The Surge in Drug-Related Fatalities During the Pandemic Highlights the Root Causes of Addiction

The crackdown on pain medication made drug use more dangerous and did nothing to address the factors driving "deaths of despair."


The Centers for Disease Control and Prevention (CDC) recorded more drug-related deaths in 2019 than ever before, and the latest preliminary data indicate that record was broken again in 2020—by a lot. The CDC estimates that more than 90,000 Americans died during the 12-month period ending in September 2020, up 29 percent from the previous 12-month period. The COVID-19 epidemic probably had a lot to do with that striking jump, an explanation that highlights the faulty premises underlying the government's response to the "opioid crisis."

These drug-related deaths mainly involve opioids, overwhelmingly heroin and illicit fentanyl. "Synthetic opioids other than methadone," the category that includes fentanyl and its analogs, accounted for 73 percent of opioid-related deaths in 2019, up from 14 percent in 2010. "Natural and semisynthetic opioids," the category that includes commonly prescribed analgesics such as hydrocodone and oxycodone, were involved in 24 percent of those deaths, but half of those cases also involved heroin or fentanyl.

According to the CDC WONDER database, three-quarters of the deaths involving pain pills in 2019 also involved illicit opioids, alcohol, barbiturates, benzodiazepines, cocaine, or methamphetamine. Pain pills by themselves (i.e., not combined with other drugs) accounted for less than 6 percent of opioid-related deaths and no more 4 percent of all drug-related deaths.

Yet President Joe Biden still wants to "stop overprescribing while improving access to effective and needed pain management," which is code for continuing to discourage and restrict opioid prescriptions. That strategy already has deprived bona fide patients of the medication they need while driving nonmedical users toward black-market substitutes that are far more dangerous because their potency is highly variable and unpredictable. The results can be seen in the ever-rising number of opioid-related deaths, a trend that not only continued but accelerated after the government succeeded in driving down prescriptions for pain medication.

Deaths involving pain pills rose more than fivefold between 1999 and 2017, then fell by 18 percent as of 2019. Meanwhile, deaths involving the category of drugs that includes fentanyl rose 50-fold, and total opioid-related deaths sextupled. That does not seem like a good tradeoff.

The attempt to reduce opioid-related deaths by making pain pills harder to obtain failed because it was based on the misconception that exposure to these drugs causes addiction. That is clearly not true.

Data from the National Survey on Drug Use and Health (NSDUH) indicate that about 2 percent of people who had used prescription opioids in the previous year (for medical or nonmedical purposes) might qualify for a diagnosis of "substance use disorder," a broad category of drug-related problems that includes what used to be called "substance abuse" and "substance dependence." By comparison, according to the latest NSDUH results, about 8 percent of past-year drinkers experienced an "alcohol use disorder."

Exposure to opioids obviously is not a sufficient explanation for opioid addiction, just as exposure to alcohol is not a sufficient explanation for alcoholism. What other factors are important? The experience with the COVID-19 pandemic suggests a few.

While opioid-related deaths were already rising, The New York Times notes, "the pandemic unquestionably exacerbated the trend, which grew much worse last spring: The biggest jump in overdose deaths took place in April and May, when fear and stress were rampant, job losses were multiplying and the strictest lockdown measures were in effect." The Times cites a study by Brendan Saloner, an addiction researcher at Johns Hopkins University's Bloomberg School of Public Health, who found that many drug users had increased their consumption during the pandemic. They also were more likely to take drugs on their own, which increases the risk of a fatal outcome, and most reported consuming mixtures of drugs, "another red flag."

In other words, pandemic-related isolation, psychological stress, and economic difficulty help explain last year's surge in drug-related deaths. The pandemic magnified the problems that make drug use more attractive, but it did not create them. Reducing opioid prescriptions does nothing to address those problems; it merely encourages people who experience them to use other, more dangerous drugs.

Contrary to the conventional narrative, which blames the "opioid crisis" on an oversupply of pain pills, "drug-related deaths have been rising since the late 1950s," as a 2019 report on "deaths of despair" from the Joint Economic Committee noted. The increase in opioid-related fatalities is the latest manifestation of that long-term trend. When it comes to drug-related "deaths of despair," the root problem is the despair, not the drugs.