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Between May 2019 and May 2020, 81,230 Americans died of drug overdoses—the highest number of drug deaths ever recorded in a 12-month span, the Centers for Disease Control and Prevention reported.

After a drop in 2018, overdoses began increasing again in 2019, before the COVID-19 pandemic, the CDC said in an advisory published last month. But early data shows that spike has accelerated during the pandemic, with the largest overdose increases taking place between March and May—when the first lockdowns began.

The jump in overdoses is largely driven by synthetic opioids like fentanyl, which is significantly more powerful than heroin, the CDC said. The agency urged local and state health departments to expand the use of naloxone, the overdose-reversing drug; make treatment more readily available; and track overdose outbreaks more effectively.

Advocates have raised concerns this year about the need to keep people in addiction safe from both the coronavirus—to which people with opioid addiction are particularly vulnerable—and overdoses.

In a Philadelphia Inquirer article last year about the rising overdose toll around the country, Northeastern University professor Leo Beletsky said lockdown measures must be designed with people who use drugs in mind, making sure they can access overdose-reversal drugs, treatment and economic and social support so they can safely stay home. He added that many response measures are “lacking” in that respect.

CDC Director Robert Redfield told MedPage Today in a statement that the “disruption to daily life” during the pandemic has “hit those with substance use disorder hard.”

“As we continue the fight to end this pandemic, it’s important to not lose sight of different groups being affected in other ways. We need to take care of people suffering from unintended consequences,” he said.