Overdose Crisis Background
Although overdose deaths involving prescription opioids and heroin have decreased, the crisis has worsened overall. Synthetic opioids, like illicitly manufactured fentanyl, and the use of other substances, like stimulants, such as cocaine and methamphetamine, and the use of multiple drugs in combination, have led to significant increases in overdose deaths.
The Impact of COVID-19
Overdose deaths were rising prior to the COVID-19 pandemic, but in 2020 there was a further significant increase in overdose deaths. According to provisional data from the CDC, in 2020, overdose deaths increased over 30% leading to more than 93,000 deaths. This increase was driven by the use of synthetic opioids (e.g. fentanyl) and stimulants (methamphetamine and cocaine), or combinations of substances.
Pandemic restrictions intended to prevent the spread of COVID-19 have unfortunately also made it harder for individuals with substance use disorders to receive treatment and support services. But this new reality also led the expansion of telehealth and virtual care, including for providing medication to treat opioid use disorder. These innovations have proven essential in protecting access to and continuity of necessary care.
A Brief Timeline of Key Events related to Opioid and Stimulant Use in the United States (Late 1800s – today)
There is a long and complex history of opioid and stimulant use in this country alongside other substances that intersects with the history of public health and the judicial system, among other institutions. These histories must be taken into account as we work to combat systemic and historic racism in the United States.
The use of opioids was common in the United States despite observed patterns of addiction. Women received opioids for gynecologic conditions, menstrual cramps, morning sickness in pregnancy, and mental health conditions. In major cities and the Western states, people also used opium and anti-Chinese discrimination led to racist stereotypes about people of Asian descent that persist today.
In part motivated by prejudice against racial and ethnic minorities, lawmakers passed legislation limiting opium and cocaine supply. This legislation drove increases in more available alternatives such as morphine and heroin in the U.S.
World War II led to increased use of stimulants. Amphetamines were supplied to United States soldiers. Civilian use of stimulants also increased for psychiatric and weight-loss effects.
The federal government’s declaration of the War on Drugs instituted racially biased efforts to criminalize and control drug use. The strategy disproportionately targeted Black people living in urban areas.
Increased supply of cocaine in the U.S. led to a price decrease and the use of cocaine increased. Harsher penalties for possession and sale of crack cocaine deepened racial disparities in drug use and prosecution, with widespread, harmful health and social outcomes for Black communities, families, and individuals.
Pharmaceutical companies created and marketed powerful painkillers in new formulations intended to treat patients with chronic pain. The companies reassured the medical community that patients would not become addicted to opioid pain relievers and healthcare providers began to prescribe them more widely.
It became clear that, in fact, the painkiller medications developed by the pharmaceutical companies in the 1990s could be highly addictive and led to a significant increase in opioid use disorders and drug overdose.
The misuse of prescription opioids was accompanied by a corresponding increase in heroin and illicitly manufactured fentanyl overdoses as people sought other drug supplies once prescription opioids became harder to obtain. Overdose deaths involving stimulants also began to rise.
There is a rising rate of overdoses driven by potent synthetic opioids, along with an increase in overdoses involving stimulants and polysubstance use.
HHS Overdose Prevention Strategy
The Overdose Prevention Strategy expands the scope of the crisis response beyond opioids to include other substances that are often involved in overdoses, including stimulants such as methamphetamine and cocaine. This new strategy promotes groundbreaking research and evidence-informed methods to improve the health and safety of our communities.
The Strategy is guided by four principles:
- Data and evidence
- Coordination, collaboration, and integration
- Reducing stigma
focuses on root causes and key predictors of substance use and substance use disorder, and how to safely and effectively manage pain.
focuses on reducing risks associated with substance use, including overdose and infectious disease transmission.
focuses on providing the most effective, evidence-based treatments without delay, stigma, or other barriers.
focuses on funding, reimbursing, training workforces for, and developing protocols around peer, employment, and housing supports.
The successful implementation of this strategy depends on federal, state, and local governments working hand-in-hand with health care professionals, law enforcement, policy makers, employers, advocacy groups, and communities to:
- Remove barriers to high-quality care;
- Invest in evidence-based public health and public safety activities;
- Advance racial equity and equity for underserved populations in access to health care, treatment in the justice system, and drug policy;
- Embrace the full range of interventions, including harm reduction and recovery support services.
The President’s Fiscal Year 2022 proposed budget for HHS on overdose prevention programs and initiatives totals $11.2 billion across the Department, $3.9 billion more than in FY 2021, a 54 percent increase from FY 2021 Enacted, and includes funding to expand access to substance use prevention, treatment, harm reduction, and recovery support services; as well as funding to bolster the nation’s behavioral health infrastructure.
- SAMHSA’s FY 2022 budget request includes $3.5 billion for the Substance Abuse Prevention and Treatment Block Grant. The FY 2022 request also included, for the first time, a 10 percent set-aside for recovery support services.
- HRSA's FY 2022 budget request includes $1.1 billion in mandatory and discretionary funding to support the substance use disorder responses in community health centers, invest in the National Health Service Corps, develop the behavioral health workforce, and expand substance use disorder response in rural America.