“This has been an incredibly uncertain and stressful time for many people, and we are seeing an increase in consumption, difficulty in accessing lifesaving treatments for substance use disorders and a tragic rise in overdose deaths.” ~ Dr. Nora Volkow, Director, National Institute of Health
Over the last year, we have seen the Covid-19 pandemic tear through America. However, at the same time, another epidemic was ravaging the country: overdose.
Throughout 2020, overdose deaths rose by nearly 30%, with around 93,000 fatalities.[1] The Centers for Disease Control and Prevention have informed us that this fatality rate is at an all-time high. Officials from the CDC have stated that the increase in deaths has been driven by pandemic related stressors, difficulties accessing care, and the lethal prevalence of synthetic opioids.
Overdose – An American Epidemic
Accidental overdose is now the leading cause of death in America among those under 50 years of age.[2] These deaths exceed those attributable to disease, accidents, firearms, and homicide.
In 2019, the CDC recorded over 65,000 accidental deaths from overdose or poisoning.[3] The CDC stated that most cases, “are acute, are unintentional, involve a single agent, occur in the home, (and) result in minor or no toxicity.” Further, statistics demonstrated that pharmaceuticals were present in 84% of serious or fatal poisonings.
Nearly three quarters of all substance abuse deaths in 2020 involved opioids, with synthetic opioids recorded in the bloodstream of over 60% of overdose victims compared with a previous figure of 41% in 2017. Preliminary statistics released earlier this month by the CDC demonstrated that fatalities from synthetic opioids rose an unprecedented 55% over these last 12 months.
Fentanyl, a super-potent opioid, usually used for sedation during operations and for people with severe pain, is frequently used as a cutting agent. The addition of fentanyl creates powerful black-market substances. Three mg of fentanyl are enough to kill someone with a low tolerance, so overdose deaths from substances laced with fentanyl, including Xanax, have rocketed.[4]
Sadly, many of these deaths are preventable. Substance use stigma, changing policies, access to care, and the Covid-19 pandemic have meant that the adoption of life-saving overdose prevention is limited.
Overdose – Covid-19 Pandemic
Coronavirus created a new healthcare crisis, with 60% of countries worldwide experiencing service interruptions. The most common services to have been disrupted, as reported by the World Health Organization (WHO), were those most needed by vulnerable populations. These included therapy, counseling harm reduction services, syringe programs, and treatment for opioid abuse.[5]
At the start of the coronavirus pandemic, experts warned that related stressors such as social distancing, lockdowns, and economic difficulties would cause significant mental health issues. In October 2020, WHO reported that soaring substance use was exacerbated by these stressors along with emotional turmoil such as isolation and grief.[6]
Every American state has reported an increase in overdose fatalities during the COVID-19 pandemic.[7] In fact, ten states have seen a 40% rise in deaths in comparison to the previous 12-month span. We must investigate why essential life-saving treatment has not been received by these individuals.
Overdose – A Stigma
Stigma, both within the United States and globally, plays an essential role when considering the implications of the rising deaths from overdose.
Too frequently, healthcare providers, hospitals, and even therapists perceive a person’s substance use problems as their own fault. This leads to substandard care or even a refusal to provide treatment altogether. Unfortunately, it is common for those requiring treatment for acute intoxication in emergency rooms to be misunderstood, ignored, or even expelled by staff. Emergency room workers may be fearful of volatile behavior or suspicious that substance users are seeking out prescription medications. This stigma results in care providers exhibiting judgment, blame, and a lack of empathy for the person who is overdosing.[8]
Overdose – Essential Policy Changes
The unprecedented rise of deaths from overdose cannot be ignored, and vital service changes must be made in order to save future lives.
The American Medical Association (AMA) released a vital report in June of this year titled Issue brief: Drug overdose epidemic worsened during COVID pandemic. This report combined data and opinions from varied sources, including national, state, and local public health agencies, emergency medical services, hospitals, treatment centers, law enforcement, and research journals.
