Drug overdoses were increasing before Covid-19. The pandemic made things worse.

America’s Covid-19 epidemic is likely making its drug overdose epidemic even worse.

While there’s no good national data for the year yet, local and state jurisdictions have reported increases in overdose deaths. According to the American Medical Association, as of July 20, more than 35 states have reported increases in drug-related deaths and other concerns with drug use and mental illness. Some municipalities reported overdose deaths increasing by 20, 40, or 60 percent — or more.

Even before the pandemic, there were signs that the drug overdose crisis was worsening. Preliminary data from the Centers for Disease Control and Prevention (CDC) found drug overdose deaths hit 72,000 in 2019, up almost 5 percent from nearly 69,000 in 2018. A preliminary study from researchers at Stanford, UCLA, and the Los Angeles LGBT Center found that fentanyl, a synthetic opioid more potent and dangerous than heroin, has started to spread to illegal drug markets in the West — a trend that will likely cause more overdoses.

“Our data shows [overdoses] were increasing before the pandemic,” Chelsea Shover, a Stanford epidemiologist who led the study, told me. “I think the pandemic can only make it worse.”

The demands of social distancing have worsened social isolation, possibly leading more people to use drugs to cope. Social services and addiction treatment programs — many of which already lacked funding and rigor — have fallen to the side as the economic collapse has crushed public and private revenues, and social distancing has forced some places to close.

Meanwhile, the actions that different levels of government have taken to shore up the gaps caused by the pandemic simply haven’t been enough. As experts told me, telemedicine — while certainly helpful for many and better than nothing — simply can’t make up for being able to pick up new syringes or naloxone, the opioid overdose antidote, at the local needle exchange program.

The result: As America sees more than 166,000 Covid-19 deaths (and rising), it’s also suffering tens of thousands of drug overdose deaths due to a decades-old crisis now likely worsened by the coronavirus pandemic.

“I’ve been really depressed by this,” Kim Sue, medical director of the Harm Reduction Coalition, told me. “I try to be very upbeat. I try to encourage people. … But I’ve been feeling really beaten down by this.”

Before the pandemic, drug overdose deaths were rising

Drug overdose deaths in the US actually fell for the first time in decades in 2018 — by about 4 percent. Based on preliminary federal data, that drop was erased in 2019, with estimated drug overdose deaths that year topping not just 2018 but also 2017, which was previously the worst year for overdoses on record. The data is preliminary and subject to change, but at the very least it suggests a reversal from 2018.

There was also reason to believe 2020 would be worse — even before the pandemic.

First, there’s the spread of fentanyl. The synthetic opioid has already contributed to a rise in overdoses in the Northeast and Midwest as it’s replaced the less potent — and therefore less dangerous — heroin in illicit drug markets. It’s the third wave of the opioid epidemic, following the first wave of opioid painkillers and the second of heroin, in these regions.

But a 2019 report from the RAND Corporation, a policy think tank, warned that fentanyl could spread to the West, which had so far been spared from fentanyl due to intricacies in its illegal drug market, and cause a spike in overdoses there. Indeed, that now seems to be happening: The preliminary study from the Stanford, UCLA, and Los Angeles LGBT Center researchers looked at overdose data in different local and state jurisdictions in the West and found significant increases in overdoses across the region.

That matches what, anecdotally, some experts on the West Coast have seen locally. “In Los Angeles and in the West Coast, 100 percent, we’re seeing more and more fentanyl,” Ricky Bluthenthal, associate dean for social justice and professor of preventive medicine at USC, told me. “We have … a more dangerous drug as a consequence.”

Beyond fentanyl, there were also signs that stimulant overdoses — particularly involving cocaine or meth — were on the rise before the pandemic, with increases in the preliminary federal data of 8 percent for cocaine and 26 percent for psychostimulants, including meth, in 2019. It’s unclear why that’s the case (though it’s not abnormal for stimulant epidemics to follow opioid epidemics), but it’s yet another way drug overdoses were on the way up going into 2020.

Along with these trends, previous years of data suggest overdoses were increasing in different kinds of communities. During the early stages of the opioid crisis, white people were disproportionately likely to be victims of drug overdoses. In recent years, particularly as fentanyl and stimulant deaths have climbed, overdoses have climbed in Black and brown communities.

Given all these factors, experts were already worried about drug overdoses in 2020. Then the pandemic hit.

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