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Observations Yankee Doodling

“Hidden” cost of the pandemic: drug overdose deaths

BMJ 2021; 374 doi: (Published 04 August 2021) Cite this as: BMJ 2021;374:n1929

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  1. Douglas Kamerow, senior scholar, Robert Graham Center for policy studies in primary care, and professor of family medicine, Georgetown University, and associate editor, The BMJ
  1. dkamerow{at}

US deaths from drugs increase dramatically; longevity falls

The US Centers for Disease Control and Prevention (CDC) has published two related sets of health statistics recently that are deeply disturbing.

Firstly, US deaths from drug overdoses rose by almost 30% in 2020, increasing dramatically in all but two of the 50 states.1 Drug related deaths totalled more than 93 000 in 2020, a record that reflected the biggest overall increase in US history. The New York Times calculated that drug overdoses were responsible for more than 3.5 million years of life lost in 2020.2

This is shocking but not surprising news. Drug overdose deaths in the US had been creeping up in the past few years, and the pandemic only exacerbated the problem. Experts attribute most of the increase to the large amount of fentanyl and fentanyl analogues that have now been mixed into heroin, cocaine, and even amphetamines. The fentanyls, powerful synthetic painkillers, are thought to be around 25-50 times more powerful than heroin. Even trace amounts can lead to respiratory suppression and death, if not reversed. Because they are easier to manufacture and ship than heroin, they are increasingly being found throughout the country.2

The covid-19 pandemic was directly responsible for about 375 000 US deaths in 2020, but many drug overdose deaths were also covid related, as drug rehabilitation programmes shut down, unemployment soared, and social distancing made overdose rescues (with drugs such as naloxone) less likely.3

The second set of data released last week were the preliminary 2020 US life expectancy numbers. Again, there was a record change for the worse.4 Average life expectancy at birth dropped 1.5 years, more than in any year since the depths of the second world war. Most of the decrease, almost 75%, was due to covid related deaths, but the dramatic increase in drug overdoses also had an important role. Experts expect covid deaths to decrease and level off in the next year or so, but it is unclear whether overdoses will.

What can be done to reverse the increase in drug overdose deaths while we wait for the pandemic to pass? Some solutions are not controversial, such as providing the education and tools to integrate drug addiction treatment into primary care medicine. Currently, restrictions on prescribing buprenorphine to treat opioid addiction inhibit treatment. Some funding has been provided to fight the drug epidemic, but more is needed. Ironically, the pandemic has led to policy changes that have decreased overdose deaths as well, such as allowing people on methadone treatment to take doses home with them rather than having to appear daily to receive their drug. This has increased methadone compliance.2

But other, more extreme and controversial reforms, such as making all drug treatment free of charge, offering supervised drug use facilities, or legalising some or all drugs of misuse, are unlikely to happen any time soon. Until Congress, the states, and the medical community focus more on preventing drug overdose deaths it is likely that they will continue to increase.