What the new overdose death data tell us

June 9, 2022

According to preliminary data released by the Centers for Disease Control & Prevention on May 1, 2022, an estimated 108,000 people died from drug overdose deaths in 2021, a 15% increase from 2020. The rise in the number of deaths appears to be driven by fentanyl and methamphetamine.

The data shows that polydrug, or polysubstance, use has become increasingly prevalent. Over half of all drug overdose deaths, including opioid overdoses, involve multiple substances. Drugs commonly used with opioids include stimulants (cocaine or methamphetamine) and benzodiazepines.

As state and local jurisdictions determine how to spend dollars received from the opioid litigation, they should consider funding programs that address the polydrug nature of the epidemic. These include:

• Primary prevention programs that address individual risk factors (such as a favorable attitude towards substance use) and strengthen protective factors (such as resiliency), rather than programs that target opioid use specifically, as discussed in Principle 3, Invest in Youth Prevention.
• Treatments designed to address polydrug use. Evidence suggests that people with opioid use disorder who use other substances are less likely to get evidence-based care. A guide from the Substance Abuse & Mental Health Services Administration outlines evidence-based practices for treating people with polydrug use. As in other circumstances, FDA-approved medications (methadone, buprenorphine and naltrexone) have the strongest evidence supporting their use.

Given the ubiquitous presence of fentanyl throughout the drug supply, increasing the availability of tests that can determine if fentanyl is present may help people who use drugs detect and avoid fentanyl. One survey found that 88% of people who used drugs would use fentanyl test strips. This harm reduction approach is cited in the recently-released National Drug Control Strategy as an evidence-based tool. As discussed in the Strategy, jurisdictions that have policies that prohibit the use of these testing strips should remove them.

The overdose death crisis in the United States continues to evolve. What started with prescription opioids and then heroin has now transitioned to fentanyl; at the same time, deaths due to polydrug use are increasing. Jurisdictions should ensure that they are not “fighting the last war”, but are funding programs that will address the changing nature of the epidemic.