CDC issues guidance to address drug overdose increases during pandemic

The Centers for Disease Control and Prevention (CDC) on December 17 issued new recommendations to address a documented acceleration of the increase in drug overdose deaths, with the largest increase recorded from March 2020 to May 2020,coinciding with the implementation of widespread mitigation measures for the COVID-19 pandemic.

The most recent provisional data available from the CDC National Center for Health Statistics (NCHS) indicate that approximately 81,230 drug overdose deaths occurred in the United States in the 12-months ending in May 2020. This represents a worsening of the drug overdose epidemic in the United States and is the largest number of drug overdoses for a 12-month period ever recorded. After declining 4.1% from 2017 to 2018, the number of overdose deaths increased 18.2% from the 12-months ending in June 2019ii to the 12-months ending in May 2020. Drug overdose deaths during this time increased more than 20% in 25 states and the District of Columbia, 10% to 19% in 11 states and New York City, and 0% to 9% in 10 states. Drug overdose deaths decreased in four states.

The recent increase in drug overdose mortality began in 2019 and continues into 2020, prior to the declaration of the COVID-19 National Emergency in the United States in March. The increases in drug overdose deaths appear to have accelerated during the COVID-19 pandemic. Provisional overdose death estimates indicate that the largest monthly increases in drug overdose deaths occurred in the 12-months ending in February 2020 (74,185 deaths) and the 12-months ending in March 2020 (75,696 deaths), the 12-months ending in March 2020 (75,696 deaths) to the 12-months ending in April 2020 (77,842 deaths), and from the 12-months ending in April 2020 (77,842 deaths) to the 12-months ending in May 2020 (81,230 deaths). These one-month increases of 2,146 deaths and 3,388 deaths, respectively for the 12-month periods, are the largest monthly increases documented since provisional 12-month estimates began to be calculated in January 2015.

Synthetic opioids are the primary driver of the increases in overdose deaths. The 12-month count of synthetic opioid deaths increased 38.4% from the 12-months ending in June 2019 compared with the 12-months ending in May 2020. Of the 38 jurisdictions with available synthetic opioid data, 37 jurisdictions reported increases in synthetic opioid overdose deaths for this time period. Eighteen of these jurisdictions reported increases greater than 50%, 11 reported increases of 25% to 49%, seven reported increases of 10% to 24%, and one reported an increase of less than 10%. State and local health department reports indicate that the increase in synthetic opioid-involved overdoses is primarily linked to illicitly manufactured fentanyl. Historically, deaths involving illicitly manufactured fentanyl have been concentrated in the 28 states east of the Mississippi River, where the heroin market has primarily been dominated by white powder heroin. In contrast, the largest increases in synthetic opioid deaths from the 12-months ending in June 2019 to the 12-months ending in May 2020 occurred in 10 western states (98.0% increase). This is consistent with large increases in illicitly manufactured fentanyl availability in western states and increases in fentanyl positivity in clinical toxicology drugs tests in the West after the COVID-19 pandemic. Increases in synthetic opioid overdose deaths were also substantial in other regions: 12 southern states and the District of Columbia (35.4%), six midwestern states (32.1%), and eight northeastern states and New York City (21.1%).

Overdose deaths involving cocaine also increased by 26.5% from the 12-months ending in June 2019 to the 12-months ending in May 2020. Other data have shown that recent increases in overdose deaths involving cocaine are primarily related to overdose deaths that involved both cocaine and synthetic opioids (primarily illicitly manufactured fentanyl). These deaths are likely linked to co-use of cocaine among people injecting opioids such as illicitly manufactured fentanyl or heroin. In contrast, overdose deaths involving psychostimulants, such as methamphetamine, have been increasing with and without synthetic opioid co-use and at a rate faster than overdose deaths involving cocaine. Provisional 12-month counts of overdose deaths involving psychostimulants in the United States increased by 34.8% from the 12-months ending in June 2019 compared to the 12-months ending in May 2020. The number of deaths involving psychostimulants now exceeds the number of cocaine-involved deaths. These increases are consistent with the increased availability of methamphetamine in the illicit drug supply and increases in methamphetamine-related treatment admissions.

Recommendations

These newly released provisional fatal overdose data, coupled with the known disruption to public health, healthcare, and social services as a result of the COVID-19 pandemic and related mitigation measures, highlight the need for essential services to remain accessible for those most at risk of overdose and the need to expand prevention and response activities.

CDC recommends the following actions as appropriate based on community needs and characteristics:

1. Expand the provision and use of naloxone and overdose prevention education for public health departments and community-based public health organizations, healthcare providers, harm reduction organizations, and first responders to overdoses.

2. Expand access to and provision of treatment for substance use disorders from healthcare providers and harm reduction organizations.

3. Public health departments, harm reduction organizations, healthcare providers, and public safety officials should intervene early with individuals at the highest risk for overdose.

4. Public health departments, medical examiners and coroners, laboratories, and harm reduction organizations should improve detection of overdose outbreaks due to fentanyl, novel psychoactive substances (e.g., fentanyl analogs), or other drugs to facilitate an effective response.

Read more and view figures and references: https://emergency.cdc.gov/han/2020/han00438.asp