The dose makes the poison

Among the devastating health crises of the Covid-19 pandemic has been a massive upsurge in drug-overdose deaths across the United States. Having risen less than 6 percent between 2018 and 2019, from 68,000 to 72,000, the overdose-death rate spiked by more than 29 percent between 2019 and 2020, to 93,000—and is currently on track to break the 2020 record in 2021. Why is this happening?

Noa Krawczyk is an assistant professor in the Department of Population Health at New York University’s Grossman School of Medicine and a member of NYU’s Center for Opioid Epidemiology and Policy. According to Krawczyk, there’s a complex set of elements behind these numbers. They include a proliferation of difficulties people have experienced in trying to get treatment during the pandemic; an increase in instances of people using opioids alone, on account of lockdowns and the need for social distancing; mental-health issues and other problems related to the fracturing of social networks. But the most significant factor driving the escalation in overdose deaths, Krawczyk says, is the emergence of the opioid fentanyl in illicit-drug supplies. “What's really important to keep in mind with opioids particularly is that so much of the overdose-death crisis really depends on the drug supply,” she says. “So, we might be seeing certain areas of the country with higher death rates, and it's not always due to more drug use, or particular patterns of drug use, but rather to illicit-drug supplies being contaminated with fentanyl” …

Eve Valentine: What’s causing this rise in overdose deaths?

Noa Krawczyk: Mostly, it’s been driven by illicit fentanyl, a very potent opioid—much stronger than other opioids like oxycodone or heroin. Since 2013, we’ve seen this substance infiltrate the illicit U.S. drug market—not only the opioid supply but also the supply of other drugs, such as cocaine and methamphetamines.