The opioid crisis has long affected the United States, but over the past decade, it has really exploded. Although it’s been an issue for quite some time, the COVID-19 pandemic has exacerbated drug overdose deaths around the country and beyond. Whether it’s meth, alcohol, or opioids, fatalities soared in what some consider the worst year of their lives. However, you might wonder, which states had the highest drug overdose deaths in 2020?

Before we delve into the specifics, it’s vital to understand how the opioid crisis began and how it got to this point today. While all drugs have increased in total usage, opioids continue to rank at the top of the list, especially with the explosion of illicit opioids like fentanyl. From 2018 to 2019, drug overdose deaths increased by five percent and have quadrupled since 1999. In 2019, there were 70,630 deaths, and opioids caused 70 percent of those. 

The opioid crisis we’ve all become numb to came in three waves. From 1999 to 2019, nearly 500,000 people died from an opioid-involved overdose, including illicit and prescription opioids. The first wave started when pharmaceutical companies assured doctors their drugs weren’t addictive, leading doctors to prescribe potent opioids like oxycodone for minor procedures or accidents. As a result, opioid prescriptions were dispensed at levels never seen in the history of the United States and left devastation in its wake. 

When the prescription opioid problem couldn’t be ignored, government officials chimed in and put restrictions on doctors to prescribe. Although it helped, it affected chronic pain patients who were then viewed as criminals. For pain patients and addicts alike, their need for opioids didn’t stop because the government put in place a new order, leading to the second wave of the opioid crisis. In 2010, people transitioned to heroin, which caused rapid increases in overdose deaths. According to the National Institute on Drug Abuse (NIDA), an estimated 80 percent of heroin users reported using prescription opioids before trying heroin. 

By 2013, the third wave, which has devastating effects today, is when illicitly manufactured fentanyl took over the country. It resulted in many deaths to those not ready to handle its strong side effects. Fentanyl is 50 to 100 times stronger than heroin. An unsuspecting customer who consumes a standard-sized dose of what they believed was heroin only for it to be fentanyl and result in immediate death. Unfortunately, fentanyl is found in heroin to potentiate its effects, counterfeit oxycodone pills, and even cocaine. 

The drug overdose crisis is undeniable nationwide, and the COVID-19 pandemic has caused ripple effects throughout the world. For those in recovery and reliant on support to safeguard their sobriety, they were forced to hunker down and isolate themselves from the world, causing many people to give in to their drug cravings to numb the loneliness and depression caused by the pandemic. 

While the entire country has seen dramatic increases in drug overdose deaths, some states have been hit harder. Let’s take a look below at how the pandemic has affected those in recovery and what states have been hit the hardest. 

How Has COVID-19 Affected the Recovery Community?

There are millions of people in the United States living with a substance use disorder (SUD) at different stages in their recovery. While some have been sober for 30 to 40 years, others might be at the beginning of their journey and battling to maintain it during these unprecedented times. The stress and isolation that have resulted from the pandemic have presented enormous challenges for these people. Since March 2020, significant increases in various drugs have been recorded.

Our lives changed dramatically when the lockdown of businesses and schools took hold, and at the end of April 2020 and early May, the Addiction Policy Forum (APF) surveyed 1,079 people around the country with substance use disorders. 

The premise of the survey was to determine how they’d been affected by the COVID-19 pandemic, and 20 percent of respondents reported that either themselves or a family member’s drug problem worsened since the beginning of the pandemic. 

In addition, an analysis of 500,000 urine drug test results conducted by Millenium Health showed steep increases in cocaine (up 10 percent), methamphetamine (up 20 percent), heroin (up 13 percent), and illicit fentanyl (up 32 percent).

The National Institute on Drug Abuse (NIDA) explains that while comprehensive national data isn’t available on overdoses, data from states like Georgia and Kentucky and other anecdotal reports suggest increases in the first half of 2020 in overdose deaths and drug-related emergency room admissions compared to the previous year. 

A surveillance tool known as the Overdose Detection Mapping Program, which was developed by the Washington/Baltimore High-Intensity Drug Trafficking Area (HIDTA), found that 62 percent of participating counties showed increases in overdose deaths. The overall overdose report shows an 18 percent increase after stay-at-home orders began in 2020. The clusters of overdoses shifted from urban areas to rural and suburban locations. Four percent of respondents have reported overdoses since the pandemic started.

The stress caused by social isolation and distancing takes a significant toll on someone trying to recover from a substance use disorder. The APF survey found that 75 percent of respondents reported emotional changes since the pandemic began. Unfortunately, 62 percent described an increase in worry, 51 percent in sadness, 51 percent in fear, and 42 percent in loneliness. Emotions like these increase the odds of the individual relapsing, and even worse, the inability to seek peer support like 12-step meetings and other groups make these more challenging. 

