The Spike in Drug Overdose Deaths During the COVID-19 Pandemic and Policy Options to Move Forward

Source: The Spike in Drug Overdose Deaths During the COVID-19 Pandemic and Policy Options to Move Forward


Jesse C. Baumgartner - Research Associate, Health Care Coverage and Access & Tracking Health System Performance, The Commonwealth Fund

David C. Radley - Senior Scientist, Tracking Health System Performance, The Commonwealth Fund

Since COVID-19 first started upending day-to-day life for Americans in March 2020, public health officials have been sounding the alarm about a potential surge in drug overdoses.

Overdose deaths rose during the second half of 2019, and experts feared the pandemic would produce conditions that would further increase overdoses and deaths: economic shock, social isolation and increased mental health distress, and disrupted access to addiction support and medications that require face-to-face visits.

Interim reports from government agencies and researchers have suggested these fears were being realized, with provisional data from the Centers for Disease Control and Prevention (CDC) now further supporting these claims.

Overdose Deaths Spiked After Start of the Pandemic, Driven by Synthetic Opioids Like Fentanyl

Note: Synthetic opioid deaths exclude those from methadone. Specific drug-class deaths are not mutually exclusive.
Data: Final 2016–2019 monthly totals: CDC WONDER; Estimated 2020 monthly totals: Calculations based on National Vital Statistics System Provisional Drug Overdose Death Counts, CDC WONDER.
Source: Jesse C. Baumgartner and David C. Radley, “The Spike in Drug Overdose Deaths During the COVID-19 Pandemic and Policy Options to Move Forward,” To the Point (blog), Mar. 25, 2021.

The CDC’s National Vital Statistics System (NVSS) provides monthly provisional data on predicted total drug overdose deaths during the preceding 12 months. The most recent data reflect September 2019 through August 2020. During that period, there were 88,295 predicted deaths, a record high that is almost 19,000 more deaths (27%) than the prior 12-month period.

Using these predicted data in combination with final data from 2019, we estimated monthly overdose deaths from January to August 2020. Our estimates show that total overdose deaths spiked to record levels in March 2020 after the pandemic hit. Monthly deaths grew by about 50 percent between February and May to more than 9,000; they were likely still around 8,000 in August. Prior to 2020, U.S. monthly overdose deaths had never risen above 6,300.

Opioid-related deaths drove these increases, specifically synthetic opioids such as fentanyl. Opioids accounted for around 75 percent of all overdose deaths during the early months of the pandemic; around 80 percent of those included synthetic opioids.

CDC recently published an interactive visualization tool with preliminary weekly estimates of overdose deaths. These data suggest that overdose deaths remained elevated well into the fall before declining toward the prepandemic baseline near the start of 2021. The final 2020 total in the United States could exceed 90,000 overdose deaths, compared to 70,630 in 2019. That would not only be the highest annual number on record, but the largest single-year percentage increase in the past 20 years.

Overdose Deaths Increased in Almost Every State During the First Eight Months of 2020

Note: District of Columbia had an estimated increase of 72%; South Dakota had an estimated decrease of –4%.
Data: Jan.–Aug. 2019 final totals: CDC WONDER; Estimated Jan.–Aug. 2020 totals: Calculations based on National Vital Statistics System Provisional Drug Overdose Death Counts, CDC WONDER.
Source: Jesse C. Baumgartner and David C. Radley, “The Spike in Drug Overdose Deaths During the COVID-19 Pandemic and Policy Options to Move Forward,” To the Point (blog), Mar. 25, 2021.

We also estimated how many overdose deaths each state experienced during the first eight months of 2020, compared to overdose deaths during the same period of 2019.

Overdose deaths increased in almost every state; 24 states and the District of Columbia had an estimated increase of at least 30 percent, and the overall U.S. total increased by 33 percent.

States like West Virginia and Kentucky have long been at the heart of the opioid epidemic, and that region is still reporting some of the largest proportional increases. Recent research has also highlighted the growing impact of fentanyl and overdose deaths within states farther West. Arizona, California, Colorado, Illinois, Texas, and Washington all experienced increases above 35 percent during the first eight months of 2020; Colorado recently reported record overdose deaths during full year 2020.

Looking Forward

President Biden campaigned on a platform to address the opioid crisis through a public health approach that includes expanding funding and resources, reforming the criminal justice system, increasing insurance coverage, and widening access to medication-assisted treatment (MAT) and mental health care. His administration has already faced early pressure to make it easier for providers to prescribe buprenorphine — a key component of MAT — during the pandemic.

One policy tool that can address multiple objectives is Medicaid expansion. Data continue to show the positive impact of expansion on coverage, MAT access, and mortality outcomes for substance-use patients.

By simply expanding Medicaid, nonexpansion states like Florida, Georgia, Tennessee, and South Carolina could access significant federal financing in their push to help an ever-growing number of people in need. These four states all experienced overdose death increases above 30 percent during the first eight months of 2020.

Utilizing Medicaid also decreases the reliance on annual discretionary funding to support siloed treatment programs, which has proven to be unsustainable in the fight to reduce drug overdoses. Policy experts recently argued for restructured financing of substance-use treatment through “mainstream public and private insurance programs” like Medicaid that allow states to reliably “pull” down funding as their needs increase.

But in the absence of further financing reform, federal discretionary funding has quickly increased to meet the growing crisis. The December 2020 funding package included $4.25 billion in mental health and substance-use emergency funding; the recently passed American Rescue Plan (ARP) will provide an additional $3.5 billion for block grants in these same areas. President Biden recently announced $2.5 billion to further support states.

Combined with ARP’s significant financial assistance for state and local governments, the targeted substance-use funding will likely be critical for struggling addiction-treatment providers and government agencies that account for a significant percentage of overall substance-use treatment funding. Many have had to contend with tighter budgets related to the pandemic’s economic impact.

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Data and Methods

The Centers for Disease Control and Prevention’s (CDC’s) National Vital Statistics System releases monthly provisional predicted overdose death totals from the preceding 12 months across different drug types. For example, the August 2020 predicted total represents overdose deaths occurring between September 1, 2019, and August 31, 2020. These predicted totals tend to lag by six to eight months and are usually 2 percent to 3 percent higher than the final U.S. annual death totals eventually released by the CDC. The agency also releases state-level provisional data.

In the first exhibit, the January–August 2020 individual month estimates are based on calculations using the CDC’s final 2019 monthly data and its 2020 provisional 12-month predicted totals — these estimates are not confirmed by the CDC. To account for the typical overcount in national-level provisional predicted deaths, we discounted the 12-month predicted totals during 2020 by the percentage difference between the final 2019 U.S. annual overdose death total and the December 2019 12-month predicted total (provisional totals are typically about 2.5% higher, depending on the drug overdose death type).

In the second exhibit, state estimates for overdose deaths between January and August 2020 are based on calculations using final 2019 monthly data for each state and the August 2020 provisional predicted 12-month total. To account for potential differences in state-level provisional predicted deaths, we adjusted the 12-month totals by the average percentage difference between a state’s final annual totals and its December 12-month predicted totals from 2015 to 2019.