The AMA advocated for the United States to adopt and promote the following changes in their policies:[9]
- U.S. Substance Abuse and Mental Health Services Administration and U.S. Drug Enforcement Administration (DEA) should have increased flexibility for providing buprenorphine and methadone to patients with opioid use disorder.
- Remove existing barriers for those who need to obtain medications. This includes removing arbitrary dose, quantity, and refill restrictions on controlled substances.
- Provide the DEA with increased flexibility to help people obtain necessary pain relief or medically required pharmaceuticals to prevent people from turning to the black market.
- Support the removal of prior authorization, step therapy, and other administrative barriers for medications used to treat opioid use disorder.
- Implement and support harm reduction strategies, including sterile needle and syringe services programs.
- Enact new laws to ensure that money from opioid-related litigation is focused on public health, treatment, and prevention efforts.
Prior to the COVID-19 pandemic, global mental health programs and substance use treatment services were chronically underfunded. WHO’s recent survey determined that although 90% of countries vowed to dedicate increased funding to their citizens’ emotional health as part of their pandemic strategy, only 17% have reported having done so.
Conclusion
Good mental health is fundamental to a person’s overall health and well-being. Over the last year, COVID-19 has disturbed essential health services at a time when they are needed most. Our policymakers and world leaders must move quickly and decisively to invest in life-saving treatment programs and remove barriers for substance use support.
Through my work, I seek to break down stigma related issues and help people and their families find a route to recovery through clear communication and therapeutic treatment programs. I hope that our society learns from the tragic deaths over the past year and extends compassion to all those who have lost loved ones by implementing new methods of support, enacting new laws, and removing barriers to care.
If you are concerned about any issues discussed in this blog, please contact Heather R. Hayes & Associates – call 800-335-0316 or email info@heatherhayes.com today.
[1]“A Record Number of Americans Died from Drug Overdoses in 2020”. The Economist, 2021, https://www.economist.com/graphic-detail/2021/07/15/a-record-number-of-americans-died-from-drug-overdoses-in-2020.
[2]“Drug Overdose.” Drug Policy Alliance, 2021, https://drugpolicy.org/issues/drug-overdose.
[3]“Faststats”. Cdc.Gov, 2021, https://www.cdc.gov/nchs/fastats/accidental-injury.htm.
[4]Arens, Ann M et al. “Adverse Effects from Counterfeit Alprazolam Tablets.” JAMA internal medicine vol. 176,10 (2016): 1554-1555. doi:10.1001/jamainternmed.2016.4306
[5]“COVID-19 Disrupting Mental Health Services in Most Countries, WHO Survey”. Who.Int, 2021, https://www.who.int/news/item/05-10-2020-covid-19-disrupting-mental-health-services-in-most-countries-who-survey.
[6]Porterfield, Carlie. “Drug Overdose Deaths Surged 29% Last Year Amid Covid Pandemic, CDC Says”. Forbes, 2021, https://www.forbes.com/sites/carlieporterfield/2021/07/14/drug-overdose-deaths-surged-29-last-year-amid-covid-pandemic-cdc-says/?sh=d08998e34d9f.
[7]“2021 American Medical Association. All Rights Reserved. 1 Issue Brief: Drug Overdose Epidemic Worsened During COVID Pandemic”. Ama-Assn.Org, 2021, https://www.ama-assn.org/system/files/2020-12/issue-brief-increases-in-opioid-related-overdose.pdf.
[8]“Addressing the Stigma that Surrounds Addiction | National Institute on Drug Abuse”. National Institute on Drug Abuse, 2021, https://www.drugabuse.gov/about-nida/noras-blog/2020/04/addressing-stigma-surrounds-addiction.
[9]“2021 American Medical Association. All Rights Reserved. 1 Issue Brief: Drug Overdose Epidemic Worsened During COVID Pandemic”. Ama-Assn.Org, 2021, https://www.ama-assn.org/system/files/2020-12/issue-brief-increases-in-opioid-related-overdose.pdf.
