Below is a complimentary Demography Unplugged research note written by Hedgeye Demography analyst Neil Howe. Click here to learn more and subscribe.

The Opioid Crisis is Looking Worse  - 4 16 2021 11 16 15 AM

New data suggest that the rise in opioid deaths during the pandemic was even more dramatic than previously thought. The final death toll for 2020 is on track to exceed 90,000, compared to just over 70,000 the year before. (The New York Times)

NH: A month ago, we reported that drug overdose deaths rose to a record high in 2020. That was not based on complete data for the year, but on trailing 12-month data that spanned August 2019 to July 2020. (See “In 2020, Drug Overdose Deaths Hit a Record High.”)

Since then, the CDC has released provisional data for the 12 months ending in August 2020 and September 2020, respectively. And the numbers look even bleaker.

There were 84,000 predicted deaths for the period ending in July 2020. For the period ending in August 2020, the figure rose to 88,400, up +27% YoY. For the period ending in September 2020, it was 90,237, up +29% YoY.

The Opioid Crisis is Looking Worse  - 4 16 2021 11 16 15 AM

So far, the story of overdose deaths in 2020 looks like this.

Monthly deaths surged beginning in February and continued climbing through the spring until they averaged more than 9,000. They then declined, but only slightly. By August, the monthly average was still around 8,000. Prior to 2020, it had never risen above 6,300.

The Opioid Crisis is Looking Worse  - April16 1

In 2019, the final tally of overdose deaths was 70,630.

It’s clear that the 2020 number will exceed that; it’s just a question of by how much. It will certainly be the highest annual total ever, and it may mark the largest single-year percentage increase in the past two decades.

Just a few weeks ago, when the September data hadn’t been released yet, the Commonwealth Fund estimated that the 2020 total would be around 90,000. That looks conservative now.

When I last covered the opioid crisis, I discussed how the geography of overdose deaths was increasingly shifting west. Now we’re seeing another shift: by race. When the opioid crisis began, it was driven by deaths among rural and suburban whites.

But in recent months, the largest increase in deaths from opioids has been among black Americans--and this is showing up in very high excess death rates for nonelderly blacks. Over age 65, the excess death rate for blacks in 2020 was about 2X the rate for whites.

That's mainly higher mortality from Covid-19. But under age 65, it was over 4X larger. That's mainly due to opioids.

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Neil Howe is a renowned authority on generations and social change in America. An acclaimed bestselling author and speaker, he is the nation's leading thinker on today's generations—who they are, what motivates them, and how they will shape America's future.

A historian, economist, and demographer, Howe is also a recognized authority on global aging, long-term fiscal policy, and migration. He is a senior associate to the Center for Strategic and International Studies (CSIS) in Washington, D.C., where he helps direct the CSIS Global Aging Initiative.

Howe has written over a dozen books on generations, demographic change, and fiscal policy, many of them with William Strauss. Howe and Strauss' first book, Generations is a history of America told as a sequence of generational biographies. Vice President Al Gore called it "the most stimulating book on American history that I have ever read" and sent a copy to every member of Congress. Newt Gingrich called it "an intellectual tour de force." Of their book, The Fourth Turning, The Boston Globe wrote, "If Howe and Strauss are right, they will take their place among the great American prophets."

Howe and Strauss originally coined the term "Millennial Generation" in 1991, and wrote the pioneering book on this generation, Millennials Rising. His work has been featured frequently in the media, including USA Today, CNN, the New York Times, and CBS' 60 Minutes.

Previously, with Peter G. Peterson, Howe co-authored On Borrowed Time, a pioneering call for budgetary reform and The Graying of the Great Powers with Richard Jackson.

Howe received his B.A. at U.C. Berkeley and later earned graduate degrees in economics and history from Yale University.