Overdose death rate increased by 30% in 2020, a 'staggering' rise

The United States saw its biggest increase ever in the rate of drug overdose deaths in the first year of the Covid pandemic, with rates rising particularly sharply among communities of color, the Centers for Disease Control and Prevention reported Tuesday.

From 2019 to 2020, the CDC said, the rate of fatal drug overdoses rose by 30% overall, from 21.6 deaths per 100,000 people in 2019 to 28.3 deaths per 100,000 in 2020. Most deaths were due to illicit fentanyl, a powerful synthetic opioid.

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"This is the largest increase in U.S. history," said Dr. Debra Houry, CDC's acting principal deputy director and director of the agency's National Center for Injury Prevention and Control. "These numbers are staggering."

The CDC report included data from 25 states and Washington, D.C.

The death rate increased most dramatically — 44% — among Black Americans, from 27 deaths per 100,000 in 2019 to 38.9 deaths per 100,000 in 2020.

Among American Indian and Alaska Native populations, the rate increased by 39%, from 26.2 deaths to 36.4 per 100,000.

Fatal drug overdoses increased among whites, too, though at a slower rate, at 22%. In 2019, 25.2 overdose deaths per 100,000 people occurred among white Americans, compared with 30.7 per 100,000 in 2020.

The disparities become even more apparent when the data is broken down by age.

Among Black men 65 years and older, the rate of deadly overdoses was nearly seven times that of white men of the same age in 2020. And the rate among younger Black Americans, ages 15 through 24, increased by 86% between 2019 and 2020. That is, 7.8 in 100,00 people in this demographic died from an overdose in 2019, compared with 14.5 per 100,000 in 2020.

The sharp increase in drug overdose deaths was apparent by 2021, when the CDC reported that the country had surpassed 100,000 such deaths for the first time ever in 12-month period.

Role of the pandemic

It is clear that the Covid-19 pandemic has had a tremendous impact on substance use, experts say. Drug overdoses were on the rise prior to 2020, Houry said, "but not at this rate."

When lockdowns first began, there were disruptions to substance use treatment centers and harm reduction programs, such as safe syringe services.

"There were a lot fewer resources," said Dr. Yelena Semenova, a psychiatrist specializing in addiction services at Northwestern Memorial Hospital in Chicago. "A lot of people told me they'd been clean and sober, but with no more in-person meetings, they've all gone to Zoom, and it's a lot harder."

What's more, people in isolation were more likely to use drugs alone, Houry said, without a bystander present to call 911 in case of emergency or administer naloxone, which can reverse opioid overdoses.

Since 2020, deadly drug overdoses have continued to climb, but not as quickly, Houry said. "We've seen the number continue to increase with our provisional data up to February 2022, but not at the same rate," she said. "It's not as steep as it was from 2019 to 2020."

The report also found that Black Americans and American Indians and Native Alaskans reported significant barriers to substance use treatment.

But simply adding treatment centers in areas with higher rates of overdose isn't likely to help, the report showed. The rate of deadly overdoses was higher in places that had substance use treatment facilities.

"Just because it's there doesn't mean everybody has the same access to it," Houry said, pointing out that people living in low-income areas are less likely to have such access. "It might be concentrated in one area of a city and not to where there's good public transportation."

Mbabazi Kariisa, a health scientist in CDC's Division of Overdose Prevention, said during a media briefing Tuesday that "there was a substantially lower percentage of people from racial and ethnic minority groups showing evidence of ever receiving treatment for substance use, compared to white people."

"Most people who died by overdose have no evidence of getting substance use treatment before their death," she said.

The glaring racial differences are troubling to clinicians, such as Dr. Akhil Anand, a psychiatrist at the Cleveland Clinic who specializes in addiction.

Anand said he and his team work to treat all patients equally, but acknowledged that more must be done to reach out to African American communities.

"How do we become allies with members of the community, and have them come to us with open arms, rather than in a state where they overdose or are in the emergency department?" Anand said.

"We need to do better."

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