The 2020s have inarguably been Covid-19’s decade.
Since the coronavirus outbreak was acknowledged as a pandemic exactly five years ago, the pandemic has killed well over 1 million Americans, derailed the global economy, and sparked political upheaval that continues today. It also yielded what many hail as the greatest scientific accomplishment in human history: the development of effective vaccines in under a year.
Yet in dominating the early 2020s, Covid-19 also distracted from what is arguably a more significant public health emergency. Even at the height of the pandemic, more young Americans died of drug overdose than Covid. And in the last year, the overall death toll from the country’s drug crisis has exceeded the Covid-19 pandemic as the deadliest health event this generation.
“Amidst all of this very tragic loss of life in the Covid pandemic, we lost sight of the fact that more young people were dying from drug overdoses than from Covid,” Nora Volkow, the director of the National Institute on Drug Abuse, said in a recent interview. “I was just exasperated. … Nobody was paying attention, or putting in the resources necessary to actually treat them, and prevent those deaths.”
Over 1.25 million people have died of non-alcohol drug overdose between 1999 and 2024, according to data from the Centers for Disease Control and Prevention, putting the crisis a tick ahead of overall U.S. deaths from Covid-19. With roughly 85,000 overdose deaths still occurring annually, the gap is sure to grow.
Drug deaths’ reemergence as the No. 1 driver of accidental deaths in the past quarter-century is a grim reminder that the overdose crisis continues largely unabated. In recent decades, waves of addiction and overdose driven first by prescription painkillers, then heroin, then fentanyl, and now a deadly mix of fentanyl and stimulants has destroyed families, significantly slowed the U.S. economy, and even shortened the country’s overall life expectancy.
It highlights, also, a jarring disconnect between the nation’s response to the two health emergencies, and the degree to which the Covid-19 pandemic helped erase what little momentum the nation’s drug crisis response had left.
In interviews, leading addiction experts at medical societies, government research agencies, and nonprofit advocacy groups uniformly agreed that the country has failed to adequately respond to the overdose crisis since it began around 1999. They assigned blame to a number of factors: fragmented leadership, stigma and misinformation about addiction, failure to recognize it as a medical condition. Most acutely, they argued that many Americans simply lack sympathy or a sense of urgency — and above all, the efforts that do exist generally lack the funds they need to be truly effective.
“The call to action really has to get some funding support behind it,” said Patty McCarthy, the CEO of the nonprofit advocacy group Faces & Voices of Recovery. “We know what we need to do. We don’t need to continue to debate the solutions. We just need to put a coordinated effort behind it to make a system that works for everyone.”
Even if urgency is lacking, the impact of the problem reverberates. Beyond the death toll, some estimates say drug addiction causes economic damage equivalent to 2% of the gross domestic product. Overdose deaths skyrocketed when Covid-19 arrived and caused widespread social isolation, just as the illicit drug supply was growing more toxic. While the current annual death toll has fallen well below its peak of roughly 114,000 in early 2023, drug overdose remains a leading cause of accidental death.
The country’s response to the two crises, however, is a jarring case study in the singular nature of America’s Covid-19 response — and by contrast, how little attention people pay to the addiction crisis.
In the immediate response to Covid, public officials encouraged strict social isolation protocols, poured billions into the development of vaccines and therapeutics, and then spent billions more on support programs for Americans suffering in the wake of Covid-related economic collapse.
The country’s response to the addiction crisis, by contrast, has been defined more by rhetoric than by action. Four successive presidential administrations — Obama, Trump, Biden, and now Trump again — have cited the opioid crisis as a key domestic policy priority. Many members of Congress have introduced and even passed bills on specific aspects of policy related to addiction treatment or law enforcement.
But none of these efforts ever came close to matching the scope of the federal drive that resulted in the first Americans receiving vaccines in December 2020, less than a year after Covid-19 made its presence known.
The $18 billion vaccine effort, known as Operation Warp Speed and executed in partnership with Pfizer, Moderna, Johnson & Johnson, and other drug companies, stands in stark contrast to the continued lack of funding for overdose prevention and new addiction treatment medications.
Brian Hurley, the president of the American Society of Addiction Medicine, argued in an interview that even the medications that already exist, like methadone and buprenorphine, remain underutilized, and the federal government hasn’t done enough to encourage their use.
While regulations surrounding methadone and buprenorphine have been moderated in recent years, the medications remain difficult to obtain, as documented in “The War on Recovery,” a STAT investigative series. Doctors are not allowed to prescribe methadone, meaning the medication is only available at specialized clinics, and few physicians prescribe buprenorphine. Many pharmacies refuse to stock buprenorphine, and many incarcerated people are also denied access to the medications, in violation of guidance issued in 2022 by the Department of Justice.
“When you look at the adoption and spread of vaccination versus the adoption and spread of medications for opioid use disorder, they’re light years apart,” he said. “I am not in any way taking away from that considerable investment in vaccination technology, but we would love to see big, bold action around access to addiction medications.”
To this day, only a minority of people with opioid addiction receive methadone or buprenorphine.
Another factor that could explain the gap in response, Hurley said, is that many Americans’ attitude toward people who use drugs remains more moralistic than compassionate.
“There’s decades of literature making it clear that addiction is a chronic illness, but I don’t know that everyone thinks of it that way,” Hurley said. “There was very clear alignment that a virus-driven pandemic is a medical illness. It really wasn’t up for debate.”
Not all addiction-related news is cause for despair, however. After peaking in early 2023, drug deaths began to plummet, and the rolling 12-month death toll has steadily dropped for each period the CDC has published data, with the most recent update showing a continued decline through last September.
In an interview, Volkow, the NIDA director, said it was difficult to attribute the declining death rates to a single cause, citing a combination of factors including a less toxic drug supply and the fact that the crisis has already claimed the lives of many of the most vulnerable drug users. She underscored, too, that improved access to certain treatment and harm reduction measures has worked as intended, resulting in greater medication uptake and fewer fatal overdoses.
But she cautioned that the declining deaths are not happening universally — deaths are still on the rise in specific states, like Nevada and Alaska, as well as in specific demographic groups, including among Black and Native American people.
The availability of Covid-level funding, too, could soon become a reality, thanks to billions of dollars that have begun to flow toward states, local and tribal governments, from settlements reached by drug manufacturers and distributors who played a role in accelerating the opioid crisis in the 1990s and early 2000s.
The local recipients often have broad leeway when it comes to how the funds are spent. Much of the money has gone toward direct remediation efforts, like childhood education about drug use, purchasing naloxone and fentanyl test strips, or expanding access to addiction medications. Some localities, however, have used the money for administrative costs or to pad local governments’ rainy-day funds. Much of the money still hasn’t been spent.
But McCarthy, the Faces & Voices of Recovery CEO, said the settlement funds process so far has fallen short of its potential, and that the spending strategy hasn’t been guided by the type of sweeping, transformative vision the current crisis requires.
“What we’re seeing is a really missed opportunity to do something significant,” she said. “Isolation kills, stigma kills, and we could do better.”
STAT’s coverage of chronic health issues is supported by a grant from Bloomberg Philanthropies. Our financial supporters are not involved in any decisions about our journalism.