Chilling Record Number of Fatal Drug Overdoses Hit U.S. in 2020

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Chilling Record Number of Fatal Drug Overdoses Hit U.S. in 2020

During 2020, as the U.S. struggled to cope effectively with the coronavirus pandemic, the country was losing another battle, too. The national (and home-grown) opioid crisis, now being driven by even more potent drugs, like fentanyl, sparked a massive, record rise in fatal drug overdoses across the country – the largest single-year percentage increase on record since 1999 – and the like of which has never been seen before.

Although the actual number is still provisional, the National Center for Health Statistics (NCHS), part of the Centers for Disease Control & Prevention (CDC), announced on Wednesday, July 14th. that, from December 2019 to December 2020, the U.S. saw 93,331 fatal drug overdoses across the country during a 12-month period – a colossal increase of 29.4% across the nation as a whole.

Here in Arizona, the increase in mortality was even higher than the national average – at 33.7%.

This is the highest number of overdose deaths ever recorded in a 12-month period, and the largest increase since at least 1999. The COVID-19 pandemic created a devastating collision of health crises in America [and] an incredibly uncertain and stressful time for many people. We are seeing an increase in drug consumption, difficulty in accessing life-saving treatments for substance use disorders, and a tragic rise in overdose deaths.” Dr. Nora Volkow, Director, National Institute on Drug Abuse

To put this national figure into something far more manageable (if that’s possible), it means that during last year, 256 people were dying from a drug overdose every single day somewhere in the U.S. – someone’s sister, brother, mother, father, or other loved one. Or, put another way, someone died needlessly from an accidental drug overdose in the U.S. every 6 short minutes.

record number of overdoses in 2020 in the US

Let’s repeat that. One person died from a drug overdose every 6 minutes

It was and is a huge and tragic public health crisis in its own right, and it happened as the attention of those who could have done something to help quell these needless deaths were drawn away to a far greater threat – the global coronavirus pandemic.

U.S. Overdose Mortality in 2020: The Drugs to Blame

As you would expect during a year of any long-running epidemic, there are certain primary elements that cause far more damage than most. In 2020, another year into the U.S.’s decade-old national opioid crisis, the primary element was,, in particular, the synthetic (man-made) opioid fentanyla drug 50 times more potent than morphine.

Opioids in general, including prescription pain medicine, caused 74.7% (around three-quarters) of all overdose deaths last year, according to the CDC. The number of cases where at least one opioid was present rose to 69,710, an increase of nearly 18,000.

Additionally, overdose mortality saw more deaths from synthetic opioids, primarily fentanyl, psychostimulants, such as methamphetamine (or meth), and cocaine. The 2020 provisional data shows deaths attributable in part to:

  • Synthetic opioids – increased by 54%
  • Cocaine – increased by 21%, and 
  • Psychostimulants, like methamphetamine – increased by 46%

If any one thing (or drug) is at the very heart of these tragic numbers, it is synthetic opioids like fentanyl. In 2015, these man-made opioids were involved in only 18% of all overdose deaths; in 2020, it is now more than 60%.

What’s really driving the surge in overdoses is this increasingly poisoned drug supply. Nearly all of this increase is fentanyl contamination in some way. Heroin is contaminated. Cocaine is contaminated. Methamphetamine is contaminated.” – Shannon Monnat, associate professor of sociology, Syracuse University, New York

The Cross-Border Stream of Fentanyl Now a Fast-Flowing River

The drugs being used became more deadly as well by becoming far more potent. In recent years, illicit drug suppliers – primarily the Mexican drug cartels – have found fentanyl and similar synthetic opioids to be far easier and far cheaper to manufacture and easier again to then successfully traffick into the U.S. 

This has led to fentanyl being mixed into virtually every other illicit drug available, eg. meth and cocaine, to boost both strength and profits across the entire marketplace. Even though the coronavirus pandemic forced temporary border closures, the steady stream of fentanyl being trafficked into the country didn’t dry up, as many policymakers and health experts predicted. Instead, the stream soon became a fast-flowing river.

Dr. Nora Volkow, director of the National Institute on Drug Abuse, who has described the record numbers of drug overdose deaths as “chilling,” stated, “The type of drugs that are now available are much more dangerous.”

Pre-pandemic research had already researched and documented the rapid growth of fentanyl within the illicit drug supply, including being mixed with drugs like cocaine and meth. Analysts are now pointing to factors like increased drug use and higher-risk usage, such as cutting or mixing drugs from an unreliable supply and using in isolation, as potential reasons for the record overdose mortality.

heroin overdoses on the rise in the US

U.S. Overdose Deaths: By Race & By Region

No region or community has been untouched by the opioid crisis or by the record number of overdose deaths witnessed in 2020. Looking at the data from the CDC more closely, in terms of regionality, you can see:

    • 28 states had 30%+ increases in overdose deaths in 2020 compared to 2019
    • 10 of these states had 40%+ increases
    • Increases were not confined to areas often associated with the opioid crisis, such as West Virginia and Kentucky; California, Colorado, Washington State, and Wyoming all show increases above 35% 
    • 9 out of the top 15 states where increases occurred were Southern or Appalachian states

