On Tuesday, July 13, 2021, President Biden announced the nomination of Rahul Gupta as the head of the Office of National Drug Control Policy, a position many have referred to as the “drug czar.” A day later, the CDC released preliminary data that showed a record 93,000 people died of a drug overdose last year in the midst of the COVID-19 pandemic. The numbers represent one of the biggest year-to-year increases ever as the number had already been at a record total of 72,000 drug overdose deaths the previous year.  


As has been the case over the last decade, the most significant increase is due to opioids, with most deaths attributed to the substitution of heroin and fentanyl for prescription opioids. The 93,000 are in stark contrast to the start of this century when 17,415 people died of all drug overdoses in 2000.


The day before the data release, the President selected Dr. Gupta, from West Virginia’s public health commissioner. He has been known for some of his strategies in that state. West Virginia is one of the top states regarding the spread and use of opioids, much of it distributed illegally. Gupta’s approach took a deep dive into data by examining who the victims were. In a recent interview, he said that physicians know the risk factors for heart disease and use them to screen patients and prescribe treatment, but “We didn’t have something like that for opioids.” As a result, his staff examined various databases, including Medicaid, death certificates, and criminal records, to determine who to focus resources on and what programs and policies might help them achieve it. Based on that analysis, the West Virginia results showed a pattern of men being twice as likely as women to die of an overdose and specific lines of work like factory and construction work with a much higher risk of overdosing.


Some of that analysis has been done at the national level, with certain states hit hard by the trafficking in prescription opioids. According to earlier CDC reports from three years ago, overdose deaths remained stable from 2009 through 2013 but then headed upward at about 27 percent each year from 2013 through 2018. At that time, approximately 80% of overdose deaths involved opioids and three of four opioid overdose deaths involved illicitly manufactured fentanyl (IMFs). 


A 2018 report by the Assistant Secretary for Planning and Evaluation (ASPE) examined the impact of increased opioid use on foster care.  Substance Use, the Opioid Epidemic, and the Child Welfare System: Key Findings from a Mixed Methods Study found a 10 percent increase in overdose death rates corresponded to a 4.4 percent increase in the foster care entry rate and a ten percent increase in the hospitalization rate due to drug use corresponded to a 3.3 percent increase in the foster care entry rate. At the time, the report indicated that more research was needed to understand better how economic opportunity and substance use interact at the community level, but they also conclude that action to address the risks and consequences of the opioid epidemic in communities simultaneously facing economic challenges need not wait. 


In announcing his nomination, the Administration pointed out that Dr. Gupta would be the first physician to lead the office, which was created over 30 years ago under President Ronal Reagan’s war on drugs.