August 10th 2020

By Bill Berkowitz and Gale Bataille 

Overshadowed by the coronavirus pandemic that has already taken 155,000-+ American lives, illegal fentanyl use is on the rise as a major cause of deaths in the U.S.  Boredom, loneliness, isolation, mental health issues, lack of family support, job loss, early release from prisons and jails, the closure of treatment programs, and the continuing widespread distribution of the powerful and deadly opioid fentanyl, are all causes of an increase in drug overdose deaths. 

A recent American Medical Association report stated that it’s “greatly concerned by an increasing number of reports from national, state and local media suggesting increases in opioid-related mortality—particularly from illicitly manufactured fentanyl and fentanyl analogs.” 

Recent headlines from such cities as Syracuse, New York, Philadelphia, Pennsylvania, and small towns in the Ohio Valley, and West Virginia, are sobering: “Opioid overdose deaths soar in Onondaga County as fentanyl rages. Will coronavirus make it worse?” reads the July 20 headline at Syracuse.com; An NBC News headline dated August 2, reads “With overdose deaths up during the pandemic, Philadelphia fights for a legal safe injection site”; On July 23, CBS Denver featured a segment titled “Fentanyl Is Back On The Streets In Denver, And It’s Killing More People”; WFPL headlined its July 5 story “Overdose Incidents Rose Sharply Around Ohio Valley During Pandemic.” 

In early July, The Guardian’s Chris McGreal reported: “Now coronavirus looks to be undoing the advances made against a drug epidemic that has claimed close to 600,000 lives in the US over the past two decades. Worse, it is also laying the ground for a long-term resurgence of addiction by exacerbating many of the conditions, including unemployment, low incomes and isolation, that contributed to the rise of the opioid epidemic and “deaths of despair.”

“The number of opioid overdoses is skyrocketing and I don’t think it will be easily turned back,” Dr. Mike Brumage, former director of the West Virginia office of drug control policy, told The Guardian. “Once the tsunami of Covid-19 finally recedes, we’re going to be left with the social conditions that enabled the opioid crisis to emerge in the first place, and those are not going to go away.”

The Guardian’s McGreal pointed out that “Public health officials from Kentucky to Florida, Texas and Colorado have recorded surges in opioid deaths as the economic and social anxieties created by the Covid-19 pandemic prove fertile ground for addiction. In addition, Brumage said significant numbers of people have fallen out of treatment programs as support networks have been yanked away by social distancing orders.”

Margaret Williams, MD, who treats substance use disorder patients at The Ohio State University Wexner Medical Center, recently wrote that “The opioid crisis was already a public health emergency. Now it’s worsened by a pandemic that makes it harder to reach people.”  William noted that Wexner Medical Center was “seeing the problem first-hand: the Franklin County coroner has reported the first four months of 2020 had 50% more overdose deaths than the same period in 2019. In addition, the coroner reported an alarming 44% increase in overdose deaths among African Americans, which is in line with national trends. In addition, the coroner reported an alarming 44% increase in overdose deaths among African Americans, which is in line with national trends.” 

In a paper titled “Fentanyl, COVID‐19, and Public Health,” Louise Shelley, PhD, the Omer L. and Nancy Hirst Endowed Chair and Director of the Terrorism, Transnational Crime and Corruption Center (TraCCC) at George Mason University's Schar School of Policy and Government, provided a concise history of the fentanyl trade and how it has been affected by the coronavirus pandemic:

COVID‐19 temporarily severed the production and the supply chains for fentanyl, a synthetic narcotic responsible for over 30,000 deaths in the United States in 2018. Much fentanyl was produced in Wuhan, China, the source of the epidemic. Fentanyl was previously sold directly to American consumers through online websites and was also supplied by Mexican drug traffickers, who produced the drug from precursor chemicals purchased from China. With the advent of the pandemic, websites from Wuhan‐based sellers reported that the drugs were not being produced or shipped. Moreover, Mexican drug traffickers were deprived of the precursor chemicals to produce this highly potent opioid. Despite the reduced entry of illicit fentanyl to the United States, enough was stockpiled by drug traffickers perpetuating a very serious problem of illegal fentanyl abuse. Deaths have increased since the start of the COVID epidemic, as the problems of drug abuse have not stopped and access to treatment and medical services are diminished. Moreover, isolation and lack of social support compound the problem. The initial data on increased deaths from illegal fentanyl consumption are consistent with the overall picture of the impact of the COVID epidemic. Those who are most vulnerable are suffering disproportionately from the drug trade.

Shelley also pointed out that “The dark web is also used to distribute fentanyl, but its sale there is primarily for the illegal wholesale market.”

At a March 29 Press Briefing, as Covid-19 escalated, Donald Trump warned about the human toll beyond lives claimed by the virus. “You’re going to have tremendous suicides, but you know what you’re going to have more than anything else? Drug addiction. You will see drugs being used like nobody has ever used them before. And people are going to be dying all over the place from drug addiction.”

Dr. Raeford Brown, a former chair of the Food and Drug Administration’s opioid advisory committee, is a longstanding critic of the pharmaceutical industry’s influence over opioid prescription policy as well as and the government’s response to the epidemic. He draws a parallel between state’s coronavirus response lifting strong social distancing orders too early under corporate pressure, and the industry pressure that perpetuated the opioid crisis. “The United States is not good at doing public health,” he said. “It failed the test with opioids and it failed the test with viral pandemics. But coronavirus and pandemics, and the things like the opioid crisis, are much more likely to get us than the Russians or the Chinese are.”

As Louise Shelley wrote, the disruption of the supply chain of fentanyl “did not eliminate the availability of illicit fentanyl. By reducing the sources of supply, operations to interdict supply and sale could be more successfully implemented, thereby raising prices. But without a concomitant program to assist the vulnerable and isolated, the fatalities from illicit fentanyl sales have continued even in the absence of large‐scale supply. One of the key lessons of the dynamics of the fentanyl trade during the COVID‐19 pandemic is that reduction of supply is not sufficient to curb illegal fentanyl‐related drug fatalities. Interventions to cut supply must be combined with accessible medical and psychological services as well as greater economic and social well‐being to reduce the deaths of the most vulnerable in our society.”

Among the many victims of the pandemic are the very substance use services that provide opiate addiction treatment.  Over the past several years an increasing number of safety net primary care medical practices have been certified to provide medication assisted opiate treatment for opiate addiction, but the financial viability of these providers has been threatened because the pandemic at least initially resulted in significant declines in patients. The impact of the pandemic on primary care, including safety net care has been tracked by the Commonwealth Fund in several recent studies.

In addition, without a substantial federal bailout, essential State funding is at risk for addiction treatment and recovery programs – already woefully inadequate to meet the need, and struggling with providing safe socially distanced care and support.