Since April 2021, the CDC has also released provisional demographic data of drug overdose mortality for deaths through September 2020 (the first 3 quarters of the year). This set of data shows that nearly every racial/ethnic group and age range saw increases in mortality. Here are the most important points:

  • During the first 9 months of 2020, overdose deaths rose dramatically for men and younger people
  • Black, Asian American, Latinx/Hispanic, and American Indian/Alaska Native communities reported the highest proportional increases
  • Black overdose deaths increased by 48% through the same period, double the increase seen in white overdose deaths*

*This is a significant change in demography. From 2013, white individuals had far higher fatal drug overdose rates up until around 2019, when the gap had virtually disappeared. 2020 is the first year that has seen black overdose rates overtake white overdose rates – and in a clearly dramatic way.

Honestly, we’re at a point where the horses are out of the barn after the gate has closed. I’m not optimistic about the capacity of our classic approaches to rein this in.” – Dan Werb, Assistant Professor, Department of Medicine, University of California, San Diego

Putting the U.S. Opioid Epidemic into “Perspective”

Historically, the national opioid crisis is not the first drug epidemic to affect the U.S. To truly put the current crisis into some kind of perspective, it’s important to remember that, according to the CDC, the U.S. has previously witnessed the heroin epidemic of the 1970s and the crack epidemic of the late 1980s.

However, as tragic as any life lost to an accidental death is, any relevant comparisons need to be tempered by the massive difference in total lives lost. Both the heroin and crack epidemics had nowhere near the mortality numbers currently being recorded again and again for the opioid crisis – that said, specific similarities do still remain.

Brief History of U.S. Drug Epidemics

The U.S., like many countries, is no stranger to sporadic outbreaks of drug abuse, and even drug epidemics. For example, the end of the Civil War saw a rise in morphine addicts, and the 1900s saw the introduction of a cure for this morphine addiction – the supposed “cure” was a new drug called heroin.

It goes on. Cocaine was originally developed to also treat morphine addiction. However, because it cleared nasal passages so efficiently, it even became the official remedy of the Hay Fever Association. In 1910, then U.S. President William H. Taft told Congress that cocaine was now the most serious drug problem the nation had ever faced.

David Courtwright, a University of North Florida historian and author of books on U.S. drug epidemics, wrote: “There are one or two or three wolves ahead of the pack that seem to be the most pressing threat, their jaws closest to you. But there’s always a pack. The history is that the lead wolves keep shifting.”

1970s opioids

1. The U.S. Heroin Epidemic (1970s)

In the late 1960s and into the 1970s, heroin use surged significantly, partly because of the prevalence of heroin abuse among U.S. soldiers fighting in the Vietnam War. However, this was different because it wasn’t “doctor-driven” – and it hit poor, inner-city areas more than anywhere else.

In 1970 and 1971, in New York City, more adolescents, predominantly Black and Puerto Rican, died of heroin-related incidents than any other cause of death. Also in 1971, President Richard Nixon declared a “War on Drugs.” With hindsight, and despite many notable successes, it was a war that ultimately would fail.

The CDC states that around 7,200 people died from the heroin epidemic.

2. The U.S. Crack Cocaine Epidemic (1980s)

Heroin use eventually faded in the late ’70s and was promptly pushed aside by another “lead wolf” – cocaine. Initially sold in powder form, there was so much cocaine around in the ‘80s that it actually caused a supply glut of the drug, so drug dealers began to sell hardened “cocaine rocks.” The small yet highly addictive rocks sold for as little as $5 to $10 on the street.

Recreational drug users, desperate to avoid the dangers of injection and dirty needles, jumped on the product, believing it was “less dangerous.” Like the heroin epidemic before it, crack was also tied to poor urban areas and violent crime.

The crack epidemic simply died out in the 1990s, with many recreational drug users turning to new drugs and new highs. Experts even say that the term “crackhead” was even partly responsible for the subsequent change in attitudes.

The CDC further states that around 9,000 people died of a crack cocaine overdose during the epidemic.

Opioid overdoses on the rise

The Primary Reasons Behind 2020’s Tragic Drug Deaths

However, the record rise in drug overdose mortality seen during 2020 in the U.S. was the direct result of a proverbial “perfect storm” as several powerful catalysts all collided at exactly the same (and the worst possible) time. Here are the primary reasons behind the huge toll of 2020 drug overdoses:

  • U.S. healthcare services were inundated with ICU-ready COVID patients, with drug addiction and behavioral health services having to go to the back of the line, and enforced business closures decimated the influx of new patients into private drug addiction rehabs and treatment centers.
  • State-led attempts to control the pandemic’s effects remained inconsistent and sporadic throughout the year, with the only real result the rapid spread of social isolation, economic strife, and ever-lengthening lines of people waiting at the unemployment offices.
  • Mutual aid support groups, like the 12-Step fellowship of Narcotics Anonymous, were moved online, at a safe and socially acceptable distance (defeating the whole point of such groups in the process) as church halls and community centers – their usual venues – were locked down, too.
  • Mexican drug cartels and homegrown U.S. drug organizations pushed more and more of the synthetic opioid fentanyl and its analog versions into virtually every other illicit product they were putting out onto the streets of the U.S. – far cheaper and far easier to manufacture and to traffick, and certainly far more potent and more dangerous than any other illicit drug those streets had ever seen.

