This article originally appeared on VICE US.
The U.S. just had its deadliest year on record for overdose deaths, and the problem will likely get worse, in part because of the COVID-19 pandemic, an expert told VICE News.
According to preliminary data from the Centers for Disease Control and Prevention, close to 71,000 people died of overdoses in the U.S. in 2019, a number that the agency said is likely an undercount. More than 36,000 of those deaths stem from synthetic opioids such as fentanyl, the CDC report said.
The increase in 2019 is a reversal from 2018, which saw overdose deaths decrease for the first time in decades, with about 68,000 in total.
Bryce Pardo, an associate policy researcher at the RAND Corporation, a nonprofit that studies the overdose crisis, said there may have been a decrease in deaths in 2018 because carfentanil exited several U.S. markets. It's possible that some dealers stopped selling carfentanil, a synthetic opioid more potent than fentanyl, due to too many people dying, or that Chinese manufacturers decided it was too risky to produce, said Pardo. However, he said the drug re-emerged in 2019 in places like Vancouver, B.C. and Ohio.
Pardo also said new non-fentanyl-based synthetic opioids are hitting the market as a way of getting around the Drug Enforcement Agency’s crackdown on all fentanyl analogues.
Pardo said when it was first introduced to the U.S., fentanyl was concentrated in areas east of the Mississippi River, like Ohio and New Hampshire. But it’s now showing up in west coast cities that have high rates of heroin consumption like Seattle and San Francisco, typically in the form of counterfeit pills made to look like Oxycontin.
Pardo said there are some markets that have completely transitioned to fentanyl markets, where powder heroin is no longer available. Vancouver drug activists who recently handed out free samples of cocaine and opium that had been tested for fentanyl said there is no clean heroin available in the city.
“The thing about this problem is it’s more like a poisoning crisis,” Pardo said. “Drug users, at least at first, aren’t demanding fentanyl. They’re looking for heroin, they’re looking for some type of diverted prescription medication.”
He said in some cases dealers are adding fentanyl to the heroin supply because it’s cheaper and more potent and it’s easy to get online.
“It’s just a matter of time before more markets flip over.”
Pardo said the COVID-19 pandemic could be leading to an increase in overdose deaths because drug users may be using at home alone due to quarantine and because more people in general may be using drugs to deal with the stress of the pandemic.
“People are just at home and they're dosing like they’re regular dose but nobody’s there to administer Naloxone so they die. Or people could be getting into trouble because they’re depressed.”
In May and June, B.C.—the centre of the opioid crisis in Canada—broke back-to-back records for its deadliest months for fatal overdoses, with 171 and 175 deaths, respectively. Most of the deaths were linked to fentanyl.
The CDC data also shows an increase in cocaine-related overdose deaths in 2019, however Pardo said it’s likely that many of those deaths can be explained by cocaine users who are also using fentanyl or heroin.
He said it's time to start piloting more harm reduction projects in the U.S., including safe consumption sites and prescription heroin programs.