Intended for healthcare professionals


Covid-19: US sees increase in sexually transmitted diseases and teen drug overdose deaths

BMJ 2022; 377 doi: (Published 19 April 2022) Cite this as: BMJ 2022;377:o991
  1. Janice Hopkins Tanne
  1. New York

The prevalence of sexually transmitted diseases (STDs) and deaths from drug overdoses increased in the US over the past two years, showing the pandemic’s effect on public health.

“Even in the face of a pandemic, 2.4 million cases of chlamydia, gonorrhoea, and syphilis were reported,” the US Centers for Disease Control and Prevention (CDC) said.

STDs declined during the early months of the pandemic in 2020 but then increased rapidly.1 Cases of gonorrhoea increased by 10% during 2020 compared with 2019. Cases of primary and secondary syphilis increased by 7% and congenital syphilis in newborns increased by 13%.2 New data suggest that primary and secondary syphilis—the most infectious stages of the disease—continued to increase during 2021, the CDC said.2 Cases of chlamydia, usually the most reported STD, declined by 13%, but that may be because of decreased screening and underdiagnosis during the pandemic, the CDC said.

Jonathan Mermin, director of CDC’s national centre for HIV, viral hepatitis, STD, and tuberculosis prevention, said, “The unrelenting momentum of the STD epidemic continued even as prevention services were disrupted.” His colleague, Leandro Mena, director of CDC’s division of STD prevention, said, “The pandemic increased awareness of a reality we’ve long known about STDs. Social and economic factors—such as poverty and health insurance status—create barriers, increase health risks, and often result in worse health outcomes for some people.”

Another disturbing trend during the pandemic has been the increase of deaths from drug overdoses, especially among teenagers.3 Just over 100 000 Americans died of drug overdoses during the year to April 2021, according to the CDC’s national centre for health statistics—an increase of 28.5% from the previous year.

Opioids were the most common cause of death, accounting for 75 673 deaths, an increase from 56 064 in the same period the year before. Overdose deaths from synthetic opioids (primarily fentanyl) and psychostimulants such as methamphetamine also increased, as did deaths from cocaine and from natural and semi-synthetic opioids such as prescription pain drugs.

Researchers from the University of California, Los Angeles, and other institutions found that drug use by adolescents aged 14-18 remained stable between 2010 and 2020 with about 30% using illicit drugs. The illicit drug supply was, however, increasingly contaminated with illicit fentanyl and other synthetic opioid and benzodiazepine analogues, increasing the risk of fatal overdoses.4

Using CDC data the researchers calculated that adolescent overdose deaths were 2.4 per 100 000 population in 2010 and remained relatively stable until 2020 when they increased to 4.57 per 100 000—and in 2021 to 5.49 per 100 000.

Among adolescents, fentanyl was identified in 77% of overdose deaths in 2021. Illicit fentanyl has “variable and high potency” and is increasingly added to counterfeit pills that look like prescription drugs, which teenagers “may not identify as dangerous,” the researchers said.

“Drug mortality is increasingly becoming a racial justice matter in the US. Our results suggest that drug overdose mortality has been exacerbated during the pandemic,” said Joseph Friedman and Helena Hansen of the University of California, Los Angeles, in a letter published in JAMA Psychiatry.5

They used CDC provisional data and found that in 2020 the highest drug overdose mortality was among American Indians and Alaska Natives—41.4 per 100 000, more than 30% higher than in white Americans (15.8 per 100 000). Overdose mortality in Black Americans was 36.8 per 100 000—higher than the mortality in white Americans for the first time since 1999. Drug overdose deaths were lowest in Hispanic or Latino people—17.3 per 100 000.

They called for provision of a safe supply of drugs; improvements to healthcare access, including harm reduction services for people with substance abuse disorders; the end of routine incarceration; and tackling the social conditions of people who use drugs.

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