Fentanyl now the leading cause of death for adults ages 18 to 45

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US Centers for Disease Control and Prevention (CDC) data now show fentanyl overdose to be the top cause of death among US adults aged 18-45, surpassing those attributed to COVID-19, suicide, and car accidents. From 2018 to 2020, out of 100,000 adults of that age group, 19.4 succumbed to a fatal fentanyl overdose.

Source: Families Against Fentanyl

A report by the nonprofit Families Against Fentanyl notes that deaths attributed to the substance nearly doubled from 32,754 to 64,178 in the two-year period between April 2019 and April 2021.

The United States recorded nearly 79,000 fentanyl deaths over 2020 and 2021 (37,208 in 2020 and 41,587 in 2021), making up at least 70% of all drug overdoses. The US Drug Enforcement Agency (DEA) describes fentanyl as “a Schedule II controlled substance that is similar to morphine but about 100 times more potent.”

By the end of January 2021, opioid overdose deaths in the US had risen 38.1%, and overdose deaths involving synthetic opioids (primarily illicitly manufactured fentanyl) rose 55.6% year-over-year. 

The CDC recorded more than 100,000 drug overdose fatalities between April 2020 and April 2021, the highest yearly number ever recorded. The DEA notes that fentanyl deaths “appear to be the primary driver of the increase in total drug overdose deaths.” 

Maine data has shown a similarly grim trend. In 2021, 632 Mainers died of an opioid overdose, 25% higher than the 504 fatalities recorded in 2020, which was 32% higher than the 380 recorded in 2019. Because processing case and death reports can take many weeks, these data can have a considerable lag time. As of this publication, the state has not yet released any drug overdose data for the first quarter of 2022.

Over 2020 and 2021, the average annual number of opioid overdose deaths in Maine was 58% higher than the 2015 to 2019 annual average of about 360. Arguably more staggering is the fact the yearly average has tripled in the past decade. Between 2009 and 2014, Maine averaged 175 opioid deaths per year, a serious, but much more manageable problem.

Source: Maine Drug Data Dashboard

The state Drug Death Report for 2020 notes that “the increase in drug deaths is not due to infection by COVID-19 itself.” In fact, the yearly average deaths from opioid overdose has been climbing since 2013. State reports also show that this increase has been driven primarily by non-pharmaceutical opioids like fentanyl.

Around 95% of reported fatal and nonfatal drug overdoses in Maine ERs are considered to be accidental. The prevalence of the synthetic opioid within the supply of other illicit drugs, of which users may not be aware, contributes to this growing danger.

National Institutes of Drug Abuse report that 75% of cocaine-overdose deaths and 50% of methamphetamine-related overdose deaths in 2021 were mixed-use with fentanyl. 

The DEA warns that 42% of the counterfeit pills it tested for fentanyl had at least 2 milligrams of fentanyl, which the agency says “can be lethal depending on a person’s body size, tolerance and past usage.”

While deaths and overdoses are climbing, seizures of the drug have also jumped considerably in the last two years. US Customs and Border Protection records both pounds of drugs seized and seizure events month-to-month. Federal authorities seized more than 11,200 pounds of fentanyl between October 2020 and September 2021, which was 135% more than the 12 months prior. The number of events in which illegal drugs were seized spiked in April 2020 and has maintained a high level since then.

Fentanyl and opioid overdoses have been at a crisis-level for Maine and the northeast US for at least the past decade. Governor Janet Mills and allies argued that the expansion of Mainecare in early 2019 would help with the opioid crisis, claims with which reality has dispensed. Even if other pre-pandemic policies were helping the situation, there is no doubt that the iron-fist public health approach of society-wide lockdowns and mandatory social distancing implemented in 2020 greatly exacerbated the problem. 

Given the many challenges, how can this problem be solved or mitigated? Some argue that changing laws which criminalize possession of small amounts of these dangerous narcotics and shift those resources to treating addiction will lessen harms to users and society. In a March 2022 report, the ACLU of Maine and the Maine Center for Economic Policy found that between 2014 and 2019, while state spending on corrections and enforcement grew 13% and 14%, respectively, spending on treatment only grew 2%. In 2019, the state spent $328 million on law enforcement, more than $100 million of that was spent on drug arrests, prosecution, and incarceration.

Shifting our mindset from one that treats addiction as criminal to one which treats addiction as a health issue, a concept known as “harm reduction,” could indeed save the state of Maine millions of dollars, in addition to providing better care to the thousands of Mainers struggling with addiction. The average cost of treatment and recovery services, including housing, is nearly $25,000 less per patient per year than a year spent in state prison. Providing those addicted with greater access to substance testing could help reduce accidental overdoses.

The philosophy of “harm reduction” in public health has many parallels to one which vehemently opposes lockdowns, known as “focused protection,”although this is not necessarily evident in modern discourse around the pandemic. In many left-leaning circles, those who support harm reduction are the same who paradoxically defend the brutal COVID mandates of governors like Gavin Newsom, Andrew Cuomo, or Janet Mills, policies which imposed indiscriminate costs on the public with zero tolerance for those who “broke the rules.”

Proposed solutions to combat the ever-worsening crisis of opioid addiction and overdose will undoubtedly vary, but it is clear the status quo, both before and after the COVID-19 pandemic, has failed. The sooner we recognize that lockdown was, and still is, a catastrophic public health strategy, the sooner we can focus on the rapid growth of opioid addiction among the many other burgeoning public health crises facing the nation in the wake of the pandemic.

Photo: Red Lake, MN Police Dept.

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