Inside America’s Other Pandemic
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. It’s not COVID-19, it’s fentanyl—and in many parts of the country, it’s killing more Americans than the virus itself.
“It’s 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.
Many Americans with addictions shifted to more potent substances after taking OxyContin, an opioid Purdue Pharma encouraged doctors to over-prescribe. Just yesterday, the Justice Department announced the drug maker will plead guilty in federal court as part of an $8 billion settlement for its role in the crisis.
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 carfentanil—substances 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 George’s 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 opioids—and 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 supply—and in many parts of the U.S., it’s killing more people than the pandemic that’s 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 communities—and even in COVID hotspots—the 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 aren’t 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 pandemic—from layoffs and evictions to “record-breaking levels of violence”—are exacerbating the stressors that lead to an overdose. Those presently abusing opioids aren’t the only ones susceptible.
The pandemic is putting additional pressure on otherwise healthy populations, including those who’ve 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 pandemic—and now they’re behind in rent—that 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 overdose—and 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. “It’s really important we don’t view the overdose crisis in isolation,” Winograd said. “It’s 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, Missouri—where overdoses killed up to 21 times as many people as the virus—local media ran 295 headlines on coronavirus through June, and none on overdoses. In Washington County, Maryland—where overdoses killed twice as many people as the virus—local media ran 259 headlines on coronavirus through June, and one on overdoses. In Milwaukee County, Wisconsin—where overdoses are outpacing the virus as of August—the coverage was over 7,300 to four.
It’s a disappointing reality, experts say, but not entirely unpredictable. “One of the things that’s 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 it’s gotten much, much worse with fentanyl and it’s 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.” “There’s so much value judgement” when it comes to overdoses, Westhoff said. “That could be another reason we’re 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 it’s 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, they’ve been horrible for a while, we get it—what’s the new story now?’,” Winograd said. COVID, on the other hand, “very much brings about an aura of innocence and victimhood. It’s 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 nation’s 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 Americans who use drugs, the specter of a fatal overdose looms large. It’s a harsh reality that confounds even those who’ve made finding a cure their life’s 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 that’s devastating,” Winograd said. “I don’t know what it’s going to take, I don’t know how many deaths it’s 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 assistant at The American Conservative and a 2020 graduate of Boston College. Contact him on Twitter @ColinMartin98.