Opioid Epidemic’s Next Wave Hits Populations Already at Risk

Annual overdose deaths are creeping toward and beyond six figures.

Rising opioid-related emergency department visits, overdoses, and deaths: this issue has re-emerged with a vengeance during the pandemic. While the incidence and prevalence of overdoses has been seen across all populations, areas and populations most prone to social risks have been especially hard-hit, primarily lower-income areas and communities of color.

A quick review of the first three major waves are associated with the opioid epidemic:

• Wave One was the well-publicized increase in overdoses and deaths from prescription opioid pills in the 1990s;
• Wave Two began circa 2010, stemming from massive increases in heroin deaths among adolescents and young adults; and
• Wave Three involved a pre-pandemic surge in overdoses and deaths from synthetic opioids, such as morphine and fentanyl.

The third wave had just begun to ebb in 2019-2020, although a dramatic rise came with the COVID-19 pandemic. Experts have noted a fourth wave that is expected to outpace those prior to it. Centers for Disease Control and Prevention (CDC) data shows a record-high number of drug overdose deaths for 2020: 93,331. This number reflected an increase of 20,000 deaths from 2019, the largest increase in 20 years; three in every five deaths were attributable to synthetic opioids. A study conducted in partnership with the National Institute on Drug Abuse at the National Institutes of Health analyzed overdose data and death certificates from four states: Kentucky, Ohio, Massachusetts, and New York. The following themes were identified:

• Rates of opioid deaths among Black people increased by 38 percent, while rates for other racial and ethnic groups did not rise.
• Rural areas were the hardest hit; the highest increases were seen in Vermont (70 percent), West Virginia (62 percent), and Kentucky (55 percent).

This fourth wave has been frightening to witness unfolding. By the end of 2021, the numbers rose further, 28.5 percent over the 12 months from April 2020-April 2021; the tally of drug overdose deaths hit 100,306 persons during that span. Treatment stigma for addiction has been a major point of attention, especially due to racial disparities. Data consistently shows that persons of color are less likely to be prescribed medications or other resources for their opioid use disorder. Many patients end up seeking heroin, which is often laced with fentanyl; overdoses in Black communities are largely due to fentanyl, which is far cheaper and easier to access.

Considerable funding is on the horizon for 2022. A total of $30 million in new grants is being aimed at harm reduction strategies to combat opioid abuse, with $10 million to be distributed annually over the next three years. Funding for needle exchanges and fentanyl test strips is included, plus other programming to enhance access to community harm reduction services and support harm reduction service providers. Applications will be accepted from state, local, tribal, and territorial governments, tribal organizations, non-profit, community-based organizations, and primary and behavioral health organizations. A link to funding will appear in my upcoming story for RACmonitor.

Our Monitor Mondays Listeners Survey this week asked participants how much of a problem opioid abuse is for their patient populations. The results are viewable here.