• Drug Overdose Deaths Reached New High in 2020, Says CDC

    Most Deaths Attributed to Opioids; COVID-19 Also a Factor

    August 6, 2021, 2:11 p.m. Michael Devitt — As the COVID-19 pandemic extends into its second year, it seems that each month brings a report or analysis that illustrates the negative effects on health and well-being in some new way.

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    For July, that news came in the form of a Vital Statistics Rapid Release from the CDC’s National Center for Health Statistics. The release reported that in 2020, drug overdose deaths in the United States increased by nearly 30% over the previous year, reaching an all-time high of more than 93,000.

    “This is the highest number of overdose deaths ever recorded in a 12-month period, and the largest increase since at least 1999,” said Nora Volkow, M.D., director of the National Institute on Drug Abuse, in a statement.

    “This has been an incredibly uncertain and stressful time for many people and 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,” Volkow continued. “As we continue to address both the COVID-19 pandemic and the opioid crisis, we must prioritize making treatment options more widely available to people with substance use disorders.”

    Most Overdose Deaths Attributed to Opioids

    The NCHS based its estimate on an analysis of death certificates from deaths due to drug overdose in each state and the District of Columbia. In instances where data was incomplete and causes of death were pending investigation, the agency developed a method for predicting drug overdose death counts.

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    The agency noted that its method produced an underestimate of drug overdose deaths relative to final counts. Based on this method, and because many states were still reporting their tallies to NCHS when the release was published, the final number of drug overdose deaths for 2020 may be higher.

    Among the relevant findings:

    • Inappropriate use of opioids was responsible for nearly three-quarters of all drug overdose deaths. According to NCHS, overdose deaths from opioids increased from 50,963 in 2019 to an estimated 69,710 in 2020.
    • The majority of opioid deaths resulted from use of synthetic opioids such as fentanyl, followed by psychostimulants such as methamphetamine. Deaths from cocaine and from natural and semi-synthetic opioids, such as prescription pain medicine, also increased in 2020, while estimated drug overdose deaths from heroin decreased slightly.
    • Drug overdose deaths increased in 48 states and the District of Columbia, and decreased in New Hampshire and South Dakota.
    • Percentage-wise, the largest increase occurred in Vermont, where overdose deaths rose more than 57% year-to-year. Other large increases occurred in Kentucky, South Carolina, West Virginia and Louisiana.
    • In terms of raw numbers, California had the most drug overdose deaths with an estimated 9,538, followed by Florida, Pennsylvania, Ohio and Texas. The fewest deaths occurred in South Dakota.

    “These data are chilling,” Volkow said in her statement. “The COVID-19 pandemic created a devastating collision of health crises in America.”

    COVID-19 and Drug Overdose Deaths

    While the analysis did not attempt to explain the increase in overdose deaths, several factors related to COVID-19 may have contributed to the situation.

    An April 2020 study, for example, found that more than 40% of syringe services programs reported a decrease in the availability of some services because of the pandemic.

    Social distancing regulations and stay-at-home orders may also have played a factor by restricting individual access to safe injection sites and limiting the ability of individuals who use illicit drugs to attend support meetings in person or to consult with clinicians or therapists in live sessions.

    In addition, the isolation caused by social distancing may have contributed to feelings of anxiety and depression, which in turn may have led to increased drug use. A Kaiser Family Foundation issue brief published earlier this year found that more than 41% of adults reported symptoms of anxiety disorder and/or depressive disorder in January 2021 compared with 11% of adults during the first six months of 2019.

    A July 2020 Kaiser Family Foundation Health Tracking Poll, meanwhile, indicated that 12% of adults reported increases in alcohol or substance consumption due to concerns about the pandemic, while another 12% reported a worsening of existing chronic conditions, which could also contribute to substance use.

    Family Physician Offers Perspective

    Robert “Chuck” Rich Jr., M.D., medical director of Bladen Medical Associates in Elizabethtown, N.C., described how the pandemic has affected his ability to care for patients with conditions such as substance use disorder in an email to AAFP News.

    “Like many family physicians, I have noted more patients being impacted by behavioral health conditions as a consequence of the pandemic along with a reduction in the resources normally available to handle those concerns. This has resulted in family physicians such as myself having to handle a greater portion of those concerns with limited access to behavioral consultants and other resources,” Rich said.

    “Additionally, patients are presenting with more intense behavioral health symptoms secondary to delayed and limited treatment options,” Rich continued. "Similar to many health care crises, these worsened behavioral health concerns are significant issues in rural and underserved populations, but such concerns are being seen across the spectrum of all our members’ offices.”

    Rich also stressed the importance of offering medication for opioid use disorder, telling AAFP News that the efforts of family physicians and others are critically necessary.

    “If an FP has not already done so, I would encourage that physician to proceed with the waiver training for substance abuse management and then look at starting their own patients with MOUD using buprenorphine under the new expanded waiver guidelines,” said Rich.

    (It should be noted that in June, the Health Resources and Services Administration launched a program that would pay federally qualified health centers and rural clinics for employing FPs and other clinicians who have recently obtained clearance to prescribe buprenorphine for the treatment of opioid use disorder.)

    Some family physicians, Rich noted, may not feel comfortable initiating care or treating patients with MOUD.  In those instances, he suggested that FPs consider resources such as the Providers Clinical Support System, a national training and clinical mentoring project, along with other state-supported mentorship opportunities or similar opportunities supported by medical schools or residency programs.

    “Family physicians also need to be more vigilant in screening their patients for behavioral health or substance abuse issues and better inventory the treatment options available in their area for treatment of such issues,” Rich added. “This inventory should include an assessment of the growing availability of telehealth counseling and treatment options which may be available in a given area.”

    Finally, Rich cautioned that FPs will likely be dealing with the direct and indirect effects of the pandemic for the foreseeable future.

    “The COVID pandemic has and continues to be a challenge to the health care system on many levels, and the growing epidemic of behavioral health and substance use issues associated with the pandemic suggests that we will be dealing with the consequences of COVID indefinitely,” Rich said.

    Academy Resources Can Help

    The AAFP has a wide range of resources to assist family physicians in treating patients with OUD and substance use disorder.

    In February, the Academy published a new Chronic Pain Toolkit to help members effectively assess, diagnose and manage chronic pain, with two sections that focus specifically on OUD and opioid prescribing. This update was funded by SAMHSA as part of an ongoing partnership with the Opioid Response Network.

    In the same month the Academy, through a grant from Indivior PLC, published an updated OUD treatment manual that is available for free download to all AAFP members.

    The AAFP also has a variety of resources on pain management and opioid abuse, along with peer-reviewed articles from American Family Physician and patient-centric materials on familydoctor.org.