Overdose deaths involving both opioids and either cocaine or psychostimulants were rising long before anyone heard of COVID-19, a National Center for Health Statistics (NCHS) report showed.
From 2009 to 2019, deaths involving both cocaine and opioids rose more quickly than those involving cocaine but not opioids, reported Holly Hedegaard, MD, of the NCHS Division of Analysis and Epidemiology, and co-authors, in an NCHS Data Brief.
From 2009 to 2019, the rate of overdose deaths involving both cocaine and opioids jumped from 0.7 to 3.8 per 100,000, while overdose deaths involving cocaine without opioids increased from 0.7 to 1.1, Hedegaard and co-authors said. In 2019, 76% of cocaine-related overdose deaths also involved an opioid. This varied by region, from 83% in the Northeast to 63% in the West.
The researchers based their estimates on National Vital Statistics System multiple cause-of-death mortality files. The findings come just months after the CDC issued a Health Alert Network advisory indicating that overdose deaths during the COVID-19 pandemic had soared to the highest number ever recorded in a 12-month period.
The advisory showed that in the 12-month period ending May 2020, cocaine-related overdose deaths increased by 26.5% and were likely connected to using cocaine with illicitly manufactured fentanyl or heroin. The advisory also reported that overdose deaths involving stimulants like methamphetamine climbed even faster than deaths involving cocaine, consistent with methamphetamine growth in the illicit drug supply and increases in treatment admissions. Synthetic opioids were the primary driver of increases in overdose deaths, the CDC said.
In the NCHS report, trends in overdose deaths involving stimulants like methamphetamine, amphetamine, and methylphenidate varied depending on whether opioids were involved. Overdose death rates involving both stimulants and opioids were stable from 2009 through 2012, but climbed from 0.3 in 2012 to 2.8 in 2019.
Patterns shifted after 2016, the researchers noted. From 2017 through 2019, overdose death rates were higher for deaths involving both stimulants and opioids for the first time in the study period; until then rates involving stimulants without opioids were higher. In 2019, more than half (54%) of overdose deaths involving stimulants also involved one or more opioids. This, too, varied by region, ranging from 80% in the Northeast to 44% in the West.