Tim Henderson | Stateline.org (TNS)
A new analysis by Stateline reveals that young adults in the United States were largely unaffected by COVID-19 during the pandemic, but faced a different threat: accidental drug overdose deaths.
In 2021, the death rate for this age group increased by nearly a third compared to 2018, and remained 21% higher in the following year.
While COVID-19 contributed to some of the deaths, accounting for approximately 23,000 fatalities between 2018 and 2022, the majority of deaths among young adults were caused by vehicle accidents, suicide, and gun homicide. Over this time period, there were about 96,000 deaths from suicide and vehicle accidents, and 65,000 deaths from gun homicide, according to data from the federal Centers for Disease Control and Prevention analyzed by Stateline.
However, accidental drug overdoses claimed the lives of nearly 177,000 young people during this time.
These overdose deaths have become the leading cause of death for individuals under 40 in 37 states, surpassing suicide in nine states and vehicle accidents in five. In Mississippi, homicide has replaced car accidents as the main cause of death. In 40 states and Washington, D.C., overdose deaths saw the largest increase among young people.
States are implementing “harm reduction” strategies to address the rising death rates. These strategies involve raising awareness about the dangers of recreational drugs laced with fentanyl, providing training and resources to address overdoses, and even considering controversial supervised drug use sites to promote safety for individuals struggling with addiction.
Daliah Heller, vice president of drug use initiatives at Vital Strategies, describes the current situation as a “fourth great wave” of accidental overdose deaths, driven by drugs laced with fentanyl. Fentanyl, which is 50 times more potent than heroin, became more accessible during the pandemic and contributed to the increase in overdose deaths.
‘Very common’ experience
Jonathan Diehl, a 28-year-old from Silver Spring, Maryland, died in 2019 after unknowingly using heroin spiked with fentanyl. According to his mother, Cristina Rabadán-Diehl, Jonathan started with opioid pills and transitioned to illegal drugs due to restrictions on prescriptions. The introduction of fentanyl further escalated the risk of overdose.
A new wave of overdose deaths, distinct from the previous three waves, is fueled by fentanyl contaminating various recreational drugs and increased solitary drug use during the pandemic.
Authorities classify overdose deaths as accidents or suicides based on individual investigations into the circumstances surrounding each death.
States with the highest death rates for young people, primarily due to accidental drug overdoses, include New Mexico, which now has the highest death rate for individuals under 40 in the country, surpassing West Virginia and Mississippi since 2018. In New Mexico, the death rate has increased by 43% since 2018 to about 188 deaths per 100,000.
Other states with high death rates for this age group are West Virginia (170 deaths per 100,000), Louisiana and Mississippi (164), and Alaska (163).
In New Mexico, the overdose problem is concentrated in impoverished rural areas like Rio Arriba County on the Colorado border. Democratic state Rep. Tara Lujan, who has relatives in that county, sponsored harm reduction legislation last year. The legislation included provisions such as widespread distribution of naloxone, legalized testing equipment for lethal additives like fentanyl, and good Samaritan laws to protect individuals reporting overdoses.
Lujan intends to reintroduce a bill advocating for the creation of supervised drug use sites or overdose prevention centers. The legislation faced opposition from Republicans who labeled the idea as “state-sponsored drug dens.”
While only New York City currently operates two supervised drug use facilities, federal law enforcement authorities threaten to close them unless there is a specific state mandate. This is due to a federal law prohibiting on-site illegal drug use.
In California, Democratic Gov. Gavin Newsom vetoed legislation last year that would have allowed jurisdictions to establish safe injection sites, citing concerns about unintended consequences in cities like Los Angeles, San Francisco, and Oakland.
Rhode Island is the only state that has passed legislation for supervised drug use sites as a pilot project, but no centers have been opened yet. New legislation has been introduced to extend the pilot project from 2024 to 2026.
Bills regarding supervised drug use sites were also considered this year in Colorado, Illinois, and New York but did not pass.
Massachusetts proposed legislation requiring all state university dorm assistants to undergo naloxone training to reverse overdoses, but the bill did not progress.
New Hampshire is one of several states experimenting with vans that visit known drug-use locations to provide overdose prevention supplies and advice.
Death rate disparities
The states with the lowest death rates for individuals under 40 in 2022 were Hawaii (78), Massachusetts and Rhode Island (79), and Utah and New Jersey (80). Massachusetts and New Jersey were the only states to see a decrease in overall deaths for this age group since 2018, with a decline in overdose deaths as well. However, overdose remained the leading cause of death for young people in both states.
Nationally, accidental overdoses were the primary driver of the death rate increase among individuals under 40, regardless of race or urban-rural divide. However, disparities exist, with overdose death rates increasing by 154% for Black Americans, 122% for Hispanic residents, and 37% for white individuals. Even among white residents, overdose deaths saw the largest increase.
The death rates for overdose increased by 70% in large urban areas and 64% in rural areas, making it the leading cause of death in both environments.
According to a data brief published by the federal National Center for Health Statistics, overdose death rates were higher for men across races and age groups. After a temporary decline in 2017, rates increased again after 2018 and surged during the pandemic until 2021.
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