WEDNESDAY, May 3, 2023 -- Overdose deaths in the United States tied to the powerful synthetic opioid fentanyl soared 279% from 2016 to 2021, health officials reported Wednesday.
With the nation reeling from continued drug overdose deaths, investigators sought to identify trends in drug-related fatalities involving the five most commonly involved opioids and stimulant drugs: fentanyl, heroin, methamphetamine, cocaine and oxycodone.
In just five years, deaths involving fentanyl -- the most frequently implicated substance -- rose from 6 per 100,000 people to 22 per 100,000, according to the U.S. Centers for Disease Control and Prevention.
"This continues to be a public health concern in the United States that we should keep monitoring," said lead researcher
Merianne Rose Spencer
, a health statistician at CDC's National Center for Health Statistics.
The rate of overdose deaths involving methamphetamine and cocaine also increased during that time period, while deaths from heroin and oxycodone dropped off, Spencer's team found.
"The report, like many others over the past few years, highlights the devastation that fentanyl is wreaking on our country as lost lives continue to mount," said
Pat Aussem
, associate vice president for consumer clinical content development at the Partnership to End Addiction.
Among the young, fentanyl and methamphetamine were the most lethal. Death rates were highest among young adults ages 25 to 44, with men more affected than women. All races were involved, but Black Americans and Native Americans were hit especially hard.
These chilling overdose deaths are driven by a number of factors, including misuse of opioid prescription painkillers, and use of heroin and fentanyl, often in combination with other substances, said Aussem, who was not involved with the study.
"Cocaine, meth, ecstasy and counterfeit pills that resemble Adderall, Xanax and Percocet or other pain medications may be laced with fentanyl, resulting in an overdose if the person using the substance has no tolerance for it," she said.
"Increasingly, fentanyl is combined with xylazine, an animal tranquilizer known as 'tranq,' that can raise the risk of overdose and death, Aussem added.
For the study, CDC researchers used data from the National Vital Statistics System. Among the other findings:
Fentanyl was the leading cause of overdose death among all ethnic and racial groups.
The rate of drug overdose deaths involving heroin decreased by nearly 41%, although that wasn't considered significant.
The rate of overdose deaths from oxycodone decreased by 21%.
Spencer said that because the CDC team used death certificate data, it's not possible to show whether overdose deaths from heroin, cocaine, oxycodone and methamphetamine also involved fentanyl.
Spencer believes the rise in fentanyl-related overdose deaths is due to the increasing supply of the drug flooding into the country. It's unlikely that this trend will be reversed anytime soon as overdose deaths continue to rise, she noted.
The latest tally from the CDC is over 107,000 people in the 12-month period ending in August 2022, Aussem said. "This is equivalent to a plane with nearly 300 people aboard crashing every day. We need a focused, coordinated response embracing harm-reduction strategies and evidence-based care we know works," she added.
Aussem said difficulty accessing addiction treatment and health care contributes to drug overdose deaths, as do social and economic factors, such as poverty and unemployment and the stigma surrounding addiction.
What's needed now?
"To address the overdose death rates in the United States, a multifaceted approach is necessary, including increased screening for mental health and substance use health issues with greater access to quality addiction treatment," Aussem said.
Also, health care professionals need more training and must be more willing to treat people with substance use disorders, she noted.
Aussem added that harm reduction services are essential. These should include fentanyl and xylazine test strips, needle and syringe exchange programs, and overdose prevention education. Medications for opioid addiction such as naloxone must be more widely available as well.
"Reducing the stigma surrounding substance use disorders is also needed so people will talk about their concerns and seek treatment," she said. "Also, educating and equipping families to respond can lead to better outcomes. They are often the first to witness the problem and can intervene to encourage safer use and/or connection to treatment."
Using test strips that identify fentanyl before someone takes a drug that might be contaminated with it can be useful, Aussem said.
"Some states treat fentanyl test strips as drug paraphernalia, but they can be helpful in saving lives," she said. "Xylazine test strips will also be needed as xylazine penetrates more of the country’s drug supply."
The wide availability of the nasal spray naloxone (Narcan) is another strategy that can help prevent overdose deaths, Aussem said.
"The [U.S. Food and Drug Administration] has approved over-the-counter naloxone so anyone can get it and learn how to use it," she said. "It would be ideal to have it in first aid kits as well as readily available in schools, offices and other places where people gather."
Because many people overdose when alone, having a phone app like Canary or access to services like the Never Use Alone overdose prevention hotline (1-800-484-3731) may provide help when it is critically needed, Aussem added.
Safe injection centers like those in New York City reduce the risks of overdosing and also transmitting diseases like HIV and hepatitis, she said.
"Center personnel also have the opportunity to build relationships, offer education and other oft-needed resources," Aussem said, which can lead to safer substance use practices and connection to treatment.
The
report
was released May 3 from the CDC's National Vital Statistics System.
Sources
Merianne Rose Spencer, MPH, health statistician, National Center for Health Statistics, U.S. Centers for Disease Control and Prevention
Pat Aussem, LPC, associate vice president, Consumer Clinical Content Development, Partnership to End Addiction
U.S. Centers for Disease Control and Prevention report,
Estimates of Drug Overdose Deaths Involving Fentanyl, Methamphetamine, Cocaine, Heroin, and Oxycodone: United States, 2021
, May 3, 2023
Posted May 2023
