Introduction
Sadly, drug overdoses are increasing again [1]. Well, before anyone had heard of COVID-19, the U.S. was grappling with the opioid and deadliest drug overdose epidemic in its history. Last year alone, the USA had 71,000 overdose deaths.
During the ten years from 1999 to 2018, over 750,000 people died from a drug overdose [2]. Excess deaths also appear in the COVID-19 data, especially among young people. These deaths occur due to substance use disorder (SUD) relapses, drug and alcohol use during this pandemic.
Drug overdoses, which resulted in fatalities, rose in the first quarter of this year, during the pandemic. According to preliminary numbers, they just released 10/20/2020 by the Centers for Disease Control and Prevention (CDC). This year’s drug overdose death statistics can be estimated from the three month CDC data.
Sadly, the data suggest that the USA will have more deaths than in the past due to more opioids, methamphetamine, and cocaine deaths. The coronavirus pandemic has left about 285,000 more people who died in the United States than would be expected to have been killed in a typical year.
The CDC, analyzing these deaths believe that two-thirds of them are due to COVID-19 itself and the rest from other causes [3]. If the CDC reports these trends, continue. The U.S. will suffer more than 75,500 drug-related deaths during the 2020 pandemic.
Drug Overdose Deaths
In real terms, according to the CDC, 19,416 Americans died January through March 2020. That’s nearly 3,000 more fatal overdoses compared with the same period last year. California and Florida each saw 20% increases, with roughly 1,000 additional overdose deaths in each state than last year [4].
The A.P. [5] reviewed preliminary overdose death statistics from nine states— Colorado, Connecticut, Kentucky, Massachusetts, Missouri, New Jersey, Rhode Island, Texas, and Washington. These State analyses show overdose deaths outpacing what was reported during the same months of 2019, in some cases by substantial margins.
Compounding the problem is treatment access changes with COVID-19 and the ubiquitous fentanyl sold and used as heroin in drug markets. Some non-opioid users are dying as fentanyl is mixed with other drugs such as cocaine and methamphetamine [6].
In 2018, opioids killed almost 50,000 Americans – more than the number killed by firearms. It is not just in the USA, but the overdose problem is everywhere [7]. The World Health Organization estimates that approximately 115,000 deaths worldwide in 2017 were attributable to opioid drug use.
Cocaine Re-emerges
Cocaine use was reported to increase after the last opioid epidemic in the 1970s and has certainly increased during the later stages of our opioid epidemic. Cocaine [8] is a powerfully addictive stimulant chewed and ingested as coca leaves (Erythroxylon coca) and used by indigenous peoples in the Andes for alertness or psychostimulant effects.
The purified chemical, cocaine hydrochloride abused by sniffing or suspension in water and injecting, was isolated more than 100 years ago. Cocaine was used as we use synthetic local anesthetics to block pain. However, it soon became apparent that while it might take away a toothache, cocaine is among the most addictive substances.
Cocaine is a Schedule II drug. This DEA schedule means that cocaine has a high potential for abuse. While this is the case, cocaine can still be given by a doctor for local anesthesia or eye, ear, and throat surgeries.
Street cocaine price depends on cocaine street availability. If it is unavailable, the price is very high. But, if the cocaine supply is abundant, the price drops, and use increases.
After years of falling supply due to Colombia’s reduced coca growing [9], production has exploded since 2013, and more cocaine, purer and cheaper, is evident on U.S. streets. “There are troubling early signs that cocaine use and availability is on the rise in the United States for the first time in nearly a decade,” the State Department noted this week in its annual report on the global narcotics trade.
As a street drug, cocaine appears as cocaine hcl a fine, white, crystalline powder and is also known as Coke, C, Snow, Powder, or Blow. Some users combine cocaine with heroin—called a Speedball.
The euphoric properties of cocaine lead to the development of chronic abuse. Cocaine use stimulates cocaine use. The cocaine high is quick, intense, and hard to forget. The crash is equally rememberable and resembles a significant depression.
