Increase in Drug Overdoses Due to Synthetic Opioids During the COVID-19 Pandemic

Clinical Update
Jan 2021

Increase in Drug Overdoses Due to Synthetic Opioids During the COVID-19 Pandemic

The challenges of the COVID-19 pandemic have continued to affect populations across the world in numerous ways. Finding a solution to the pandemic has been at the forefront of healthcare companies, governments, and clinical researchers. Amid all this, the opioid epidemic has affected vulnerable populations more than ever, including those susceptible to drug overdoses. Data reports from multiple sources, including emergency medical services, have indicated a rise in opioid overdose during COVID-19.1-2 Individuals with opioid use disorder (OUD) are at a heightened risk of overdose due to the long periods of social isolation, economic distress, and interrupted treatment services.2  It has been reported by the Centers for Disease Control and Prevention’s (CDC) National Center for Health Statistics (NCHS) that approximately 81,230 drug overdose deaths have occurred in the 12-month period ending in May 2020. This has been the largest number of drug overdoses for a 12-month period ever recorded.1

Factors Driving the Increase in Overdose

The nationwide changes due to the COVID-19 pandemic are believed to be the driving force in the increase of overdoses. The primary evidence-based treatments for OUD require in-person and often frequent visits to healthcare providers which are limited by stay-at-home orders.2 Public health departments have come under tremendous strain and can only offer reduced support while the majority of their efforts and focus are shifted to the COVID-19 pandemic. The lack of access to these safety net services coupled with social isolation, anxiety, and depression increases the risk of drug abuse and potential for fatal overdoses. The economic uncertainty during the pandemic is also another factor that may increase the risk of relapse in individuals who are abstinent. Beyond the challenges of staying safe and healthy during the pandemic, individuals with OUD face additional barriers to remain safe, not only from COVID-19, but also the negative health outcomes associated with their living environments, socioeconomic positions, and injection drug use.3 The concerning acceleration of overdose deaths recorded from March 2020 to May 2020 coincides with the implementation of widespread mitigation measures for the COVID-19 pandemic.1

Recent Published Data

The increase in drug overdose mortality dates back to 2019 and has continued through 2020.1-6 Synthetic opioids are the primary driver of the overdose deaths. Deaths associated with synthetic opioids increased 38.4% for 12 months until June 2019 compared with the 12 months ending in May 2020, with a total of 37 jurisdictions reporting increases in synthetic opioid overdose deaths. Of the 37 jurisdictions, 18 had greater than a 50% increase, 11 reported increases of 25% to 49%, 7 reported 10% to 24%, and 1 reported less than 10%. Furthermore, 10 western states have a combined increase of 98% in overdose deaths. This is consistent with the large increase in availability of illicitly manufactured fentanyl and positivity rates in clinical drug tests in the western states after the pandemic began.4 The map below from the CDC illustrates the percentage change in the 12-month provisional count of fatal overdoses involving synthetic opioids from June 2019 – May 2020.

cdc overdoses
Source: CDC Health Alert Network, 2020

Recommended Mitigation Methods

The need for essential services to remain accessible to vulnerable populations is highlighted by the increase in overdose deaths and the known disruption to healthcare, public health, and social services due to the COVID-19 pandemic. While the implemented mitigation measures have primarily focused on the needs for the COVID -19 pandemic, the need for services catered to the evolving overdose crisis is essential. There are numerous ways and methods to address the crisis, but the CDC has recommended the following actions based on community needs and characteristics:

  1. Expand the provision and use of naloxone and overdose prevention education
  2. Expand access to and provision of treatment for substance use disorders
  3. Intervene early with individuals at the highest risk for overdose
  4. Improve detection of overdose outbreaks due to fentanyl, novel psychoactive substances (e.g., fentanyl analogs), or other drugs to facilitate an effective response

These recommended actions require the collaborative work of public health departments, community-based organizations, healthcare providers, and toxicology laboratories.1,5-6 The CDC recommendations aim to ease the barriers that persist, increase awareness and education, and address the needs of vulnerable populations. Services such as compliance monitoring can enhance patient care, highlight illicit drug use, and offer clinicians valuable tools in making better decisions for their patients.   Aegis offers novel psychoactive substance testing, including testing for synthetic opioids, as part of its flexible testing services. 

NOTICE: The information above is intended as a resource for health care providers. Providers should use their independent medical judgment based on the clinical needs of the patient when making determinations of who to test, what medications to test, testing frequency, and the type of testing to conduct.



1. Increase in fatal drug overdoses across the united states driven by synthetic opioids before and during the covid-19 pandemic. Centers for Disease Control and Prevention website. Updated December 17, 2020.
2. Slavova S, Rock P, Bush HM, Quesinberry D, Walsh SL. Signal of increased opioid overdose during COVID-19 from emergency medical services data. Drug Alcohol Depend. 2020;214:108176. doi:10.1016/j.drugalcdep.2020.108176
3. Walters SM, Seal DW, Stopka TJ, Murphy ME, Jenkins WD. COVID-19 and People Who Use Drugs - A Commentary. Health Behav Policy Rev. 2020;7(5):489-497. doi:10.14485/hbpr.7.5.11
4. National forensic laboratory information system: NFLIS-drug 2019 midyear report. Drug Enforcement Administration, Diversion Control Division. Updated 2020. 
5. Wakeman SE, Green TC, Rich J. An overdose surge will compound the COVID-19 pandemic if urgent action is not taken. Nat Med. 2020 Jun;26(6):819-820. doi: 10.1038/s41591-020-0898-0
6. Wainwright JJ, Mikre M, Whitley P, Dawson E, Huskey A, Lukowiak A, Giroir BP. Analysis of Drug Test Results Before and After the US Declaration of a National Emergency Concerning the COVID-19 Outbreak. JAMA. 2020 Sep 18;324(16):1674–7. doi: 10.1001/jama.2020.17694. Epub ahead of print.