Overdose deaths exceed 500 in a month for first time

Death surge continues unabated throughout summer

Problem likely related to COVID-19

(Article updated September 29, 2020.)

More Ohio residents died from drug overdoses in May 2020 than in any month in Ohio history. The record-breaking death toll appears to be linked to stress, job loss and social isolation caused by the COVID-19.

Preliminary Ohio Department of Health mortality data show that at least 532 Ohio residents died of drug overdoses in May 2020, exceeding the previous high of 484 deaths in January 2017.

This is the first time Ohio’s overdose death toll has exceeded 500 in a single month. The number of deaths that occurred during May will increase from 532 as additional overdose fatalities from across Ohio are documented and entered into the state’s mortality data.

The state added 117 confirmed overdose deaths to mortality data this week, bringing the documented overdose death toll to 2,703 statewide. At this pace, 2020 may exceed the horrific record of 4,854 overdose deaths that shocked the nation in 2017.

Overdose deaths are being reported at exceptionally high levels for June and July, too. Twenty-eight  overdose deaths were added to the June this week, bringing that month’s confirmed overdose death toll to 401. Next week, it is likely June 2020 will officially become the deadliest June on record, exceeding 415 deaths that occurred in June 2017.

The previous overdose death peak in 2017 was driven by a sudden influx of ultra-potent, ultra-deadly carfentanil into Ohio’s drug supply. The historic death surge now underway in 2020 does not appear related to carfentanil or other changes in the composition of Ohio’s drug supply.

As this year goes on, more overdose deaths from May will be documented and recorded in the state’s mortality data. The final count of fatal drug overdoses in May is likely to surpass 500, a threshold never before reached in Ohio, even during the worst of times.

It’s unclear if May was a horrific anomaly or if the record-breaking level of overdose death is continuing in Ohio. What is known is this year’s death surge has occurred broadly and statewide, spanning all of Ohio’s geographic regions, touching all demographics groups and affecting big cities, small cities and rural areas.

2020: Ohio’s deadliest year?

Ohio’s mortality database is updated weekly based on newly confirmed deaths to the state’s health department sent from Ohio’s 88 counties. Ohio added 64 overdose deaths to the official mortality data this week, including 7 that occurred in May, 14 in June, 23 in July and 10 in August.

The final death toll for 2020 won’t be available until the fall of 2021. About 90% of deaths in Ohio are recorded in the state mortality data within four months. However, some cases take longer to code and enter into the mortality data because causes of death can be complicated to determine. Also, some counties delay filing death certificates for various reasons, such as awaiting toxicology results. Of the 64 overdose deaths added to the mortality data this week, one was from January and four from February.

So far, the state has recorded 2,436 overdose deaths in 2020. That’s about 25% to 30% more than reported at this time last year. Ohio is on track this year to approach the overdose death record of 4,854 in 2017.

Ohio suffered 4,028 overdose deaths in 2019., a 7% increase from 2018. The deadliest months in 2019 occurred in the second half of the year, meaning overdose deaths began rising before COVID-19.

(The 2019 death toll is complete but has not yet been officially certified as final by the state. In the chart, both 2019 and 2020 death totals are marked with an * because they are not yet certified.)

In Ohio, overdose death rates fluctuate, often dramatically, both up and down, month-to-month and even week-to-week.  It’s impossible to predict if things will get better or worse, so it’s unclear what is happened now, statewide, in the second half of 2020.

However, at the current pace of death, 2020 could be the deadliest year in Ohio history for drug overdoses. That’s saying a lot considering the horrific overdose levels of 2016 and 2017 when fentanyl, carfentanil and various analogs expanded rapidly throughout the state’s drug supply.

It’s different this time

Since 2015, all significant changes in Ohio’s overdose death rates have been caused by changes in the chemical composition of drug supply — i.e., the introduction of fentanyl, then carfentanil, then the spread of fentanyl and its analogs into cocaine and other drugs. Despite the state’s emphasis on treatment and prevention, drug use levels in Ohio are largely constant and shift only slowly, over time.  The chemical composition of the drug supply — how much cocaine contains fentanyl, for example — is what changes quickly and drives overdose death rates up and down.

The introduction of carfentanil into Ohio’s drug supply drove overdose deaths to record levels in the second half of 2016 and the first half of 2017. A sharp decline in carfentanil’s presence drove overdose death levels down in late 2017 and throughout 2018 (when carfentanil nearly vanished from Ohio).

(Harm Reduction Ohio tracks the changing composition of the state’s drug supply by analyzing drug seizure data provided by the Ohio Bureau of Criminal Investigations crime labs. Many stories on our web site document this phenomenon, including this recent one.)

However, this spring’s overdose death surge — especially the historic jump in death that occurred in May — appears to be related to COVID-19, rather than changes in the contents of the drug supply. HRO’s most recent analysis of drugs seized across Ohio by law enforcement so (and analyzed by the three BCI crime labs) shows no changes in Ohio’s fentanyl-heavy drug supply that would explain nearly 500 overdose deaths in May.

The most likely explanation for May’s death toll is that it was driven by stress, job loss and social isolation related to the COVID-19 pandemic. Reduced access to medication-assisted treatment and naloxone may also have played a role.

What it means

No data yet exists supporting the idea that covid-19 has spurred changes in drug use levels or patterns. However, many anecdotal reports from people who use drugs support this theory.

What is known for certain is that overdose death broke a record in Ohio this May, during the heart of the pandemic, and remain tragically high. There is no evidence that Ohio is succeeding at reducing drug overdose death or even making notable progress.

— Dennis Cauchon, President, Harm Reduction Ohio 

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