Increased social and economic stress and diminished health care capacity contributed to Nevada being one of 28 states placed on “red alert” status for increased risk of death from overdoses from opioids and other drugs, officials announced on Friday.

The National Drug Helpline made the risk determination in late November, citing “reports from law enforcement, state officials and health providers” who pointed to rising overdose deaths around the nation. In Nevada, officials have reported a 50 percent increase in opioid- and fentanyl-involved overdose deaths from the first to the second quarter of 2020, with 98 occurring from January to March, and 147 from April to June.

“The COVID-19 pandemic has presented unprecedented challenges to healthcare systems in the United States. Combined with the ongoing opioid epidemic, this has resulted in a complicated and potentially deadly situation,” the National Drug Helpline report said.

Opioid-related deaths have been on the rise throughout the COVID-19 pandemic in Nevada after declining for the past few years. A report released by the American Medical Association in mid-August showed the national scope of the issue, citing reports from 40 states and Washington, D.C. that showed a rise in overdoses and illicit substance abuse.

Health care providers in the state have previously noted that “fear, anxiety and depression” as a result of the pandemic has had an impact on substance abuse. Limitations on health care capacity because of staff falling sick and treatment centers closing has also impacted the ability of those struggling with addiction to seek treatment.

One study noted by the National Drug Helpline found an increase in the detection of illicit substances in 150,000 random urine drug tests ordered by health care professionals after March 2020, with a notable increase in fentanyl and methamphetamine detection. Additionally, the organization listed health problems caused by opioid abuse that can put individuals at a higher risk for COVID-19, including lung damage and lowered immunity.

State officials are particularly worried about the increased threat of fentanyl, a synthetic opioid. In its prescription form, the drug is used to treat cancer pain, but it is increasingly manufactured illicitly and mixed with stimulants such as methamphetamine and cocaine, leading to unknowing consumption and accidental overdoses.

The American Medical Association released updated policy recommendations on Tuesday for state and local leaders to “reduce stress being experienced by patients with opioid use disorder.” Recommendations include easing barriers to access of medications to treat addiction and reverse opioid-related overdose.

Nevada allows residents to order naloxone, an opioid overdose antidote, through an online system that also provides training on how to administer the drug.