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U.S. Reaches 100,000 Annual Overdose Deaths… Now What?

The CDC recently announced that the U.S. surpassed 100,000 overdose deaths—the highest ever recorded in a year, from April 2020 to April 2021. This record-setting number follows the previously-reported figure of 93,145 overdose deaths for 2020—including 69,586 from opioids—indicating that mortality continued to rise well into 2021.

The opioid epidemic began in the late 1990s and was recently exacerbated by the emergence of deadly fentanyl. Increased fentanyl use, accompanied by the long-standing stigma towards addiction and the COVID-19 pandemic, intensified the conditions leading to overdose. People with substance abuse disorders were greatly affected by the pandemic’s disruption of daily life, forced stay-at-home and social distancing orders, and limited access to treatment services.

Reaching the grim milestone of 100,000 overdose deaths in a 12-month period reminds us that the opioid epidemic, alongside the COVID-19 pandemic and other emergencies, necessitates a more coordinated federal response. BPC’s 2019 and 2020 reports both note significant investments in federal spending to address the opioid addiction and overdose epidemic. Despite these investments, overdose mortality rates continue to rise, driven by illicitly manufactured fentanyl and an increased prevalence of methamphetamine and cocaine involved in overdose deaths.

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Overdose Death Rates Increase Across All Regions

Overdose mortality rates have been increasing across all regions of the country. Between April 2020 and April 2021, overdose mortality rates have continued to increase in both the Northeast (10% over 12 months and 18% since January 2019) and the Midwest (22% over 12 months and 37% since January 2019). Even more noteworthy is the stark percentage increase in overdose mortality rates in the West (39% over 12 months and 67% since January 2019) and the South (36% over 12 months and 57% since January 2019) compared with the same period a year earlier. These faster percentage increases in drug overdose mortality rates in the West and South are supported by data that also indicate an increase in the use of fentanyl in these regions. Moreover, the South has surpassed the Northeast as the region with the highest drug overdose mortality rate.

Even the worst regional mortality rate a year ago is lower than the best regional mortality rate a year later. In April 2020, the highest regional mortality rate—27.2 per 100,000 in the Northeast—was exceeded by the lowest regional mortality rate in April 2021—27.3 per 100,000 in the West.

The increase in drug overdose mortality in 2020 was not uniform across demographic groups: Black and Hispanic mortality rates increased by over 40%, compared to a 24% increase for whites. Differences in mortality by sex were roughly the same by quarter between 2019-2020: 30% of overdose deaths were female and 67%-70% of overdose deaths were male.

Congress, Biden Administration Respond

In the past year, Congress responded to the worsening overdose mortality rates by appropriating billions of dollars to opioid-related programs.

  • The Consolidated Appropriations Bill—also known as the COVID-19 Relief Bill — included $350 million for the Substance Abuse and Mental Health Services Administration (SAMHSA) to expand Certified Behavioral Health Clinics and provide mental health and substance use disorder emergency grants.
  • The American Rescue Plan included $2.1 billion across a variety of opioid-related programs at SAMHSA and Health Resources and Service Administration. These funds within the ARP also specify a $1.5 billion increase to the Substance Abuse Prevention and Treatment Block Grant (SABG) at SAMHSA.
  • The House fiscal year 2022 Appropriations Bill included $2.8 billion for SABG, a $1 billion increase over FY2021; and $2 billion for the State Opioid Response (SOR) Grants, a $500 million increase over FY2021, including an additional $56.5 million for medication-assisted treatment.

The White House Office of National Drug Control Policy (ONDCP) in conjunction with HHS recently released the Biden Administration’s four-part government-wide strategy for fighting addiction. This approach—comprised of primary prevention, harm reduction, evidence-based treatment, and recovery support—is underpinned by equity, data and evidence, coordination, collaboration, and integration, as well as reducing stigma. This strategy notes, among other things, a lack of coordination within HHS and the value of prevention and harm reduction programs. Moreover, there are opportunities to apply this strategy more broadly to inspire cooperation with groups outside of HHS — such as states, other agencies, ONDCP —as well as to expand the focus of evidence-based interventions beyond medical treatments.

Despite the additional funding for existing programs and new strategies being outlined by federal leaders, swift and effective action is needed to stem the growing number of overdose deaths in the U.S. The 100,000-death milestone prompted an immediate response from ONDCP Director Dr. Rahul Gupta, who said he hopes to ease treatment restrictions as part of HHS’s government-wide strategy. Congressional leaders have also noted the importance of interagency collaboration as a solution to the growing harm posed by illicit fentanyl-related substances. These are certainly steps in the right direction, but the lag in illuminating this milestone limits key decision-makers’ ability to take more timely and meaningful action. With more frequent information, ONDCP and HHS may have been able to declare and implement eased restrictions sooner to prevent a portion of the 100,000 deaths reported.

It is useful to think about an effective emergency response to the opioid epidemic based on the federal government’s response to the COVID-19 pandemic. While drastically different health problems and COVID-19 being a novel and highly infectious disease, access to daily case counts, hospitalizations, deaths, and tests have been helpful to guide the pandemic response, foster interagency collaboration, and enhance federal-to-state coordination. Imagine if federal leaders had more frequent and upstream data on the opioid epidemic – federal funding would be consistent with policy priorities and effective interventions. However, the need for stronger federal leadership to align these is impeded by a serious lack of data which can be used to compare and evaluate program effectiveness.

To tackle some of these startling statistics, BPC is developing recommendations to optimize federal spending for opioid-related programs with our Opioid Crisis Task Force. These recommendations will focus on understanding the extent to which federal funding can be used effectively and how an ideal effective response to the opioid epidemic could and should look. Our recommendations fall in four policy areas:

  1. Discretionary spending with a focus on “smarter” spending that is evidence-based and coordinated.
  2. Mandatory spending which can be more fully leveraged.
  3. Data reporting and metrics which can be more uniform, frequently reported, and actionable.
  4. Governance and leadership to best ensure coordination and accountability. 

Stay tuned for more concrete policy recommendations in an upcoming report due out in early 2022.

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