“Many people are dying without knowing what they are ingesting”:  Dr. Nora Volkow, director of the National Institute on Drug Abuse

More than 100,000 Americans died from drug overdoses in the yearlong period ending in April, government researchers said.

Americans died of drug overdoses in record numbers as the pandemic spread across the country, federal researchers reported on Wednesday, December 1, the result of lost access to treatment, rising mental health problems and wider availability of dangerously potent street drugs. In the 12-month period that ended in April, more than 100,000 Americans died of overdoses, up almost 30 percent from the 78,000 deaths in the prior year, according to provisional figures from the National Center for Health Statistics. The figure marks the first time the number of overdose deaths in the United States has exceeded 100,000 a year, more than the toll of car crashes and gun fatalities combined. Overdose deaths have more than doubled since 2015.

Administration officials said on Wednesday that they will expand access to medications like naloxone, which can reverse an opioid overdose, by encouraging states to pass laws that will make it more widely available and promoting its use by Americans.

“I believe that no one should die of an overdose simply because they didn’t have access to naloxone,” said Dr. Rahul Gupta, director of the Office of National Drug Control Policy. “Sadly, today that is happening across the country, and access to naloxone often depends a great deal on where you live.”

Though recent figures through September suggest the overdose death rate may have slowed, the grim tally signals a public health crisis whose magnitude was both obscured by the Covid pandemic and accelerated by it, experts said. “These are numbers we have never seen before,” said Dr. Nora Volkow, director of the National Institute on Drug Abuse. The fatalities have lasting repercussions, since most of them occurred among people aged 25 to 55, in the prime of life, she added.

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“They leave behind friends, family and children, if they have children, so there are a lot of downstream consequences,” Dr. Volkow said. “This is a major challenge to our society.”

The rise in deaths — the vast majority caused by synthetic opioids — was fueled by widespread use of fentanyl, a fast-acting drug that is 100 times as powerful as morphine. Increasingly fentanyl is added surreptitiously to other illegally manufactured drugs to enhance their potency.

Overdose deaths related to use of stimulants like methamphetamine, cocaine, and natural and semi-synthetic opioids, such as prescription pain medication, also increased during the 12-month period.

While some drug users seek out fentanyl, Dr. Volkow said, others “may not have wanted to take it. But that is what is being sold, and the risk of overdose is very high.”

“Many people are dying without knowing what they are ingesting,” she added.

People struggling with addiction and those in recovery are prone to relapse, Dr. Volkow noted. The initial pandemic lockdowns and subsequent fraying of social networks, along with the rise in mental health disorders like anxiety and depression, helped create the crisis.

So, too, did the postponement of treatment for substance abuse disorders, as health care providers nationwide struggled to tend to huge numbers of coronavirus patients and postponed other services.

Dr. Joseph Lee, president and chief executive of the Hazelden Betty Ford Foundation, said that community and social support that was lost during the pandemic, along with the closing of schools, contributed to the death toll. “We’re seeing a lot of people who delayed getting help, and who seem to be more sick,” Dr. Lee said.

The vast majority of these deaths, about 70 percent, were among men between the ages of 25 and 54. And while the opioid crisis has been characterized as one primarily impacting white Americans, a growing number of Black Americans have been affected as well.

There were regional variations in the death counts, with the largest year-over-year increases — exceeding 50 percent — in California, Tennessee, Louisiana, Mississippi, West Virginia and Kentucky. Vermont’s toll was small but increased by 85 percent during the reporting period.

Increases of about 40 percent or greater were seen in Washington State, Oregon, Nevada, Colorado, Minnesota, Alaska, Nebraska, Virginia and the Carolinas. Deaths actually dropped in New Hampshire, New Jersey and South Dakota.

Understand the Opioid Crisis During the Pandemic

The first months. As Covid-19 brought the U.S. to a standstill, the opioid epidemic took a sharp turn for the worse. More than 40 states recorded increases in opioid-related deaths in the first six months of the pandemic.

A reversal of progress. Despite modest gains against addiction — including a slight dip in deaths in 2018 — fatal overdoses were rising even before Covid arrived. But the pandemic unquestionably exacerbated the trend.

An unprecedented spike. U.S. overdose deaths rose nearly 30 percent in 2020 to 93,000, then the largest single-year increase recorded. Deaths peaked nationally in the spring amid the most severe period of shutdowns.

Fueled by fentanyl. The rise in deaths was fueled by increased use of fentanyl, a cheap and readily available drug that is 100 times as powerful as morphine. It is often added surreptitiously as a substitute to other drugs.

A grim threshold. Overdose deaths in the U.S. exceeded 100,000 for the first time in the yearlong period ending in April 2021. The figure is more than the death toll of car accidents and guns combined.

“If we had talked a year ago, I would have told you deaths are skyrocketing. But I would not have guessed it would get to this,” said Dr. Andrew Kolodny, medical director of the Opioid Policy Research Collaborative at Brandeis University’s Heller School for Social Policy and Management.

Most of those who died probably already suffered from addiction, or were in recovery and relapsed, an ever-present risk exacerbated during times of stress and isolation, Dr. Kolodny said. Many of those with an addiction to synthetic opioids very likely became addicted after being given prescription opioids by medical providers. “Teenagers are routinely being given opioids to this day when their wisdom teeth come out,” he said. The vast stimulus bill passed last spring included $1.5 billion for the prevention and treatment of substance use disorders, and $30 million to fund local services for people struggling with addiction, including syringe exchange programs.

Federal funds can also be used now to buy rapid test strips to detect whether illicit drugs have been laced with fentanyl. But critics say the federal response has been inadequate, given the magnitude of the public health emergency. They have called for new funding to provide universal access to treatment, and for treatment centers in every county that offer same-day access. For example, physicians still need federal permission to prescribe buprenorphine, a first-line treatment for opioid use disorder, which limits the number of providers. “If you really want to see deaths comes down, you have to make it much easier for someone who is addicted to opioids to access treatment, particularly with buprenorphine,” Dr. Kolodny said.

“It has to be easier to get treatment than to buy a bag of dope.”