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Opioid-related deaths increased by 35 percent in Iowa in 2020, following a national trend that has advocates raising the alarm about the surge.
State officials reported 212 opioid-related deaths last year, up from the 157 deaths reported in 2019, according to provisional data from the Iowa Department of Public Health.
In 2019, 157 people died from opioid overdoses.
The previous high for opioid overdose deaths was 206 in 2017. The number of deaths declined in 2018 but has been increasing since, state data shows.
State and federal public health experts say factors related to the pandemic likely contributed, including isolation and reduced access to health care services due to social distancing and other safety precautions.
But state public health officials say it’s too early to directly link COVID-19 to the increase.
“Right now, we can't say whether or not COVID has caused the increase we're seeing in the number of deaths involving opioids,” said Sarah Ekstrand, spokeswoman for the Iowa Department of Public Health.
The latest report from the U.S. Centers for Disease Control and Prevention on drug-related overdoses suggests that overdose deaths were accelerated as a result of the pandemic.
“The disruption to daily life due to the COVID-19 pandemic has hit those with substance use disorder hard,” CDC Director Robert Redfield said in a statement.
Nationwide, more than 81,000 Americans died due to drug overdoses between May 2019 and May 2020, according to CDC provisional data.
A total of 70,630 drug overdose deaths occurred in the United States in 2019, including nearly 50,000 deaths involving opioids, according to the CDC.
To date, preliminary state data shows 25 deaths involving opioids have occurred in Iowa this year.
The social isolation that marked 2020 could be a factor, with Ekstrand noting that using drugs in isolation typically comes in the later stages of a substance use disorder.
Using drugs in isolation may mean individuals don’t have the benefit of others around them to notice an overdose, Ekstrand said.
In addition, individuals may have experienced barriers to accessing health care — including opioid-related treatment — in the midst of the pandemic. Typically, substance use disorder is treated through in-person clinic visits, and such visits were delayed or moved online during the pandemic.
“Some of these individuals may have resorted to other options for treating things like pain, which could include using illicit versions of opioids,” Ekstrand said.
The economic upheaval caused by the pandemic also may have driven higher rates of use, with Commonwealth Fund researchers linking unemployment rates to trends in drug-related deaths.
State officials also point to how COVID-19 makes it more difficult to breathe and that respiratory depression is the primary cause of death for those who overdose on opioids.
“There’s a possibility that the two issues combined could cause additional risks,” Ekstrand said.
But state officials said overdose deaths are likely due to a number of factors, including an increase in the use of synthetic opioids. Synthetic opioids — which includes illicitly manufactured substances like fentanyl — were involved in 76 percent of deaths in 2020, according to the state’s provisional data.
Nationwide, synthetic opioids, primarily fentanyl, were the main driver in overdose deaths, increasing 38 percent compared to the year before, according to the CDC’s latest report.
Iowa saw a 13 percent increase from 2019 in the number of deaths involving opioids and psychostimulants, such as methamphetamine. National data reported similar trends across the United States.
“These deaths are all likely due to the fact that individuals didn’t know what they were using,” Ekstrand said.
In light of this trend, the CDC recommends that essential services remain accessible to those most at risk for an overdose. It also recommends expanding prevention and response services, including distribution of the overdose-reversal drug naloxone.
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Pharmaceutical fentanyl is a synthetic opioid, approved for treating severe pain, typically advanced cancer pain. 1 It is 50 to 100 times more potent than morphine.
Illegally made fentanyl is sold for its heroin-like effect. It is often mixed with heroin and/or cocaine as a combination product — with or without the user’s knowledge — to increase its euphoric effects.
Source: Centers for Disease Control and Prevention