While one public health crisis demands nearly all of our attention, another rages on in the background.

Deaths from drug overdose have continued to climb in 2020 after spiking again in 2019, taking the air out of the any optimism generated by 2018, when fatal overdoses nationwide dropped for the first time 25 years.

No, the drug crisis has not gone away, even if it has ceded the stage to the all-encompassing COVID-19 pandemic. If fact, in many ways it is getting worse — stronger, more difficult to manage.

The response, never enough even when the crisis was in the forefront, has to keep up.

FALSE HOPE

Drug overdoses killed a record number of Americans last year, nearly 72,000 — higher than the peak years of deaths from car accidents, guns or AIDS.

That number represented a 5% increase from 2018, when the first drop in a quarter century raised hopes that measures put in place across the country were finally taking hold.

But overdose deaths climbed back in 2019, and have continued to rise in 2020, 13% according to an analysis released last week by the New York Times.

The same scenario has played out in Maine. After drug deaths rose every year from 2011 to 2017, topping out at 417, they fell in 2018, which was taken as a signal that moves by the Legislature to increase drug treatment, harm reduction and prevention were having their intended effect. With the election of Gov. Janet Mills and a renewed commitment to fighting the epidemic, we were hopeful that the trend would continue.

But overdose deaths in Maine were back up 7 percent last year, a trend that has continued this year, with deaths in the first three months up 23% over the same quarter a year ago. Portland police last week reported a total of 86 overdoses since May 1 alone, with seven fatal.

Rhode Island and Vermont, the Times reported, are also among the states with large increases in overdose deaths this year.

Maine hasn’t sat idly by. Treatment is more widely accessible. Treatment is now available for incarcerated persons, before and after they are released, a precarious time. The overdose-reversing drug naloxone is more widely available.

Those initiatives likely saved lives. But they’ve been outpaced by the changes in the drug crisis.

CHANGING CRISIS

The crisis has always been driven by opioids, and those opioids are getting stronger. Fentanyl, a synthetic drug far more potent than heroin, is now the opioid of choice, and it is a killer. Once mainly seen in the Northeast and the Rust Belt, fentanyl is now spreading west, bringing death with it.

At the same time, methamphetamine, once relegated to the West, is coming east. In Maine and around the country, stimulants are becoming a bigger factor in overdoses, typically in combination with fentanyl.

And unlike with opioids and naloxone, there is no way to instantly reverse a stimulant overdose, nor is there a medication-assisted treatment like methadone or Suboxone for meth or cocaine.

Further complicating matters is the pandemic, which increased isolation and anxiety, put jobs in peril and disrupted routines, all factors that drive the misuse of substances. Treatment providers and advocates have adapted, but it has become harder to treat people in recovery, particularly those in vulnerable populations.

Where does this leave us? With a lot more to do.

MORE TO DO

There remain large holes in the accessibility of proven medication-assisted treatments, and there must be more support for people in recovery, including housing.

In Maine and across the country, still too many people end up incarcerated only as a result of addiction, then are unable to get the help they need.

Work on prevention — on keeping people away from taking drugs in the first place — is starting to take hold, but we won’t see the benefits for a while.

More immediately, there needs to be investment in harm reduction. Naloxone should be everywhere. Needle exchanges prevent disease and provide a venue for interacting with people with addiction, letting them know what they can do if they want help. When overdoses occur, they should be treated like a health event, not a crime scene, so that people feel safe calling for first aid if someone needs it.

A lot of what is necessary will be difficult, and expensive. Some of it will make people uncomfortable.

But without it, things will get worse. 2018 may have momentarily looked like a peak in the drug crisis, but 2020 has shown that we have more to climb before coming back down the other side.