(Chicago) – As the opioid epidemic continues to claim lives across the country, attention has focused rightfully on the unprecedented scope of the crisis. What is often overlooked, however, is that deaths from methamphetamine (meth) and cocaine have surged, while rates of alcohol use disorder have long outpaced rates of other substance use disorders. As drug epidemics in the U.S. have escalated and waned across many decades, one enduring common thread is that they all result in harmful consequences to individuals, families, and communities, in virtually all dimensions of life.
The starkest of these consequences are overdose deaths. After rising continuously since 1990, the number of drug overdose deaths in the U.S. likely fell in 2018, according to provisional data released by the Centers for Disease Control and Prevention (CDC) in July. While final data will not be released until later this year, if the predicted 5.1 percent decrease is confirmed, it would represent the country’s first decline in annual overdose deaths in nearly 30 years.
And yet, the overdose death rate is still about seven times higher than it was a generation ago. After more than 70,000 overdose deaths in 2017, the final count of fatalities in 2018 will still approach that number. Among these, overdose deaths related to cocaine and methamphetamine increased in 2018. Additionally, while overdose deaths related to prescription painkillers declined in 2018, those related to fentanyl and its analogs rose sharply, to more than 31,000.
When it comes to understanding drug use patterns, it is seldom a question of just one substance or another. It is very common for people to use more than one drug (i.e., polysubstance use), and alcohol as well. The portion of people seeking treatment for opioids who also reported using meth in the last month jumped from 19 percent in 2011 to 34 percent in 2017. Meanwhile, a study recently published in JAMA found that, in a five-year, cross-sectional study of one million drug tests, increasing numbers of urine samples testing positive for cocaine or methamphetamine also tested positive for unprescribed fentanyl. Study authors noted that this may be due both to intentional polysubstance use and unknowing use of multiple substances.
These increases are part of a larger trend of a growing cocaine and meth crisis. According to CDC report released in May, the number of drug overdose deaths involving cocaine increased 34 percent from 2016 to 2017, while the number of overdose deaths involving psychostimulants (such as methamphetamine) increased by 37 percent. A December 2018 CDC report
stated that the rate of drug overdose deaths involving methamphetamine more than tripled from 2011 to 2016, while the number of overdose deaths involving cocaine nearly doubled between 2014 and 2016.
Trends in Illinois
Drug crisis trends in Illinois align with these national patterns. The opioid crisis in the state has led to a surge in overdose deaths in recent years. There also has been a steep rise in overdose deaths related to cocaine and psychostimulants, particularly meth. An analysis of CDC data shows that from 2012 to 2017, the rate of Illinois drug overdose deaths related to cocaine increased by 119 percent, and those related to psychostimulants leapt by 600 percent.
“We’ve been witnessing that huge resurgence in methamphetamine use” said Brad Bullock, administrator of TASC’s services in southern Illinois. “People who were using opioids before saw their peers dying, and fentanyl added even more fuel to the fire. So as this happened, the market for illicit drugs shifted, both from the demand side and from what suppliers were putting out there.”
Methamphetamine seizures by law enforcement also have increased nationally and in Illinois. A recent analysis by the Illinois Criminal Justice Information Authority (ICJIA) found that both the arrest rate and the number of people in prison for methamphetamine-related offenses has grown significantly in the state. Researchers also found that treatment admissions for meth increased five-fold between 2000 and 2017.
Learning from Drug Crises
These emerging or reemerging crises may involve a longer-term, exponential growth curve of overdose mortality rates, observed by researchers who analyzed U.S. drug overdose data from 1979 through 2016. Examining nearly 600,000 unintentional drug overdoses over a 38-year period, researchers found that this growth curve is actually made up of a “composite of several underlying subepidemics of different drugs” and that “geographic hotspots have developed over time, as well as drug-specific demographic differences.”
In fact, the U.S. has a long history of drug crises. Since the country experienced its first opiate epidemic in the late 1800s, the use of various drugs—including but not limited to opioids, cocaine, and amphetamines—has swelled and ebbed, along with an array of responses by public interest groups and government officials.
The profound consequences of these crises may vary in their particular characteristics, but not in their persistence. They include devastated families and communities, as well as the far-reaching impacts of punitive policy responses, beginning with a 171 percent increase in drug arrests between 1980 to 2016, the current incarceration of almost half a million people for drug offenses, and the attendant collateral consequences of a criminal record.
Furthermore, there have been disparate responses to different groups of people using drugs. There are stark contrasts between responses to the crack cocaine crisis in the 1980s and early 1990s, which was presented almost exclusively as a problem in African-American and urban communities, and today’s opioid epidemic, which frequently has been portrayed as a problem affecting young white people in suburban and rural areas—even though rates of opioid-related deaths among black people have been rising at a much faster pace in today’s crisis.
Federal drug laws established in the 1980s created a 100-to-1 crack cocaine versus powder cocaine sentencing disparity. Distribution of 500 grams of powder cocaine carried a minimum sentence of five years, but distribution of just five grams of crack cocaine carried the same minimum sentence. Following four separate recommendations from the U.S. Sentencing Commission (in 1995, 1997, 2002, and 2007) to eliminate or significantly reduce this disparity in federal sentencing, the Fair Sentencing Act of 2010 reduced the disparity to 18-to-1. While this represents a clear improvement, it also signifies an arbitrary imbalance that persists today.
Similarly, laws to increase penalties for meth, and more recently fentanyl, have been introduced or adopted both federally and in state legislatures.
As in the justice system, disparities are evident in health system responses to addiction. Even as opioid-related mortality rates have risen among black and Hispanic populations, there are large disparities in the issuing of opioid treatment medication. A University of Michigan study found that buprenorphine (brand name Suboxone), a medication that curbs opioid cravings and reduces the risk of overdose, has been accessible almost exclusively to white people. In fact, they are nearly 35 times as likely as black Americans to have had a buprenorphine-related medical visit.
“We have decades of lessons now that should help to not only mitigate and respond to future crises, but also to formulate responses that are evidence-based and equitable,” said TASC Director of Policy Laura Brookes.
While there are some differences in how different types of substance use disorders are treated (for example, there are three FDA-approved medications for treating opioid use disorder, while there are no such medications approved for the treatment of cocaine or methamphetamine use disorders), there are many principles that are applicable in any type of drug crisis, according to Brookes.
“Effective treatment responses to substance use disorders require an array of options and supportive services, with therapies to treat conditions involving various substances, and designed with and for people with different life experiences and circumstances,” she said. “In all cases, substance use disorders and their symptoms should not be criminalized. And in all cases, we must ensure that our treatment delivery and financing systems ensure timely access by all to an array of quality services that can meet individuals’ needs.”
Noting that federal funding has played an essential role in efforts responding to the current opioid crisis, Brookes added that policymakers can help strengthen the range of treatment options and supportive services available in communities by easing funding restrictions and giving states and municipalities more flexibility to respond to drug trends as they emerge, rather than requiring that funds be used to respond to any specific type of drug.
“As with any public health crisis, we need a full range of strategies in place, including comprehensive prevention, quality treatment, and a spectrum of recovery support services, from housing to employment to peer-based supports,” said Brookes. “These assets need to be embedded in communities, and treatment must be included in healthcare coverage, regardless of where people live."