Note: This was originally written 12/27/17 but not posted. I was on a writing roll, but unforunately my verocity resulted in this unpublished post. It’s never a bad time to consider the reality of the opioid crisis and finding this article has me thinking about what has actually been done since a State of Emergency was declared regarding this epidemic. More on that to follow in a future post. Stay tuned!
In 2016, the age-adjusted rate of drug overdose deaths in the United States was more than three times the rate in 1999.
Last month, In December, the U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES Centers for Disease Control and Prevention National Center for Health Statistics released NCHS Data Brief 294 (Hedegaard & Miniño, 2017). This 8 page report shook me to the core for many reasons. Let’s look at some of the the ‘Key Findings’:
In 2016, there were more than 63,600 drug overdose deaths in the United States (Figure 1).
• The age-adjusted rate of drug overdose deaths increased from 6.1 per 100,000 standard population in 1999 to 19.8 in 2016 (Figure 1). The rate increased on average by 10% per year from 1999 to 2006, by 3% per year from 2006 to 2014, and by 18% per year from 2014 to 2016.
• This age-adjusted rate of drug overdose deaths in 2016 (19.8 per 100,000) was 21% higher than the rate in 2015 (16.3).
• Among persons aged 15 and over, adults aged 25–34, 35–44, and 45–54 had the highest rates of drug overdose deaths in 2016 at around 35 per 100,000.
• West Virginia (52.0 per 100,000), Ohio (39.1), New Hampshire (39.0), Washington D.C. (38.8), and Pennsylvania (37.9) had the highest observed age-adjusted drug overdose death rates in 2016.
• The age-adjusted rate of drug overdose deaths involving synthetic opioids other than methadone (drugs such as fentanyl, fentanyl analogs, and tramadol) doubled between 2015 and 2016, from 3.1 to 6.2 per 100,000.
The rates of drug overdose deaths increased from 1999 to 2016 for all age groups studied (Figure 2).
● Rates in 2016 were highest for persons aged 25–34 (34.6 per 100,000), 35–44 (35.0), and 45–54 (34.5).
● From 2015 to 2016, the greatest percentage increase in the drug overdose death rates occurred among adults ages 15–24, 25–34, and 35–44 with increases of 28%, 29%, and 24%, respectively.
● From 2015 to 2016, the drug overdose death rates for adults aged 45–54, 55–64, and 65 and over increased 15%, 17%, and 7% respectively.
In 2016, 22 states and the District of Columbia had age-adjusted drug overdose death rates that were statistically higher than the national rate (Figure 3).
● 22 states and the District of Columbia had drug overdose death rates that were higher than the national rate (19.8 per 100,000); 5 states had rates that were comparable to the national rate; and 23 states had lower rates (Figure 3).
● West Virginia (52.0), Ohio (39.1), New Hampshire (39.0), and Pennsylvania (37.9) were the four states with the highest observed age-adjusted drug overdose death rates. The District of Columbia had a rate of 38.8 per 100,000.
● Iowa (10.6), North Dakota (10.6), Texas (10.1), South Dakota (8.4), and Nebraska (6.4) were the five states with the lowest observed age-adjusted drug overdose death rates.
The age-adjusted rate of drug overdose deaths involving synthetic opioids other than methadone doubled from 2015 to 2016 (Figure 4).
● The rate of drug overdose deaths involving synthetic opioids other than methadone, which include drugs such as fentanyl, fentanyl analogs, and tramadol, increased from 0.3 per 100,000 in 1999 to 1.0 in 2013, 1.8 in 2014, 3.1 in 2015, and 6.2 in 2016. . The rate increased on average by 18% per year from 1999 to 2006, did not statistically change from 2006 to 2013, then increased by 88% per year from 2013 to 2016.
● The rate of drug overdose deaths involving heroin increased from 0.7 in 1999, to 1.0 in 2010, to 4.9 in 2016. The rate was steady from 1999 to 2005, then increased on average by 10% per year from 2005 to 2010, by 33% per year from 2010 to 2014, and by 19% from 2014 to 2016.
● The rate of drug overdose deaths involving natural and semisynthetic opioids, which include drugs such as oxycodone and hydrocodone, increased from 1.0 in 1999 to 4.4 in 2016. The rate increased on average by 13% per year from 1999 to 2009 and by 3% per year from 2009 to 2016.
● The rate of drug overdose deaths involving methadone increased from 0.3 in 1999 to 1.8 in 2006, then declined to 1.0 in 2016.
Drug poisoning (overdose) deaths: This includes deaths resulting from unintentional or intentional overdose of a drug, being given the wrong drug, taking a drug in error, or taking a drug inadvertently.
Natural and semisynthetic opioids: Includes such drugs as morphine, codeine, hydrocodone, and oxycodone.
Synthetic opioids other than methadone: Includes such drugs as fentanyl, fentanyl analogs, and tramadol.
I’ve been writing about the dangers of fentanyl for over 5 years now. I first wrote about Fentanyl and its effect on society when it became clear that it was being cut into heroin allowing dealers to meet the demand for heroin that skyrocketed after the government cracked down on prescription opiates which resulted in many of those users moving to heroin in a desperate attempt to prevent opiate withdrawal. I originally proposed that it was the reason behind the increase of fatal heroin overdoses at the time. This number has only grown and the presence of fentanyl laced heroin only became national news after the death of Philip Seymour Hoffman, but many fatal overdoses had already occurredacross the country with users of heroin injesting fentanyl laced heroin unbeknownst to them. Regardless, it’s a mess of a situation and very scary as even more powerful synthetic opiates have made their way into the country and the street drugs sold to users not only in major cities but all across the country.
For some perspective, this picture illustrates the amount of highly pure heroin compared to Fentanyl which would likely kill a 200lb male who was not a long term opiate user, and even then, the results could be fatal for the user, EMT, and family members and loved ones who can injest a fatal dose of fentanyl just by touching or breathing it.
Photo: New Hampshire State Police Forensic Department
Hedegaard H, Warner M, Miniño AM. Drug overdose deaths in the United States, 1999– 2016. NCHS Data Brief, no 294. Hyattsville, MD: National Center for Health Statistics. 2017. ISSN 1941–4935 Online ed. DHHS Publication No. 2018–1209 CS287423.
Hedegaard H, Warner M, Miniño AM. Drug overdose deaths in the United States, 1999– 2015. NCHS data brief, no 273. Hyattsville, MD: National Center for Health Statistics. 2017. Available from: https://www.cdc.gov/nchs/data/databriefs/db273.pdf.
Mounteney, J., Giraudon, I., Denissov, G., & Griffiths, P. (2015). Fentanyls: Are we missing the signs? Highly potent and on the rise in Europe. The International Journal on Drug Policy, 26 (7), 626-631.