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Substance Use and Overdose Deaths

Oct 19, 2021 | 4 min read

Key Takeaways

  • More people died of overdoses last year than in any other one-year period in U.S. history.
  • The opioid substance use crisis originated in the 1990s, but stigma and the COVID-19 pandemic have likely perpetuated it.
  • In the workplace, employers can help employees who may be struggling with substance use disorder.


While the COVID-19 death rate made the headlines, more people died of overdoses last year than in any other one-year period in U.S. history.1

The Centers for Disease Control and Prevention (CDC) released startling drug overdose statistics in July—rates increased by as much as 30% in 2020 over 2019.2

Estimated overdose deaths from opioids increased from 50,963 in 2019 to 69,710 in 2020.3 The synthetic opioid Fentanyl was responsible for about 42,700 of overdoses in 2020.4  Moreover, cocaine deaths also increased, as did deaths from natural and semi-synthetic opioids (such as prescription pain medication).5

The National Institute on Drug Abuse stated that the overdose death toll of more than 93,000 was “simply horrifying,” calling for radical change to address the drug crisis.6


Infographic showing statistics for the 30% increase in drug overdoses, and how 42,700 were related to Fentanyl overdoes, and 93,000 resulted in death.



The COVID-19 pandemic may have worsened the crisis


During a year that was like no other, the pandemic likely exacerbated the crisis based on these reasons:

  • Social isolation unexpectedly upended many individuals’ recovery support.
  • Long-standing substance use disorder support meetings had to shut down and many treatment programs went remote.
  • The isolation, fear, and anxiety that people experienced from March 2020 forward resulted in increased substance use to cope with those feelings. People in recovery were impacted even more profoundly than those without a history of substance use disorder.



Stigma is the main reason for a continuing crisis


The National Institute on Drug Abuse defines addiction as a treatable medical condition, but it is often considered by the public to be a weakness, character defect, and sign of social deviance. The institute notes that this is even true within healthcare systems, leading to the inability for some people to get proper care.7

In 2017, a Johns Hopkins survey asked people, “Are individuals who are addicted to prescription opioids to blame for the problem?” Seventy-eight percent answered yes. 8



The opioid substance use crisis didn’t happen overnight; it originated in the 1990s


When discussing combatting stigma and the continued crisis, it’s also important to examine the history of the crisis. In 2020, Prudential released research on the connection between chronic pain and opioid dependence. We stated that the pharmaceutical companies pushed opioids as a safe pain management solution in the 1990s, assuring physicians that addiction would not be an issue. As physicians wrote more opioid prescriptions, their patient satisfaction scores relative to pain management in the hospital increased, too. Unfortunately, addiction rates subsequently rose after hospital discharge.9

Fentanyl, the semi-synthetic opioid, also emerged in the 1990s. Fentanyl was used in the 1950s and 1960s as a miracle pain medication. Because the drug is up to 300 times more potent than morphine, it was designed as a last resort for terminal patients in severe pain that couldn’t be managed with less potent drugs. Fentanyl is essentially legal heroin, gaining popularity in the 1990s as a more mainstream pain treatment.10 It’s highly addictive but cheaper to make than heroin. As a result, street heroin is often cut with Fentanyl. Drugs sold as OxyContin are sometimes actually Fentanyl.  Because the lethal dose for Fentanyl is only .002 grams, it’s often the culprit in unexpected overdoses.11



Employers can consider options to help employees struggling with substance use


  • Ensure there’s chronic pain/surgery support for employees to reduce opioid use/abuse risk.
  • Incorporate substance use disorder into campaigns to reduce mental health stigma.
  • Encourage leaders to share their experiences with substance use disorder.
  • Educate managers on the signs of emerging substance use disorder and equip them to make referrals for care.
  • Examine your health plan benefits to make sure they cover substance use disorder treatment.
  • Work with your Employee Assistance Program to offer resources for those seeking support groups/treatment.
  • Ensure the workplace health plan requires evidence-based treatment protocols for substance use disorder
  • Provide transitional return-to-work options for those reintegrating to the workplace after treatment.

A key to an employer’s understanding is that substance use disorder is a chronic, relapsing, and remitting disease. The National Institute on Drug Abuse concludes that a common mistake in addressing the crisis is that we often only care for those who are drug-free. To reduce the overdose rate, the institute states, we must offer care and compassion to those still using and those who are amid a relapse.12



Since Prudential published a chronic pain and opioid use disorder article in 2020, pharmaceutical issues have come full circle


As the data for overdose deaths was released in 2021, a settlement involving four pharmaceutical companies for $26 billion was reached, and the money was distributed to the states and local governments for opioid treatment and prevention programs. This could be a turning point as the spotlight is shown on the crisis, the stress of the pandemic continues, and states are given more resources.13 More work is needed to raise community awareness and reduce stigma.




Ph.D., CRC, LPC Vice President, Health and Productivity Practice, Prudential

Dr. Kristin Tugman has more than 20 years’ experience as a health and productivity consultant. Her work is founded on a specific cognitive behavioral model to help individuals overcome psychological barriers and return to productivity. In addition, she’s the author of several publications on the psychological aspects of disability. A certified rehabilitation counselor and licensed professional counselor, Dr. Tugman earned a master’s in rehabilitation counseling from Georgia State University and a Ph.D. in industrial and organizational psychology from Capella University. Dr. Tugman leads a team focused on identifying disability trends that impact Prudential customers and making actionable recommendations to help maximize productivity and minimize absence.



MS, LCMHC, CCM Vice President, Disability Claims, Prudential

Gail Ballin is a clinical leader with proven success in all areas of operations. She is solution-focused with solid ability to assess business needs and identify efficiencies that result in better workflows, cost savings, and an improved client and employee experience. She has a master’s degree in counseling from Nova Southeastern University and is a licensed professional counselor with over 20 years of experience as a clinician. She spent close to 20 years in the disability and absence industry before joining Prudential in 2019. Gail leads a team of professional resources with clinical, medical, behavioral health, and vocational rehabilitation expertise. Her teams focus on assessing wellness, functional capacity, and return to work.


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The Prudential Insurance Company of America (Prudential)


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