As we now know, in this perfect storm of unresolved or ignored issues, many, many thousands of lives, over 90,000 and still counting, and predominantly those of the young, were simply swept away.

Opioid Manufacturers & Distributors to Pay Billions of Dollars

It has taken years and years of federal and state-level intense and argument-strewn negotiation to ensure the different pharmaceutical companies and distributors that form the “U.S. prescription opioid industry” will be financially punished for the clear and major parts they have all played in the opioid crisis.

Leading U.S. Medical Distributors & Johnson & Johnson

Only this week, it has been announced that the 3 leading medical distributors in the U.S. –  Cardinal Health, McKesson, and AmerisourceBergen – and the pharmaceutical manufacturing company Johnson & Johnson will together pay $26 billion for their role in a crisis that has cost over half a million lives, and created hundreds of thousands of opioid addicts.

However, as with many of the “deals” being done between federal and state attorney generals in lieu of compensation, it involves the so-called “global peace” agreement, where in exchange for the various payments, all the plaintiffs involved agree to put a stop to any future litigation against the companies concerned.

Additionally, the companies will avoid accepting any legal responsibility on their part. As a J&J spokesperson stated, “The settlement is not an admission of liability or wrongdoing, and the company will continue to defend against any litigation that the final agreement does not resolve.”

The main premise of the agreement is a national formula for disbursing money to states, which will be used for alleviating the opioid epidemic and preventing its recurrence. The actual allocation to each state now relies on extensive federal data, including the size of a state’s population, the number of overdose deaths, opioid pill sales, and disorders related to prescription pain pill abuse.

Once this has been done and the money allocated, it will pay for opioid treatment plans and other social services related to the opioid crisis.

Perdue Pharma Opioid Crisis

Purdue Pharma & The Sackler Family

Probably the highest-profile agreement is also close to some kind of conclusion. Purdue Pharma, owned by the Sackler billionaire family, recently announced that a further 15 U.S. states had signed on the dotted line of their “deal” – a bankruptcy agreement that will ensure that the members of the Sackler family who own Purdue would contribute around $4.3 billion from to help compensate the people and communities harmed by their $35 billion-grossing prescription pain medication – Oxycontin.

While some progress has been made – especially around the public document depository – this plan is far from justice. Purdue and the Sacklers have misused this bankruptcy to protect their vast wealth, and evade consequences for their callous misconduct. This deal alarmingly allows the Sacklers to still walk away with their personal wealth intact.”– William Tong, Attorney General of Connecticut 

In exchange, the Sacklers and many of their associates (who notably have not filed for bankruptcy) would enjoy a similar deal to the “global peace” arrangement described previously – so-called “third party releases,” which again would avoid future opioid lawsuits.

In a recent development, again only this week, The Justice Department in the U.S. has now called the “third party releases” under the proposed deal from Purdue Pharma both unconstitutional and actually illegal. It remains to be seen what happens next.

External Sources:

  1. U.S. Centers for Disease Control & Prevention (CDC): Provisional Drug Overdose Death Counts” System. July 2021. Available at CDC.gov.
  2. National Institute of Drug Abuse (NIDA): Director’s Page: Nora Volkow. 2021. Available at DrugAbuse.gov
  3. U.S. Centers for Disease Control & Prevention (CDC): Percentage of Drug Overdose Deaths by Quarter, by Sex, Age, and Race and Hispanic Origin: United States (2019-Q1 through 2020-Q3). April 2021. Available at CDC.gov.
  4. STAT (Healthcare Media Company): “U.S. Overdose Deaths Hit Record 93,000 in 2020 during Pandemic.” July 2021. Available at STATNews.com.
  5. NPR (News Media): “States Are Near A $26 Billion Opioid Settlement With Drug Distributors.” July 2021. Available at NPR.org.

NPR (News Media): “Justice Department Slams Purdue Pharma’s Bankruptcy Plan.” July, 2021. Available at NPR.org.


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WRITTEN BY GERARD BULLEN
JULY 21, 2021

Gerard has been writing exclusively for the U.S. substance addiction treatment industry for many years, providing a range of medically-reviewed work, including white papers, long-form, and short-form content articles, and blog posts for accredited addiction treatment centers. A member of the American Medical Writers Association, Gerard’s specific focus is substance addiction (an area that has impacted Gerard’s personal life in several ways), and he is particularly drawn to the topics of professional, evidence-based treatment, new and alternative therapies, and enabling readers to find their own sustainable, long-term recovery. Gerard lives and works in Maryland, U.S., he’s happily married, and a proud father. His interests include hiking with the family, reading fiction (from the classics to virtually all of the current NYT bestseller list), American and British film classics, and his beloved dogs, Toby and Coco, both rescued from the local pound.

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