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something we’ve never seen. 2020 was a record year for overdose deaths.” He examined the evolu- tion of prescription opioids in the late 90’s to the 2000s and fentanyl and fentanyl analogs starting to emerge in about 2013 as a primary driver. One important point he

made was underneath this is really polysubstance use. “People who are dying from drug overdose we may label them as opioid overdose or cocaine overdoses, but in most cases people are using more than one substance,” he said. Factoring into this rise is the impact of the pandemic. Jones told the crowd they were still trying to determine the impact of COVID-19 on overdoses. Early data showed people reporting increas- ing substance use as a result of coping with the pandemic disruptions along with gaps in service delivery and lack of access to care. This has con- tributed to a 30% increase in overdose deaths in 2020 according to the latest provisional data and suggests for 2021 that increase had continued. “First few months of the pandemic you see a pretty substantial spike in the rate of increase and that has maintained some elevation,” he argued. Turning back to the question of polysubstance use, he said: “Opioids are the most common drug involved in overdose deaths. Synthetic opioids like fentanyl are contributing to the increase but we are also seeing increases in overdoses for psychostimulants primarily methamphetamines and cocaine”. Jones explained how drug policy could be mis- led by a focus on a particular drug. “Especially when we come to realize people with substance use disorders, they may have

preferences for certain types of drugs but often they are using multiple drugs that are available, so we have to look at this more holistically,” he explained. He illustrated his point by showing how co- caine related deaths have increased despite use and availability which had not changed. “What we found is that the majority of those deaths also involved heroin and increasingly fentanyl. A few years later we started to see a rise is psychostimulant overdose deaths. About 75% of all overdose deaths involving also involved opioids,” he said. He contrasted cocaine usage against psychostimulants. “Rising methamphetamine use is happening with and without opioids. This raises some chal- lenges in how we respond from a public health perspective. The overdose crisis is evolving,” he declared. Jones went on to outline some of the trends discerned from the annual national survey on drug use and health conducted by the Substance Abuse and Mental Health Services Administration. They show an increase in methamphetamine use and an increase in higher-risk use. These increases cut across geographic areas, ethnicities, age groups, and genders. →

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