By Pat Anson, PNN Editor

A new report by the Centers for Disease Control and Prevention shows that the vast majority of drug overdose deaths in the United States involve illicit fentanyl and other street drugs.  

The study, reported in the CDC’s Morbidity and Mortality Weekly Report, analyzed data from 24 states and the District of Columbia enrolled in the State Unintentional Drug Overdose Reporting System (SUDORS) from January to June, 2019. SUDORS captures detailed information from toxicology reports and death scene investigations, and is considered more reliable than overdose data gathered from death certificates.

Among the 16,236 overdose deaths reported by SUDOR during the study period, illicitly manufactured fentanyl (IMF), heroin, cocaine or methamphetamine were involved 83.8% of deaths, either alone or in combination with other drugs. Nearly half of those deaths involved two or more illicit drugs.

About one in five overdoses involved prescription opioids such as hydrocodone, oxycodone, morphine and buprenorphine. The study did not indicate whether the medication was obtained legally or if it was borrowed, stolen or purchased illicitly. What is clear, however, is that street drugs are the primary driver of the U.S. overdose crisis.

“The finding of this report that nearly 85% of overdose deaths involved IMFs, heroin, cocaine, or methamphetamine reflects rapid and continuing increases in the supply of IMFs and methamphetamine, coupled with illicit co-use of opioids and stimulants,” researchers reported.

More than two thirds (68.5%) of overdose victims were male, and over half (53.3%) were 25 to 44 years of age; demographics that don’t fit the profile of most chronic pain patients, who are generally older and female.

NBER Report Blames Rx Opioids

The new CDC report is at odds with a working paper recently published by the National Bureau of Economic Research (NBER), a non-profit, private think tank. The NBER report largely blames prescription opioids for the U.S. overdose epidemic – not street drugs or so-called “deaths of despair” caused by rising social isolation and economic distress.  

“People have blamed all sorts of things, heroin from Mexico and fentanyl from China and economic decline and so on and so forth,” co-author Janet Currie, PhD, a professor of economics at Princeton University, told Yahoo Finance. “But really the issue is that a whole lot of people got addicted because they were prescribed pain medications which aren’t prescribed in the same way in other countries.”

Currie and co-author Hannes Schwandt, PhD, an economics professor at Northwestern University, say pharmaceutical companies aggressively marketed opioids at a time when doctors were being encouraged to treat pain as “the fifth vital sign.”

“We argue that the development and marketing of a new generation of prescription opioids sparked the epidemic and that provider behavior is still helping to drive it,” the NBER report states. “Prior to the marketing push, most doctors had believed that opioids were too addictive and dangerous for anyone except terminally ill patients. Aggressive marketing by pharmaceutical companies changed those perceptions: Sales of opioid pain killers quadrupled between 1999 and 2013, fueling the rise in overdose deaths.”

What Curry and Schwandt fail to mention is that opioid prescriptions have fallen by nearly 40% since 2013. And their report only briefly mentions the rising toll taken by illicit fentanyl and other street drugs.

Fatal drug overdoses fell in 2018, for the first time in nearly 30 years, but many signs indicate they are rising again and that the COVID-19 pandemic is making the crisis worse in the U.S. and Canada.   

Canada’s Chief Public Health Officer recently warned the pandemic is fueling another surge in drug deaths in Canada.

“Tragically, in many regions of the country, the COVID-19 pandemic is contributing to an increase in drug-related overdoses and deaths,” Dr. Theresa Tam said in a statement. “There are indications that the street drug supply is growing more unpredictable and toxic in some parts of the country, as previous supply chains have been disrupted by travel restrictions and border measures. Public health measures designed to reduce the impact of COVID-19 may increase isolation, stress and anxiety as well as put a strain on the supports for persons who use drugs.”