Special Feature: Polysubstance Use and Emerging Drug Overdose Trends.
Introduction
Over the past two decades, deaths from alcohol, drugs, and suicide in the United States have all increased alarmingly. This critical public health issue intertwines with several other concerning trends: higher rates of mental health issues, particularly among youth; increased loneliness; and reduced economic opportunity; a dangerous shift in the illegal drug supply; and insufficient investment in public health and prevention policies that could reduce underlying drivers of poor mental health and substance use. The COVID19 pandemic added extensive trauma, stress, and isolation on top of these trends, and the United States saw parallel, extraordinarily large, increases in alcohol, drug, and suicide deaths in 2020 and 2021. The most recent mortality data, from 2022, show total deaths from alcohol, drugs, and suicide in the United States was slightly lower for the first time in five years. While the long-term trends remain alarming the 2022 rate is still more than double the rate compared with 20 years ago this year is markedly better than an increase of 11 percent, as in 2021, or 20 percent, as in 2020.
The 2022 trends include a 6 percent decline in the overall alcohol induced mortality rate, after more than a decade of increases, and nearly identical rates for overall drug overdose and suicide mortality. Most of the underlying trends in 2022 are an improvement over 2021, too, though there is still notable variation in trendlines by demographic and geographic groups. For example, White and Native Hawaiian and other Pacific Islander populations had modest decreases in drug overdose rates while other populations of color still saw increases; and younger Americans (under age 35) had declining suicide rates, while Americans ages 35 and older had higher rates.
While the rates of alcohol, drug, and suicide deaths have each risen over the past decades, drug overdoses in particular have increased relentlessly in the past decade as synthetic opioids have become ubiquitous. More recently, stimulants, xylazine, and polysubstance use have also become more common in the drug supply and in overdoses. This year’s special feature explores the latest data on substance use and drug overdoses, emerging substances and polysubstance use trends, and reflections on policy responses to evolving circumstances. The nation is at a critical moment and needs to build on the recent tentatively positive developments and lessons in order to reverse the long-term trends in alcohol, drug, and suicide deaths. In particular, additional attention is needed on strengthening primary prevention, harm reduction, early intervention, and treatment policies and programs to save lives, boost resiliency, and improve mental health and well-being for all Americans.
This report includes three sections: (1) a special feature on polysubstance use and emerging drug overdose trends (page 7); (2) a deeper analysis into the 2022 mortality trends from alcohol, drugs, and suicide for all groups (page 20); and (3) an outline of key policy recommendations that, if implemented, could reduce alcohol, drug, and suicide deaths in the country and promote wellbeing for all Americans (page 31). There are also expanded appendices in this year’s report that include national and state-level alcohol, drug, and suicide mortality data; national and state-level substance use and mental health data; and state policies, programs, and other indicators (page 42).
SPECIAL FEATURE:
Polysubstance Use and Emerging Drug Overdose Trends
Drug overdose deaths in the United States have risen considerably over the past few decades and exponentially in recent years, though there have been tentatively positive trends in the last two years. The increases in overdose deaths have paired with other serious public health issues, including rising alcohol-induced and suicide mortality, mental health issues, and loneliness and social isolation—and have been further exacerbated by COVID-19.
Also underlying the overdose trends are changes to prescription opioids and the illegal drug supply. Prescription opioid drugs were the primary drivers of the opioid epidemic when it began in the late 1990s. In 2010, the crisis centered on illegal opioids: first heroin and then, starting around 2013, synthetic opioids. In the last few years, synthetic opioid overdoses (primarily from illegal fentanyl) continued to increase along with increases in overdoses involving stimulants, like cocaine and methamphetamines, and more recently xylazine. At the same time, substance use for most kinds of drugs in the United States, besides marijuana, has largely remained unchanged in recent years, though the illegal drug supply has become more dangerous.
This section examines the latest data in substance use and drug overdoses, important trends and considerations for understanding the ongoing and evolving crisis, and key strategies and policies for tackling this crisis. To build on the current small, positive developments, careful attention to current and evolving trends; capacity building to better serve communities in need; continued improvement of access, availability, and quality of treatments for overdose and substance use; and proactive early prevention measures are needed.
A. Substance Use and Drug Overdose Data
Examining the most recent substance use and drug overdose data available for the overall U.S. population as well as data from across time, demographic groups, geography, and drug types can further an understanding of current circumstances, reveal notable trends, and highlight population groups and communities that are disproportionately impacted in order to direct additional resources.
Substance Use Trends
The Substance Abuse and Mental Health Services Administration (SAMHSA) conducts an annual survey on the substance use and mental health trends of Americans called the National Survey on Drug Use and Health (NSDUH). The 2022 iteration found 70.3 million individuals ages 12 and older in the United States about one-quarter of the adolescent and adult population reported any illegal drug use in the past year. Reported drug use among all adolescents and adults ages 12 and older increased by 14 percent between 2021 and 2022. The increase was primarily due to higher use of marijuana, while the reported use of most other kinds of drugs surveyed remained relatively unchanged. Notably, 2022 was the first year that fentanyl use was surveyed. It found 0.4 percent of the population reported fentanyl misuse, including 0.2 percent of the population reporting illegally-made fentanyl use in the past year. The survey authors note, however, that other illegal drugs may contain fentanyl without the person’s knowledge and the true usage figure is likely higher.
NSDUH also includes questions about substance use disorders (including alcohol and drug use disorders) and found 9.7 percent of individuals ages 12 and older in the United States had a drug use disorder in the past year. More than half of those with drug use disorder had a mild drug use disorder (55.2 percent), while 23.5 percent had a moderate disorder and 21.3 percent had a severe disorder.