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Drug overdose deaths top 1 million since 1999, report finds


Annual financial cost is more than $1 trillion.

Drug overdoses have killed more than a million Americans since 1999, more than the number killed in battle during all wars the U.S. has fought in its history, according to a bipartisan Congressional report issued Tuesday.

The report, a product of the Commission on Combating Synthetic Opioid Trafficking, calls deaths from drug overdoses a “national emergency.” It notes that the situation has grown more dire recently, with about 100,000 Americans dying from overdose deaths during the 12 months ending in April 2021, the majority involving fentanyl and other synthetic opioids. That is twice the number who died from traffic fatalities or gun-related violence during the same period.

Along with their social and psychological costs, overdose deaths represent an enormous financial cost. The report cites a 2018 White House Council of Economic Advisors report putting the cost of overdose fatalities at $696 billion. Since the number of deaths then was about two-thirds the current total, the report estimates that drug overdoses now cost the United States about $1 trillion annually.

The report traces the roots of the crisis to the FDA’s 1995 decision to approve OxyContin, a prescription opioid painkiller. It and similar drugs were marketed as non-addictive cures for pain without considering a patient’s other conditions that might drive misuse of the drugs. The result was a dramatic increase in prescription opioid dependence and addiction.

After prescription opioids became less easily available, people with substance abuse disorders frequently began using heroin and, sometimes unknowingly, powerful synthetic opioids. “In less than a decade, illegal U.S. drug markets that once were dominated by diverted prescription opioids and heroin became saturated with illegally manufactured synthetic opioids,” some of which are easier and cheaper to produce than heroin, according to the report.

When fentanyl and other synthetic opioids first appeared in the U.S. in 2014, they were largely made in and shipped from China. But in recent years Mexico has become the country of origin. Fentanyl’s potency, combined with a lack of quality control and imprecise dosing increase the risk of fatal overdose.

“The bottom line is that fentanyl is undeniably extremely dangerous to people who acquire drugs from illegal markets that operate with little transparency or care for consumer safety,” the report reads.

Reducing the number of overdose deaths will require addressing both demand for and supply of illegal drugs. To do that, the report lays out a multi-pronged strategy built around five “pillars” that include:

  • developing a unified, central body to coordinated planning, implementation and evaluation of all U.S. drug policies,
  • using targeted oversight and enforcement to disrupt drug supply,
  • making public health demand-reduction approaches central to the fight against opioid trafficking so as to reduce the number of potential buyers,
  • collaborating with other countries involved in producing and distributing synthetic opioids and the materials used to make them; and
  • improving surveillance and data analysis to allow for more timely and effective interventions

“Given the gravity of this crisis, new approaches, additional resources, and a reconsideration of ongoing interventions are essential,” the report concludes. Absent such steps, “the economic costs will continue to rise, and hundreds of thousands more Americans will perish from preventable drug overdoses.”

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© National Institute for Occupational Safety and Health