States Hit the Hardest By Drug Overdoses

Unfortunately, overdose deaths increased in almost all 50 states, and 24 states, including the District of Columbia, had an estimated increase of at least 30 percent; the overall United States total increased by a staggering 33 percent. 

Kentucky and West Virginia have been at the forefront of the opioid crisis and reporting figures much higher than the national average. The region has reported some of the most significant proportional increases. Research has also shown the impact of fentanyl and overdose deaths further west, including California, Colorado, Arizona, Texas, Illinois, and Washington, which encountered increases of more than 35 percent during the first eight months of 2020. For the state of Colorado, they reported record overdose deaths for the entire 2020 calendar year. 

Colorado worried that overdoses would be a problem in 2020, and unfortunately, their fears came true. The provisional numbers from the Colorado Department of Public Health and Environment (CDPHE) for 2020 overdose deaths among Colorado residents totaled 1,333, the highest number and rate of overdose deaths since 1975. Drug addiction experts call it frustrating and discouraging, and they’re heartbroken by the revelation. 

California is another west coast state that saw an unprecedented number of overdose deaths caused by the COVID-19 pandemic, far surpassing the national rate. The state saw 7,121 deaths from May 2020 until the end of the year. The figures increased 26.8 percent from June 2019 to June 2020, while nationally, they were up 21.3 percent. In 2019, males died of overdoses at a rate of 21.46 per 100,000 in the state, while 8.45 per 100,000 women died. White individuals accounted for 60 percent of overdose deaths in 2019. 

Louisiana, on the other hand, saw the nation’s steepest spike in drug overdose deaths from 2019 to 2020. The number of overdose deaths in the state rose more rapidly than any other state during the period that includes the first months of the COVID-19 pandemic. An estimated 1,720 people died from overdoses in a year that 86,000 took place. Louisiana witnessed a 53 percent increase from the year before, double the national average. 

The majority of these deaths occurred in the early months of the pandemic when people were told to lock down and isolate, which caused a significant toll on mental health and contributed to more drug and alcohol use. It also stems from a decade-long increase in overdose deaths, mostly caused by fentanyl. 

From January 2020 to March 2020, New York City witnessed 440 overdose deaths, 41 more than the previous highest quarter. New York was hit especially hard by the COVID-19 pandemic, leading to extremely strict lockdowns throughout the state. It put significant stress on the residents. The city pledged two million dollars in outreach and overdose prevention resources to address the recent uptick, including access to buprenorphine treatment and increased naloxone distribution. 

Further to the south, South Carolina witnessed a 44.9 percent increase in opioid overdose deaths in 2020 compared to 2019. The COVID-19 pandemic is directly related to the rise in overdoses, and the stress of everything was the perfect storm for overdoses. Another thing to keep in mind is that opioids can become addicting in a short period of time, so with this prolonged period of being locked down, addiction and overdose are likely. 

Tennessee believes that 2020 will be the deadliest year in its long history for overdoses when the official numbers are released. The preliminary data shows that fatal overdoses greatly exceeded those in 2019. From January 2020 to September 2020, the initial numbers had already surpassed the total number from 2019, with more in May than any other in 2020. In 2019, 2,000 people lost their lives in Tennessee, mostly in part caused by fentanyl. 

Tennessee has taken a strong stance on moving away from prescription pain meds, and the rate of opioid prescriptions decreased in every county in the state. In 2016, 1.96 million opioid prescriptions were filled for pain, while in 2020, only 1.26 million were dispensed, marking a 35.7 percent decrease. 

More than 2,800 overdose deaths were tied to opioids in Illinois, amounting to a 30 percent increase from the year before. Although opioid abuse has been surging in the state, the pandemic has a lot to do with the rise, with many pointing to synthetic opioids like fentanyl as the main culprit behind the surge in overdose deaths. Social isolation is another reason for the surge, as well as the interruption of medical treatment addicts were receiving. 

According to the U.S. Centers for Disease Control and Prevention (CDC), more than 81,000 drug overdoses occurred in the 12 months ending in May 2020 throughout the United States, which is the highest number ever recorded in a 12 month period. The pandemic itself has been devastating, but the death toll tied to the pandemic far exceeds the numbers the media has reported. 

Overdose deaths were already increasing in the months before the pandemic, but these figures show that it was accelerated during the months of the pandemic. The disruption American’s faced was unlike anything they’ve endured before, and as the pandemic goes on, we must stay focused on how other groups are being affected. We must take care of friends and family members to ensure they’re not suffering from unintended consequences. 

As we’ve touched on several times, fentanyl has been the main driver of overdose deaths, increasing 38.4 percent in that same 12 months period leading up to May 2020. The statistics show that 37 of the 38 U.S. jurisdictions with available fentanyl data reported increases in overdose deaths, and 18 jurisdictions reported a greater than 50 percent increase. Ten western states reported over a 98 percent increase in fentanyl-related deaths. 

