Even though opioids have been the key focus in the past few years in the nation's battle to end the U.S. addiction crisis, other illicit drugs, primarily cocaine and methamphetamine, have reemerged and are driving many of the recent overdose deaths, public health officials said.
In Rhode Island, cocaine accounted for 50% of overdose deaths in 2019, double what it was a decade ago, said Nicole Alexander-Scott, the director of the state's health department.
Rep. Diana DeGette
Use of methamphetamine has also been on the rise in Rhode Island, Alexander-Scott told lawmakers at a Jan. 14 House Energy and Commerce Oversight and Investigations Subcommittee hearing.
While recently reported provisional data from the Centers for Disease Control and Prevention indicated drug overdose deaths in the U.S. have fallen, "this crisis is far from over," said Rep. Diana DeGette, D-Colo., chair of the subcommittee.
The next big wave of the addiction epidemic is already cresting, with overdose deaths now rising from methamphetamine, cocaine and benzodiazepines, said Kody Kinsley, deputy secretary of behavioral health and intellectual and developmental disabilities for North Carolina's health department.
Since last year, methamphetamine has been detected in more deaths nationally than opioids, such as oxycodone and hydrocodone, said Rep. Brett Guthrie, R-Ky., the subcommittee's ranking member.
In 14 of the 35 states that report overdose deaths to the federal government on a monthly basis, methamphetamine was involved in more deaths than fentanyl, Guthrie said.
"The threats are evolving and the fight is not over," he said. "It's important to not let our foot off the gas."
"This is an alarming trend that threatens to become the next epidemic," added Rep. Frank Pallone, D-N.J., chairman of the Energy and Commerce Committee.
Pallone, DeGette and Guthrie joined other bipartisan leaders on the committee in asking the heads of the Departments of Health and Human Services and Homeland Security, as well as the Drug Enforcement Administration about what their agencies were doing not only to curb opioid addiction but also to rein in the rise of cocaine and methamphetamine use.
Cocaine was involved in 14,948 drug overdose deaths in 2017, accounting for one in five overall overdose deaths that year, the lawmakers noted in their Jan. 14 letters to the agency chiefs.
In 2017, more than 10,000 Americans died from an overdose involving psychostimulants, including methamphetamine, a 37% increase from 2016, they said.
"Our country's fight against illicit substances must be multifaceted and we want to ensure that the appropriate attention and resources are devoted to combat these other substances as well," Pallone and the other committee and subcommittee leaders wrote.
Because federal funding in recent years to address the U.S. addiction crisis has largely been directed specifically at opioid use and abuse, that lack of flexibility has impeded some states' efforts to respond to the reemergence and growing threat of overdoses from cocaine and methamphetamine, state health department officials testified at the Jan. 14 hearing.
"We need flexibility to address the system not a substance," Jennifer Smith, secretary of Pennsylvania's Department of Drug and Alcohol Programs, told the subcommittee. "We need consistency with funding vehicles and reporting mechanisms where possible."
Pennsylvania's greatest challenge has been recruiting, training and retaining the workforce it needs to address the growing crisis in cocaine and methamphetamine addiction and overdose deaths, Smith said.
"There is opportunity to be more deliberate in allowing for the flexibility so that we can look more upstream and engage more at the community level," Rhode Island's Alexander-Scott said.
In the recent fiscal 2020 government funding bill, Congress decided to let states use some of the $1.5 billion in funds granted through the U.S. Substance Abuse and Mental Health Services Administration to address stimulant use "in response to the changing drug abuse landscape," DeGette noted.
Those grants, North Carolina's Kinsley said, have been the only sustainable tool to help his state build the workforce it needs to address the addiction epidemic.