Policymakers, public health advocates and community groups that work to prevent overdoses find glimmers of encouragement in data showing no dramatic increase in overdoses from the previous year while emphasizing that the death toll remains unacceptably high.
“We can’t truly celebrate it. Every single death was preventable,” said Lauren McGinley, executive director of the New Hampshire Harm Reduction Coalition, which hands out overdose reversal drugs and fentanyl test strips in a state where at least 471 people died of overdoses in 2022, the most since 2017.
Brandon Marshall, an epidemiologist at Brown University who tracks overdose trends, said the sheer scale of deaths illustrates the epidemic will be a “multigenerational problem” that will require massive financial investment and new approaches to preventing fatalities.
“It’s easy to become numb to these figures,” Marshall said. “The urgency should not change.”
During the past two decades, the nation’s overdose deaths have risen dramatically, fueled first by prescription pain pills, then heroin and now dominated by fentanyl, the synthetic opioid primarily smuggled into the United States by Mexican cartels. The nation’s increasingly toxic drug supply is replete with other dangerous synthetic drugs such as xylazine, the animal tranquilizer that causes rotting flesh wounds and has been named by the federal government as an “emerging threat” when mixed with fentanyl.
The overdose crisis has also contributed to the nation’s alarming drop in life expectancy, and was exacerbated by the coronavirus pandemic, which increased social isolation, elevated stress and complicated treatment for substance use disorders.
In 2022, opioids, including fentanyl, will have accounted for nearly 83,000 overdose deaths, according to the estimates from the CDC’s National Center for Health Statistics.
“The gasoline that was COVID has diminished, but the underlying fire of the opioid epidemic remains,” Keith Humphreys, a drug policy adviser and professor of psychiatry at Stanford University, said in an email. “The country still faces an enormous public health and safety challenge.”
The Biden administration has made combating the drug crisis a priority, increasing efforts to seize fentanyl at the U.S.-Mexico border, pushing expanded access to opioid-reversing drugs such as naloxone and loosening restrictions on a key medicine to treat opioid use disorder. President Biden has asked Congress for an additional $100 million for harm-reduction services.
But the epidemic has also become a political flash point, with some Republicans blaming Biden’s border policies for the increase in fentanyl from Mexico. State legislators from both parties have pushed tougher laws in an attempt to curb fentanyl dealing, while even Republican-led states have legalized fentanyl test strips in the face of mounting deaths.
Despite the estimate of more than 109,000 deaths, Rahul Gupta, director of the White House Office of National Drug Control Policy, struck a positive tone in a statement released Wednesday. He said the administration has improved access to naloxone and was “attacking the illicit fentanyl supply chain.”
“As a result, around 19,000 people are still alive and can be there at the dinner table, at birthdays, and at life’s most important moments,” Gupta said in a statement.
Not everyone is so optimistic. Researchers Donald S. Burke and Hawre Jalal, who have modeled 40 years of data showing an exponential growth in U.S. overdose deaths, said in an interview Wednesday the plateau might be a “wobble” before an increase.
“Anybody looking at this with historical trends in mind, and a bit of statistics in mind, will probably say it’s not going to go down,” said Burke, of the University of Pittsburgh School of Public Health.
For now, the CDC’s estimates show several states hit hard by the opioid crisis — such as Ohio, Pennsylvania and West Virginia — will probably have fewer overdose deaths in 2022 than the previous year. Some credit efforts to widely distribute naloxone, the drug that reverses opioid overdoses. It was recently approved by the Food and Drug Administration for sale as a nasal spray without a prescription.
In Michigan, which the CDC estimates will have slightly fewer deaths in 2022 than the roughly 3,000 recorded a year earlier, one harm-reduction organization last year began a campaign to repurpose newspaper vending boxes so that they can distribute naloxone free of charge. Today, there are 80 such boxes in 26 counties, in front of homeless shelters, churches and even bars and restaurants.
“It’s a step in the right direction,” Pamela Lynch, executive director of Harm Reduction Michigan, said of the decline in deaths, while cautioning: “There are corners of the state where there isn’t any perspective on drug-user health services. People continue to die, and things are not changing as quickly as we’re hoping they will.”
Beyond the statistics, the stories of heartbreak — and shattered families — stretched coast to coast in 2022: Oregon teenage girls dead from fentanyl-laced pills, five young adults dead from fentanyl-laced cocaine in a Colorado apartment, 18 people dead from two separate deadly batches in D.C.
Patrick Robert Anderson, originally from New Hampshire, battled depression and addiction for years. A former high school football star with a passion for music, Anderson was in and out of rehab centers for years but last year was working two jobs as a waiter in New Haven, Conn. He hoped to one day get married and have children.
In November, a roommate found Anderson dead, on his bed and in front of an open laptop. He’d ingested fentanyl-laced cocaine, his family said.
“He was poisoned. He didn’t want to die,” his mother, Pat Anderson, 67, said Tuesday. “He just wanted to use cocaine that night, and he was alone. He wanted to have a life and he was trying.”
Anderson’s death illustrates what experts say has led to many deaths: Some users have no idea their drugs are laced with fentanyl.
“Many people who use stimulants don’t have any opioid tolerance, so a very small amount of fentanyl in that context can be deadly,” said Marshall, of Brown University.
The CDC estimates that deaths involving cocaine and heroin also increased in 2022. Jon E. Zibbell, a senior scientist at the nonprofit research institute RTI International, said many chronic opioid users turn to illicit stimulants to counter the highly sedative effects of fentanyl.
“But it’s really fentanyl — fentanyl is what’s killing people,” Zibbell said.
Across the country, the increasingly unpredictable drug supply has frustrated gains in overdose prevention.
The CDC estimates Washington state’s overdose deaths rose by 21 percent in 2022, Maine by 13 percent. In New York City, which has a government-approved site where people can use drugs under the supervision of staff trained to intervene in overdoses, the CDC estimates a nearly 14 percent increase in fatal overdoses in 2022.
In New Hampshire, the opioid crisis claimed nearly 500 lives in 2017, spurring many state initiatives, including establishing nine 24-hour hubs to help people dealing with substance use disorder. Jonathan Ballard, the state health department’s chief medical officer, said New Hampshire experienced a steady decrease in deaths over five years — until 2022.
To try to stem deaths, New Hampshire last month announced it was working with harm-reduction groups to place 700 acrylic boxes, similar to ones used to store emergency defibrillators, in public places across the state to dispense free naloxone.
“What’s changed is the drug composition,” Ballard said. “The drugs themselves are much more potent and deadly.”