Cocaine high appears to involve the acute activation of central DA neuronal systems [10]. DA depletion is hypothesized to result from cocaine or methamphetamine driving and exhausting these neurons and the neurotransmitter.
DA depletion may underlie dysphoric aspects of cocaine abstinence and cocaine urges. Neurochemical disruptions caused by cocaine are consistent with the concept of “physical” rather than “psychological” addiction.
Cocaine Drug Overdose Increase Dramatically
While much of the recent attention on drug abuse in the United States has focused on the heroin and opioid epidemic, cocaine has also been making a comeback. Nearly 4% of high school seniors have used cocaine, and 1.75% have smoked crack already in their lifetimes [11].
It is clear that cocaine use has increased, and cocaine deaths have also increased. Actual data shows that the rate of drug overdose deaths involving cocaine was stable between 2009 and 2013, but then abruptly tripled from 2013 through 2018 [12]. Cocaine overdose deaths are highest for adults aged 35–44. That rate increase is approximately 2½ times more cocaine-related deaths than in 2014.
The Drug Enforcement Administration reports increased availability and purity of cocaine and decreases the price. They attribute this to record levels of coca cultivation and cocaine production in Colombia. DEA cocaine test samples seized on the streets show that 90 percent of the cocaine for sale in the United States is of Colombian origin [13].
Data from the National Vital Statistics System, Mortality, [14] offers the most exact picture of what is going on with cocaine and cocaine deaths. The rate of drug overdose deaths involving cocaine was stable between 2009 and 2013, then nearly tripled from 1.6 per 100,000 in 2013 to 4.5 in 2018.
In 2018, rates were highest for adults aged 35–44 and lowest for those aged 65 and over. The age-adjusted rate of drug overdose deaths involving cocaine remained stable from 2009 through 2013, ranging from 1.3 to 1.6 per 100,000, then increased on average by 27% per year from 2013 through 2018.
For males, the rate increased from 2.1 in 2009 to 6.4 in 2018. For females, the rate increased from 0.7 in 2009 to 2.6 in 2018. For each year, rates were 2.4 to 3.0 times higher for males than females. From 2014 through 2018, the rate of drug overdose deaths involving cocaine with opioids increased faster than the rate of cocaine deaths without opioids.
In 2018, there were 14,666 drug overdose deaths involving cocaine in the United States for an age-adjusted rate of 4.5 per 100,000 standard population. More teenagers and college students are using cocaine, first-time usage increased 61 percent from 2013 to 2015 and has continued to grow since.
Cocaine purity, supply, and cost appear to be behind the cocaine use and overdoses. While use has increased in teens, college-age, and middle age, the CDC reports the rate of overdose deaths from cocaine is more common among middle-aged people (35 to 44 years old), males, those living in urban areas, and people residing in the Northeast region.
Cocaine overdoses can cause shortness of breath, high body temperature, high blood pressure, seizures, heart attacks, and strokes. In addition to cocaine use causing death, cocaine laced with fentanyl increased faster in recent years than overdose deaths from pure cocaine.
Conclusion
Drug overdose deaths continue to wreak havoc, causing deaths and destruction across the United States [15]. Drug deaths in America fell for the first time in 5 years in 2018, rose to record numbers in 2019, and have resumed their increase worsened by the coronavirus pandemic.
In 2018, at least 70,000 people died from drug overdoses. Drug overdose is the number one leading cause of injury-related death in the United States. Two out of three overdose deaths involved an opioid like heroin or synthetic opioids (like fentanyl).
According to preliminary data released 10-20-2020 by the CDC, overdoses increased during the pandemic — an increase of 5 percent from 2018. Overdose deaths remain higher than the peak yearly death totals ever recorded for car accidents, guns, or AIDS.
Overdoses and deaths of despair and their acceleration in recent years have pushed down overall life expectancies [16]. Available data suggest an acceleration since COVID-19 hit. In nearly every state reviewed by the A.P., overdose death counts reached their highest numbers in April or May and then dipped down somewhat afterward.