While opioids have dominated these statistics, overdose deaths involving cocaine also increased dramatically by 26.5 percent. However, these deaths are likely linked to the drug getting used in conjunction with heroin or fentanyl. Overdose deaths of methamphetamine also increased 34.8 percent, equating to a number that exceeds cocaine-involved deaths. 

Recognizing Addiction and Helping Those Struggling

The sheer volume of those succumbing to addiction or falling back into their old ways is staggering and backed up byoverdosethese figures. If you’re someone on the outside looking in, recognizing an addiction problem in someone you know might be harder than it seems. While some may show outward symptoms immediately, others may carry themselves a little better. However, that doesn’t mean they aren’t struggling. 

Addiction is defined as a chronic disease that affects the brain’s motivation, reward, and memory functions. A person addicted to drugs or alcohol will crave a substance or other behavioral habits, and they’ll ignore other areas of their lives to use drugs. This is especially true right now during the pandemic when there isn’t anything else to do other than use drugs.

The most common signs of addiction you should pay attention to include the following:

  • Decreased socialization, such as abandoning commitments and ignoring relationships
  • Losing control of their behavior and an inability to stay away from drugs or alcohol
  • Ignoring risk factors, such as sharing needles and knowing the potential consequences
  • Physical effects, including withdrawal symptoms or the need to use higher doses of the drug

These signs are routinely linked to one another, and the degree of intensity for each one depends on how long someone has been addicted. In the case of the pandemic, a person may have relapsed or had recently become addicted to a substance. 

A healthy person can usually identify adverse behaviors and stop them. However, this isn’t the case with addiction. Rather than admitting a problem exists, the individual will find ways to justify it and continue on. 

The first step to help someone is to recognize the mental, physical, and emotional signs, including personality or weight changes in friends or family members. 

Types of Addiction

Although addiction is typically linked to substance abuse, other behavioral issues like gambling can be just as severe. Addiction is when someone is unable to abstain from a behavior or substance, typically at the cost of their physical and mental health. 

Addiction means you’re dependent on one or more of the following:

  • Alcohol
  • Medication
  • Drugs, illicit or non-illicit
  • Inhalants, such as spray paints, over cleaners, or other aerosol products
  • Nicotine or tobacco

Behavioral addictions can be as severe as substance addictions, and both result in dependency that leads to adverse consequences. Behavioral addiction includes the following:

  • Sex
  • Shopping
  • Working
  • Gambling
  • Video games
  • Internet

No matter the addiction, you must understand the warning signs. In the early stages, a person may not exhibit the typical signs of full-blown addiction, but they include:

  • Experimentation
  • Family history of addiction
  • Episodes of binging or loss of control without remorse
  • Seeking out situations where substances will be involved

When a person moves past the experimentation phase, they’ll start showing a major shift in their personality. These changes include the following:

  • Distinct changes in their sleep patterns, which may be difficult to determine when locked down
  • Taking risks they wouldn’t otherwise consider
  • Missing obligations like work or school
  • Neglecting their relationships
  • Losing interest in hobbies or activities that were important
  • Keeping secrets
  • Depression
  • Apathy
  • Sudden changes in mood

Based on the figures above, addiction can be deadly, especially if you were to overdose.

Signs of an Overdose

If you witness an overdose, you should immediately call 911 to prevent any long-term damage or death. Any time a person uses drugs, they carry the risk of overdosing, which can occur with all types of drugs. Overdoses are the result of consuming a substantial amount of heroin, fentanyl, cocaine, or meth. The exact signs of an overdose will vary from one person to another, but the most common signs indicating an overdose include the following:

  • Chest pain
  • Rapid heartbeat
  • Increase body temperature
  • Dilated pupils
  • Difficulty breathing
  • Cessation of breathing
  • Nausea
  • Vomiting
  • Blue fingers or lips
  • Gurgling sounds, indicating the airway is obstructed
  • Violent behavior
  • Dizziness
  • Aggression
  • Confusion
  • Unconsciousness
  • Seizures

An individual who overdoses may not exhibit all of these signs, but even a few can tell you to seek immediate help. The first step is to call 911 and try to keep the person awake by asking questions. If they’re not breathing, make sure to turn them on their side to avoid choking on vomit. Listen to the 911 operator and provide first aid as directed. If possible, administer Narcan in the event of an opioid overdose. If you’re qualified, perform CPR. 

It may sound obvious, but never let the person continue using the substance they’ve overdosed on. In addition to this, stay on guard of the immediate results of Narcan. Although Narcan will offset the effects of an opioid overdose, it shouldn’t be used as a substitute for professional medical care. The individual must receive emergency services even if they gain consciousness and seem fine. It’s possible that once the Narcan wears off, they can overdose again. 

When waiting for emergency services to arrive, make sure to get as much information as possible to give to paramedics. For example, make sure to ask questions such as the size of their dose, the last time they used the drug, and the type of drug. This way, first responders can treat the person accordingly. 

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