Trendspotting: Overdose Deaths Up 30% in 2020

NewsWire: 7/28/21

• U.S. drug overdose deaths jumped nearly 30% in 2020. The number of deaths topped 93,000 and marked the sharpest annual increase in at least 30 years. (The Wall Street Journal)
• NH: Last week, the CDC reported that life expectancy at birth declined by 1.5 years in 2020. That was exactly the decline we had predicted back in February.
• Now another Hedgeye mortality prediction has proved to be on the mark. In our 2020 Demography Review: United States presentation, we predicted that drug overdose deaths would increase by +28% YoY in 2020. Now the CDC has released its preliminary findings. Last year, overdose deaths increased by +29.4% YoY to 93,331 fatalities.

• Much of this rise in overdose deaths was caused by synthetic opioids. Robert Anderson, chief of mortality statistics at the NCHS, reported that there were 57,550 synthetic opioid-caused deaths, a +54% YoY increase. Overall, opioid deaths were up +37%.
• The main culprit was fentanyl, often unknowingly mixed with other drugs. Fentanyl has been a significant problem in the US for the last three years. It’s relatively easy to make in a lab and to ship. And it's stunningly potent. The DEA puts the lethal dose at only 2 mg. For comparison, a mosquito weighs 2.5 mg. The lethal median dose for VX nerve agent is 5 to 10 mg. And the lethal dose for heroin is 30-50 mg. (See “Overdose Mortality Falling, But Fentanyl Deaths Still Rising” and “How the Deadly Drug Fentanyl Is Making Its Way to the US.”)

• The pandemic also played a role in the increase. Lockdowns resulted in heightened emotional distress, isolation, physical dislocation, boredom--and reduced access to healthcare providers and emergency workers armed with Naloxone. (See "Americans Continue to Struggle with their Mental Health.") 
• Undoubtedly, this news adds more political energy to crackdowns on opioid manufacturers. Johnson & Johnson (JNJ), Cardinal Health (CAH), AmerisourceBergen (ABC), and McKesson (MCK) all just agreed to a $26b lawsuit for their role in the opioid epidemic. But the agreement must be approved by "a vast majority" of state and local governments, or litigation will resume. (The exact percentage has not been made public by the court.)
• So what happens if the settlement passes but a state doesn't sign on? The individual state can take the four companies separately to trial. Washington has already declared that the payment is not enough, and they will go to court. While many localities will probably support the settlement, I wouldn't be surprised if politicians from opioid-devastated communities demand more money, particularly if their state is now flush with funds.
• The Biden administration is also likely to raise pressure on foreign governments to crack down on fentanyl production. Almost all the ingredients are fabricated in China and are later synthesized in Mexico. (See our recent Q&A presentation for a discussion of the foreign fentanyl trade: “Demography Q&A.”)