COVID-19 ISO Insights

Opioid Updates: CDC Report, COVID-19 Impacts, and Illicit Market Status

April 20, 2020

By: David Geller, CPCU

This past March, the Centers for Disease Control and Prevention (CDC) released an analysis of data produced by 39 U.S. states and jurisdictions from 2017-2018. Some noteworthy results include the following:

  • The number of opioid overdose deaths in 2018 decreased by 4.1% from 2017.
  • While death rates involving heroin decreased by 4% in that time, prescription-involved opioid overdose death rates dropped by 13.5%.
  • Conversely, death rates involving synthetic opioids (excluding methadone, which, per the National Institute on Drug Abuse, is used to treat opioid addiction), increased by 10%. The CDC notes that 31,355 of the 46,000 opioid overdose deaths in 2018 that they evaluated resulted from synthetic opioids.

The CDC cites the following factors that may have contributed to the decrease in heroin-related deaths:

  • “reductions in the number of people initiating heroin use
  • shifts from a heroin-based market to a fentanyl-based market
  • increased treatment provision for people using heroin
  • expansion of naloxone access”

COVID-19 Impacts Spilling into Legal Opioid Treatments

On the heels of this analysis, the Wall Street Journal has reported that social distancing measures undertaken to contain the COVID-19 outbreak are leading to difficult decisions for the treatment of addicts.

Per the article, crowded detox centers and walk-up needle exchanges have historically been used to treat addictions and keep drug users safe. Now, however, various assistance centers have scaled back their efforts in order to limit the potential for further COVID-19 spread.

Additionally, while some recent federal rule changes have reportedly allowed individuals to receive their initial buprenorphine (another method used to treat opioid dependency) evaluations remotely, permitting users to begin taking methadone still requires an in-person visit, as of posting. In addition to users potentially being reluctant to attend an in-person visit, the WSJ notes that 320 addiction specialists penned a letter to the assistant secretary at the U.S. Substance Abuse and Mental Health Services Administration, stating, in part, that:

[Many physicians] “are currently unwilling to perform physical examinations without adequate [personal protective equipment], which may lead to a significant decrease in access for new or readmitted methadone patients.”

According to the Wall Street Journal, a director of Boston Medical Center’s addiction medicine fellowship program is concerned that, individuals who have these dependencies but no access to these drugs could be inclined to “‘go to things that are much more dangerous.’”

Illicit Market also Affected by COVID-19

On their website, the CDC mentions that the increase in deaths stemming from synthetic opioids have involved positive tests for fentanyl, and that “the source of the fentanyl is more likely to be illicitly manufactured than pharmaceutical.”

For years, the bulk of this fentanyl had reportedly been imported illegally from China. A New York Times article mentioned that the U.S. Drug Enforcement Administration (DEA) pointed to China being responsible for 97% of fentanyl that was seized by United States law enforcement in 2016 and 2017.

However, in 2019, per the Times, China tightened the regulatory structure that had previously enabled mass shipments of fentanyl abroad. On May 1, 2019, 91 Chinese manufacturers and 234 individual distributors were placed under “‘strict supervision’” and were warned not to export fentanyl or related drugs. As a result, per the article, shipments of fentanyl to the United States from China had “declined significantly” from 2018 to 2019.

But in the illicit market, it appears that when one door closes, another one opens. Vice reports that, subsequent to this crackdown by Chinese authorities, production of fentanyl in Mexico was “stimulated”, with chemicals necessary for the cooking process reportedly being provided by… exporters based in China.

However, in a world where supply chains across all sectors are being disrupted from the outbreak of COVID-19, it appears that the black market will be no exception. The Vice article uniquely covers how Mexican cartels, which source different components from China to mass-produce meth, fentanyl, and other drugs that are then shipped to the United States illicitly, are encountering significant roadblocks.

Will this produce any short-term or long-term trends in the United States? Some treatment advocates, according to the Wall Street Journal, contend that opioid users could be at greater risk of fatal overdoses, as their tolerance could be reduced if they are unable to acquire opioids for a period of time. Additionally, with cocaine and meth reportedly in short supply, dealers are reportedly mixing in fentanyl to stretch these drug supplies, which could pose additional health risks for users of these drugs.