The COVID-19 pandemic has led to a dramatic increase in drug overdose deaths in the United States, according to data from the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics. Between April 2020 and April 2021, more than 100,000 deaths were recorded, the majority among adults aged 25 to 55 years.
The figure is almost 25% higher than in the same period from 2019 to 2020, when some 78,000 deaths were registered from this cause. The 100,000 overdose death toll exceeds that of traffic accident and gun deaths combined.
Dr. Nora Volkow, director of the National Institute of Addictions, said in a statement that the record number has been partly triggered by the use of fentanyl, a fast-acting drug that in a medical context can be used to treat severe pain, and that it is 100 times more powerful than morphine.
The period in which a record number of overdose deaths has been recorded has also seen an increase in the use of synthetic drugs and cocaine.
Experts agree that the quarantines in the first months of the pandemic, social isolation, broke community support networks and made access to treatment difficult.
All states and the District of Columbia had overdose deaths. This interactive map from the CDC shows the number of deaths.
California leads the list with 10,585 overdose deaths, although public health experts say the pandemic may also have led to more underreporting.
Other states that had 50% more than predicted cases were Tennessee, Louisiana, Mississippi, West Virginia and Kentucky.
Fentanyl, lethal production
Fentanyl is a synthetic opioid, developed with laboratory chemicals, unlike heroin or morphine, whose main ingredients are extracted from the opium sap of a poppy plant. According to the Drug Enforcement Administration (DEA), the federal agency that fights illegal drugs in the United States, clandestine laboratories in China are the main source of illegally sold fentanyl.
The producers then ship the drug to Mexico, where the cartels mix it with heroin or press it into blue, pink or white tablets that look like prescription pills for anxiety or pain. The powder or pills are delivered to distributors, or directly to users, via the Internet or darknet, an online area used for illegal purchases. Or on the corners of marginal neighborhoods.
The DEA explains that the producers of this deadly drug change their chemical formulation permanently, making it very difficult to detect. The international control system is only capable of detecting, processing and banning around 10 new psychoactive substances per year.
The State Department is working through the United Nations, and with individual countries, to ensure that police in all parts of the world can identify new drugs and prosecute traffickers.
Prevention, the first step
Fentanyl is addictive due to its potency. Even a person taking fentanyl prescribed according to a doctor’s instructions can experience dependence, characterized by withdrawal symptoms when the drug is stopped. A person can be dependent on a substance without being addicted, but dependence can sometimes lead to addiction.
People addicted to fentanyl who stop using it may have severe withdrawal symptoms that begin within a few hours of taking the drug for the last time. These symptoms include:
- muscle and bone pain
- trouble sleeping
- diarrhea and vomiting
- chills with goose bumps
- uncontrollable leg movements
- severe cravings
These symptoms can be extremely uncomfortable and are the reason why many people find it so difficult to stop taking fentanyl.
Fentanyl works by binding to the body’s opioid receptors, which are found in areas of the brain that control pain and emotions. If the person cannot control their consumption, there is an escalation of symptoms and effects that include extreme happiness followed by:
- depression and respiratory arrest,
- coma and death
The high potency of fentanyl greatly increases the risk of overdose, especially if a person using drugs does not know that a powder or pill contains it. They can underestimate the dose of opioids they are taking and lead to an overdose.
Ideally, never take fentanyl, neither by prescription, nor by acquiring it on the illegal market.
Like other opioid addictions, behavioral therapy medication has been shown to be effective in treating people with addiction to fentanyl. PThey can help people change their attitudes and behaviors related to drug use, and improve their abilities to lead a healthy life.
In general, psychological therapies are combined with medication.
Medications used to treat opioid addiction are buprenorphine and methadone, which work by binding to the same opioid receptors in the brain as fentanyl, reducing cravings and withdrawal symptoms. Another drug, naltrexone, blocks opioid receptors and prevents fentanyl from having any effect.
Psychological treatment also helps the person adhere to their pharmacological treatment, which means that they take their medications as prescribed by the doctor.
People can discuss treatment options with their healthcare provider.
Naloxone is the medicine used to reverse a fentanyl overdose. Both the person who consumes and close loved ones should have this medication on hand, and know how to use it, in case of an overdose emergency.
Sources: National Institute of Addictions, CDC, National Institute of Health Statistics, KHN, NYT.