Drug deaths lower in 2023. What have we learned?
The CDC released new data on drug overdose fatalities last week.
The good news is that, overall, drug-related fatalities are down nationwide. The bad news is how high the numbers remain. Here’s the national data (rolling 12-month figures) just released by the CDC on Friday:
Now, as some of you may recall, my colleagues and I were the first to publish that accidental drug overdose fatalities increased after the Covid-19 pandemic began, in the Journal of the American Medical Association back in 2021.
Nobody really knows why this happened, but many people have no problem fitting a narrative to their biases. Often, I hear the problem blamed on one of two specific causes: Covid-19 pandemic mitigation or lax drug policies and laws.
Let’s interrogate these.
It wasn’t the lockdowns.
Of course, some people like to blame the rise in overdose deaths on Covid-19 “lockdowns.” But, as we pointed out back in 2021, the statistical increase in accidental drug overdose fatalities seems to have begun after that time, not so much during it. The largest initial increases happened not in March and April, when most places were shut down, but in May, when many places were re-opening. Larger increases in many places happened far later, by which time a lot of the country was not shut down in any discernible way.
To make this point, look at overdose deaths in Massachusetts over several years. I’ve cropped out the dates from the X-axis intentionally. Can you see where the pandemic began?
That peak you see at 240 deaths in a single month? That’s March 2021, a year after the shelter-in-place period. There was a little increase in May of 2020, but it didn’t last long (and the strictest shelter-in-place period occurred in March and April, as you’ll recall).
It’s not drug decriminalization either.
Another pet theory people have around the increase in drug overdose fatalities surrounds drug decriminalization. I’ve written about this before. In 2021, Oregon decriminalized possession of small amounts of illicit drugs. Critics collectively lost their marbles when, after the policy went live, there was an apparent increase in drug fatalities in that state. But when you look at the data (see below) you detect a momentary spike right after the Covid-19 shelter-in-place period, followed by a steady increase leading into 2021 when the new law went into effect, a trend that continued (with an apparent small additional increase) during 2022 and 2023.
But something in the newest tranche of CDC data caught my attention. Take a look.
As you can see, there was already an ongoing increase in fentanyl deaths (brown line) and methamphetamine deaths (grey line) underway, which picked up in 2020, and then even more so after. If you look deep into 2021 (the data above is rolling 12-month figures, so July of 2021 is actually August 2020-July 2021), you’ll find that these two drugs were increasing steadily during that time. Meanwhile, deaths due to cocaine, heroin, and other opioids were flat, and eventually decreased. Remember, Oregon’s 2021 decriminalization law applied to all of these substances. If the policy was responsible for the increase, why would cocaine and heroin deaths go down? It does not make sense, if the new decriminalization law was entirely “responsible” for the increase in drug deaths in Oregon. Rather, it’s more likely that what was observed in Oregon is what happens when fentanyl and meth enter a market. The answer: a lot of bad things.
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In fact, look back to Massachusetts. Below is all-drug deaths monthly, from 2015-2024. When do you think fentanyl showed up in Massachusetts? Indeed, during the 2012-2016 period.
And what about the other state I wrote about when we last discussed this issue? Oklahoma. I chose Oklahoma as a comparison because, in contrast to Oregon, that state has among the strictest drug laws in the US. Take a look at the data from there.
As you can see yet again, when fentanyl and/or methamphetamine appear in a market, drug deaths are apt to increase shortly thereafter. Deaths from other drugs seem either to be unaffected or go down—such as when fentanyl replaces heroin.
Treatment is the answer.
While it’s convenient to assign blame for increases in drug deaths on some political action that you may not like, the real culprit is much more likely to be what is in the drug supply. Strong drugs can kill and today’s drugs are indeed stronger than they have been in the past. That’s why easy access to treatment and antidotes (naloxone, or “Narcan”) is more important than these other frequently cited “problems”.
Comments? Questions? Leave them below.
There are no doubt multiple reasons for an issue as complex as this one, but in general, it is my belief that human caused climate change and COVID came together to be our WWII moment, and we failed miserably at both. We could have used these issues as an opportunity to come together as a country and work together to make the changes we need to make to effectively deal with them, but we didn't. I think whether people are aware of this consciously, it is having a profound effect on the nation's mental health. I know it has on mine.
Another lost opportunity was the successful launch and deployment of the Webb telescope. That was a huge undertaking and required international cooperation. We should have aired that "unfolding" moment around the world to bring people together on a major human achievement. There was something like 300 and some single points of failure where things had to work or all was lost, and everyone of them worked! Our feelings of divisiveness, isolation, and separateness are going to be our undoing.
Great data. I'm wondering if the current downtick in OD deaths could be due to a drop in available addicts after wiping out so many in recent years. I have the same question for the 2023-2024 decline in homicide rate nationally. Are a high percentage of bad actors in jail or dead?