In Connecticut, for example, preliminary overdose death counts were up more than 19% through the end of July, compared with the same time frame last year. They were up 9% in Washington through August, 28% in Colorado, and 30% in Kentucky during that same period.
Drug overdose deaths have remained at all-time highs. The recent CDC data on COVID-19 deaths cover the period February 1 to September 16, 2020, meaning that excess deaths have almost certainly reached 300,000. Experts believe that they are likely to hit 400,000 by the end of the year.
The leading causes of excess deaths were COVID-19, heart attacks, diabetes, strokes, and Alzheimer’s disease. The CDC also found, surprisingly, that COVID-19 has struck 25- to 44-year-olds very hard too.
Their “excess death” rate is up 26.5 percent over previous years [17], the most considerable change for any age group. Among younger people, drugs, alcohol, vaping, and COVID-19 are likely additional causes of excess deaths in young adults in the USA.
References:
1. https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm
2. https://www.cdc.gov/injury/features/prescription-drug-overdose/index.html
3. https://www.washingtonpost.com/health/coronavirus-excess-deaths/2020/10/20/1e1d77c6-12e1-11eb-ba42-ec6a580836ed_story.html
4. https://www.npr.org/sections/coronavirus-live-updates/2020/10/14/923721544/sharp-rise-in-drug-overdose-deaths-seen-during-1st-few-months-of-pandemic
5. https://www.usnews.com/news/health-news/articles/2020-10-20/us-drug-overdoses-appear-to-rise-amid-coronavirus-pandemic
6. https://www.usnews.com/news/healthiest-communities/articles/2020-10-14/opioid-deaths-americas-other-fatal-health-crisis-continues-during-covid-19
7. https://abcnews.go.com/Health/wireStory/us-drug-overdoses-rise-amid-coronavirus-pandemic-73715719
8. NIDA. 2020, July 20. What is Cocaine?. Retrieved from https://www.drugabuse.gov/publications/research-reports/cocaine/what-cocaine on 2020, October 20
10. Dackis CA, Gold MS. New concepts in cocaine addiction: the dopamine depletion hypothesis. Neurosci Biobehav Rev. 1985 Fall;9(3):469-77. doi: 10.1016/0149-7634(85)90022-3. PMID: 2999657.
11. https://www.drugabuse.gov/drug-topics/cocaine/cocaine-trends-statistics
12. https://www.cdc.gov/nchs/products/databriefs/db384.htm
13. https://www.washingtonpost.com/health/us-cocaine-overdose-deaths/2020/10/09/6a3706ea-0977-11eb-9be6-cf25fb429f1a_story.html
14. https://www.cdc.gov/nchs/products/databriefs/db384.htm
15. https://www.cdc.gov/injury/features/prescription-drug-overdose/index.html
17. https://www.washingtonpost.com/health/coronavirus-excess-deaths/2020/10/20/1e1d77c6-12e1-11eb-ba42-ec6a580836ed_story.html
About the Author:
Mark S. Gold, M.D., Professor, Washington University School of Medicine – Department of Psychiatry, served as Professor, the Donald Dizney Eminent Scholar, Distinguished Professor and Chair of Psychiatry from 1990-2014. He was the first Faculty from the College of Medicine to be selected as a University-wide Distinguished Alumni Professor and served as the 17th University of Florida’s Distinguished Alumni Professor.
Dr. Gold is also a Distinguished Fellow, American Society of Addiction Medicine; Distinguished Life Fellow, the American Psychiatric Association; Distinguished Fellow, American College of Clinical Pharmacology; Clinical Professor of Psychiatry, Tulane University School of Medicine; Professor( Adjunct), Washington University in St Louis, School of Medicine, Department of Psychiatry; National Council, Washington University in St Louis, Institute for Public Health
Learn more about Mark S. Gold, MD
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Published on November 2, 2020. Published on AddictionHope.com
Reviewed by Jacquelyn Ekern, MS, LPC on November 2, 2020