
“If and when Covid restrictions ease, you won’t see a reversal in the same way you saw the acceleration because these drug distribution networks and addiction become embedded in the community. And it’s not like they turn off overnight,” said Katherine Keyes, an associate professor at the Columbia University Mailman School of Public Health whose research focuses on psychiatric and substance use epidemiology.
There are ways to prevent drug overdose deaths right now, experts say.
Programs like syringe exchanges and heavy distribution of naloxone, an overdose reversal drug, can make an “immediate” difference, said Dr. Nora Volkow, director of the National Institute on Drug Abuse.
“Harm reduction can be life saving for individuals, for example, that are not ready to receive medications or treatment but are at a very high risk of dying,” she said, and there is clear data that it works.
But these harm reduction strategies have faced controversy. Utilizing them to their full potential will require an ideological shift, a challenge not unlike what the US has faced when it comes to Covid-19 vaccines, experts say.
“We have a lot to learn from social scientists. Human behavior is complicated, and addressing ideology and opposition to things is really complicated. It’s not as simple as just saying, ‘This is what the science shows,'” said Dr. Sarah Wakeman , medical director for the substance use disorder initiative at Mass General Hospital and an associate professor at Harvard Medical School.
“We’re seeing that right now with harm reduction, where there’s this counter narrative that is becoming very polarized.”
The latest federal data through September 2021 marks the sixth month in a row that provisional data has held at more than 100,000 deaths annually.
Nationwide, 14,000 more people died of drug overdoses than in the previous year, a 16% increase. Overdose deaths were up in all but three states compared to a year earlier, the provisional CDC data shows. New Hampshire, Hawaii and Delaware each saw year-over-year declines.
In the 12-year period ending September 2021, about two-thirds of overdose deaths nationwide involved synthetic opioids, like fentanyl, which are stronger and faster-acting.
The new federal data shows that overdose deaths from methamphetamine and other psychostimulants also increased significantly, up nearly 36% from the year before. They accounted for about 30% of all overdose deaths in the latest 12-month period, up from about 25% a year earlier.
The link between Covid-19 and the drug epidemic is clear — the $1.9 trillion coronavirus relief package enacted last year included millions of dollars intended to reduce the harms of drug abuse. But the pandemic may also present broader lessons to carry into the fight against drug overdoses.
“If we invested the sort of attention, resources and political will into addressing the overdose crisis that we have with Covid, I think we would see thousands of lives saved every year. The thing that’s different with addressing the overdose crisis that is in many ways easier than thinking about Covid or HIV is that we don’t need to wait for scientific breakthroughs,” Wakeman said.
“With Covid, it’s been incredibly inspiring to see how quickly we can create absolutely seismic changes when there’s the acceptance that we’re in a state of emergency and that people’s lives matter and we have to do things quickly.”
Wakeman and others were encouraged to see federal support for harm reduction as one of the four key pillars outlined in the Biden Administration’s plan to combat drug overdoses, which was released by the US Department of Health and Human Services in October.
Also included were measures aimed at addressing opioid prescription practices and removing barriers to treatments, as well as recovery support.
Volkow says she believes the Biden administration is committed to efforts outlined in the plan, but others are worried that there may be some backtracking amid recent controversy.
“When we’re seeing human suffering at this level, now is not the time to moralize about drug use. Now is the time to save lives,” Keyes said. “And, you know, we’re in a crisis situation. We need to double down and do everything that we can to save every human life because that’s how we’re going to get out of this epidemic.”
There are signs that the conversation is starting to shift in federal policies and public discourse.
“We’ve seen a shift throughout the opioid epidemic in the way people talk about drug use and drug users as a public health issue and not a criminal justice issue,” Keyes said.
“A lot of times it’s really about seeing people close to you who have experienced these conditions, or seeing people that you identify with who’ve experienced these conditions, that really change people’s mindsets.”