Overdose deaths are surpassing COVID deaths in many places across Americayet media coverage of the crisis remains sparse.
A silent killer is percolating in America. It began its journey in Wuhan, China, where it emerged from a lab, crossed the Pacific Ocean, and infiltrated the United States. Its not COVID-19, its fentanyland in many parts of the country, its killing more Americans than the virus itself.
Its not wrong to call the fentanyl crisis a pandemic too, said Ben Westhoff, author of Fentanyl, Inc. 2020 is on track to be the worst year yet for overdose deaths, Westhoff said, and fentanyl is the main contributor.
More than 40 states have documented increases in overdose deaths this year, according to the most recent brief from the American Medical Association. The crisis is rapidly intensifying. Overdose deaths climbed to record numbers nationally in 2019, despite falling for the first time in 25 years in 2018. Deaths in 2020 are continuing to soar, driven by an influx of synthetic opioids such as fentanyl and carfentanilsubstances 50 to 10,000 times more potent than morphine. Experts doubt the crisis will abate anytime soon.
We were starting to think things were moving in the right direction, said Dr. Rachel Winograd, an addiction researcher at the Missouri Institute of Mental Health. Once March came along, overdose numbers really started to skyrocket.
Winograd said overdose deaths in Missouri spiked 33 percent through May, while deaths in St. Louis rose 32 percent through July. The trend is hardly limited to the state.
City- and county-level data shows overdose deaths spiking in every region of the country. In San Diego, California, Madison, Wisconsin, and West Palm Beach, Florida, deaths rose upwards of 50% from 2019 levels. In Cincinnati, Ohio, and Prince Georges County, Maryland, overdose deaths more than doubled.
The surge in fentanyl deaths is a product of the thriving illicit opioid trade. China is the biggest supplier of synthetic opioids, Westhoff said, since many substances that are banned in the U.S. and Europe are completely legal there. Chinese authorities only regulate a select handful of synthetic opioidsand even if a drug is on the list, a chemist can subtly manipulate it to create a similar yet just as potent version.
It sounds crazy, Westhoff said, but the Chinese government is directly subsidizing the production of these drugs. Chinese chemical companies receive substantial grants and value-added tax rebates, including Yuancheng in Wuhan, which produces more fentanyl ingredients than any other company in the world. The substances are then sold and shipped to Mexico, where cartels finish the product and smuggle it into the U.S.
China, the drug cartels, and dealers all tend to do things the most cost effectively, Westhoff said. In addition to heroin, fentanyl is now being added to drugs like cocaine, methamphetamine, and counterfeit opioid pills, according to a recent study published in Missouri Medicine. The result is a more unreliable and increasingly lethal drug supplyand in many parts of the U.S., its killing more people than the pandemic thats intensified demand.
The Deadlier Pandemic
In a sizable portion of America, COVID-19 is not the deadliest health crisis in town. Nearly 500 counties have yet to record a single death, and an additional 1700 have less than 20. Yet in many such communitiesand even in COVID hotspotsthe overdose crisis is taking its toll.
In Boone County, Missouri, COVID-19 killed 2 people through the first half of 2020. Pending confirmation from the medical examiner, overdoses killed between 9 and 43. In Washington County, Maryland, COVID-19 killed 26 people through the first half of the year. Overdoses killed a confirmed 57. In Milwaukee County, Wisconsin, COVID-19 is projected to kill 455 people by years end. If current trends hold, overdoses will kill 514.
The two crises arent acting in parallel. While opioid users are known to have weakened respiratory and immune systems, the surge in overdose deaths is not a direct effect of the virus. Instead, Winograd said the indirect effects of the pandemicfrom layoffs and evictions to record-breaking levels of violenceare exacerbating the stressors that lead to an overdose. Those presently abusing opioids arent the only ones susceptible.
The pandemic is putting additional pressure on otherwise healthy populations, including those whove made progress towards sobriety. Depression and loneliness have hit all-time highs, Winograd said, and resources for those in recovery have been drastically reduced. People who were seeking addiction treatment or rehabilitation now have nowhere to turn.
The economic devastation wrought during the lockdowns is adding another layer of pressure. If someone lost their job as a result of the pandemicand now theyre behind in rentthat additional stress can lead some people to have a relapse, said Brandon Costerison, a policy coordinator for the National Council on Alcoholism and Drug Abuse. Costerison said housing instability is one of the primary indicators of an overdoseand areas moving forward with evictions are laying the groundwork for overdose deaths to increase.
Amidst the influx of fentanyl and the uncertainties of the pandemic, experts say the overdose crisis is too pervasive to ignore. Its really important we dont view the overdose crisis in isolation, Winograd said. Its a constellation of factors that always hits people who are most vulnerable the hardest.
The Forgotten Pandemic
For all its synergy with the coronavirus pandemic, one might think the overdose crisis would be widely covered in the press. Yet even in areas hit hardest by the opioid crisis, local media outlets dedicate magnitudes more coverage to COVID-19. Over the past several years, media interest in overdoses has fallen flat.
In Boone County, Missouriwhere overdoses killed up to 21 times as many people as the viruslocal media ran 295 headlines on coronavirus through June, and none on overdoses. In Washington County, Marylandwhere overdoses killed twice as many people as the viruslocal media ran 259 headlines on coronavirus through June, and one on overdoses. In Milwaukee County, Wisconsinwhere overdoses are outpacing the virus as of Augustthe coverage was over 7,300 to four.
Its a disappointing reality, experts say, but not entirely unpredictable. One of the things thats been remarkable to see is how rapidly the overdose crisis disappeared, said David Herzberg, a professor specializing in the history of narcotics at the University at Buffalo. There was a moment when I was talking to more than one journalist every week, and then suddenly it was just over as a phenomenon.
Westhoff believes the peak coverage of the overdose crisis was when pills and heroin were mainly affecting white suburbs. Now its gotten much, much worse with fentanyl and its no longer discriminating by race, he said. Poor and black neighborhoods are being decimated by synthetic opioids, while overdose victims are frequently deemed morally compromised people. Theres so much value judgement when it comes to overdoses, Westhoff said. That could be another reason were not seeing it in the media as much.
In a day of 24-hour news cycles and short attention spans, experts say the overdose crisis is no longer a compelling story. The news is quite predictably interested in things that can be portrayed as new, Herzberg said. It seems like its difficult to make the case that they should write an article that says the same thing as one they wrote the other day, just with new names in it.
I spoke with a journalist this week, and they were like, Overdoses are horrible, theyve been horrible for a while, we get itwhats the new story now?, Winograd said. COVID, on the other hand, very much brings about an aura of innocence and victimhood. Its a very sympathetic story to tell.
Born in an obscure region in a faraway land, dual pandemics are cutting through America, their death counts rivaling those of the nations bloodiest wars. Yet while progress toward a coronavirus vaccine has raised hopes for the end to one pandemic, the prospects of an end to the overdose crisis are bleak. With an unstable supply and an uncertain future, for millions of American drug users, the specter of a fatal overdose looms large. Its a harsh reality that confounds even those whove made finding a cure their lifes work.
Even after COVID gets resolved, to the extent that it does, we will continue to deal with tens if not hundreds of thousands of lives lost each year due to preventable deaths, and thats devastating, Winograd said. I dont know what its going to take, I dont know how many deaths its going to take, but really we need a more generous society, and that applies to COVID and the overdose crisis alike.
Colin Martin is an editorial intern at The American Conservative and a 2020 graduate of Boston College. Contact him on Twitter @ColinMartin98.