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Overdose deaths continue rising, with fentanyl and meth key culprits

A reporter holds up an example of the amount of fentanyl that can be deadly.Jacquelyn Martin/Associated Press

WASHINGTON — Deaths from drug overdoses continued rising to record-breaking levels in 2021, nearing 108,000, according to preliminary new data published Wednesday by the Centers for Disease Control and Prevention.

The increase of nearly 15 percent followed a much steeper rise of almost 30 percent in 2020, an unrelenting crisis that has consumed federal and state drug policy officials. The number of drug overdose deaths has increased every year but 2018 since the 1970s.

A growing share of deaths came from overdoses involving fentanyl, a class of potent synthetic opioids that are often mixed with other drugs, and methamphetamine, a synthetic stimulant. State health officials battling an influx of both drugs said many of the deaths appeared to be the result of combining the two.


Drug overdoses, which long ago surged above the country’s peak deaths from AIDS, car crashes, and guns, killed about one-quarter as many Americans last year as COVID-19.

Deaths involving synthetic opioids — largely fentanyl — rose to 71,000 from 58,000, while those associated with stimulants like methamphetamine, which has grown cheaper and more lethal in recent years, increased to 33,000 from 25,000. Because fentanyl is a white powder, it can be easily combined with other drugs, including opioids like heroin, and stimulants like meth and cocaine, and can be stamped into counterfeit pills for anti-anxiety drugs like Xanax. Such mixtures can prove lethal if drug users are unaware they are using fentanyl or are unsure of the dose.

Deaths from both classes of drugs have been rising in recent years.

But there is growing evidence that mixing stimulants and opioids — into combinations known as “speedballs” and “goofballs” — is growing more common, too. Dan Ciccarone, a professor of family and community medicine at the University of California, San Francisco, who studies drug markets, has just begun a multiyear study of the combination of opioids and meth.


“There’s an intertwined synthetics epidemic the likes of which we’ve never seen,” he said. “We’ve never seen a powerful opioid such as fentanyl being mixed with such a potent methamphetamine.”

The numbers released Wednesday are considered provisional, and may change as the government reviews more death records. But they added more definition to a crisis that has escalated sharply during the pandemic.

The White House in recent weeks announced President Biden’s first national drug control strategy, and a plan to combat meth use, unveiled last week by his drug czar, Dr. Rahul Gupta, the first medical doctor to oversee the White House Office of National Drug Control Policy. Overdose deaths involving meth almost tripled between 2015 and 2019 in people 18 to 64, according to the National Institutes of Health.

Biden is the first president to embrace harm reduction, an approach that has been criticized by some as enabling drug users, but praised by addiction experts as a way to keep drug users alive while providing access to treatment and support.

Instead of pushing abstinence, the approach aims to lower the risk of dying or acquiring infectious diseases by offering sterile equipment — through needle exchanges, for example — or tools to check drugs for the presence of fentanyl. Strips that can detect fentanyl have become increasingly valuable resources for local health officials, and some states have moved recently to decriminalize them, even as others resist.

The causes of the continued increase in overdoses are complex and hard to untangle, experts said. But state health officials and some addiction experts said the spike in overdoses, which began before the pandemic, could not be blamed solely on the disruptions that came with it, or on a major increase in the number of Americans using drugs.


Social isolation and economic dislocation, which have been widespread during the pandemic, do tend to cause relapses in drug use, and could have contributed to rising overdoses. Shutdowns early in 2020 also caused some addiction treatment providers to temporarily close their doors. But the pandemic alone does not explain the recent trend.

Policy changes made during the pandemic may have helped prevent more deaths. Regina LaBelle, an addiction policy expert at Georgetown University, said that early research has found that loosening rules to permit take-home methadone treatment had been beneficial, along with an increase in treatment via telemedicine.

Fentanyl, which is made in a lab, can be cheaper and easier to produce and distribute than heroin, enhancing its appeal to dealers and traffickers. But because it is strong and sold in varying formulations, small differences in quantity can mean the difference between a drug user’s usual dose and one that proves deadly. It is particularly dangerous when it is used unwittingly by drug users who do not usually take opioids.

A recent study of illicit pills seized by drug enforcement authorities found that a substantial share of what is marketed as OxyContin, Xanax, or the attention deficit hyperactivity disorder drug Adderall now contains fentanyl. The spread of these counterfeit pills may explain a recent sharp increase in overdose deaths among teenagers, who are less likely to inject drugs than older people.