When I first dug through the CDC’s website for an article to include in this week’s Scalpel Weekly News, I skipped this one because the data it is based on stopped in 2012, which is a little stale. But then I noticed that this wasn’t just another lament about the rising rates of heroin overdose. The authors of the CDC study draw a connection between abuse of prescription opioids and heroin use. We often see these two issues addressed, but rarely together. While the report falls shy of asserting a causal link, it certainly opens up avenues for further research that could lead to additional liability related to prescription opioids.
Nationally, death rates from prescription opioid pain reliever (OPR) overdoses quadrupled during 1999 to 2010, whereas rates from heroin overdoses increased by less than 50%.
Individual states and cities have reported substantial increases in deaths from heroin overdose since 2010. The CDC analyzed recent mortality data from 28 states to determine the scope of the heroin overdose death increase and to determine whether increases were associated with changes in OPR overdose death rates since 2010.
The CDC published a report that summarizes the results of that analysis. The report found that from 2010 to 2012 the death rate from heroin overdose for the 28 states increased from 1.0 to 2.1 per 100,000. However, the death rate from OPR overdose declined from 6.0 per 100,000 in 2010 to 5.6 per 100,000 in 2012. Heroin overdose death rates increased significantly for both men and women, all age groups, all census regions, and all racial/ethnic groups other than American Indians/Alaska Natives. OPR overdose mortality declined significantly among males, people under 45 years old, persons in the South, and non-Hispanic whites.
Increases in heroin overdose death rates were significantly associated with increases in OPR death rates. Similar patterns in the death rates for males and non-Hispanic whites, the two populations with the largest numbers of heroin deaths, also were observed, but the associations were not significant.
The rapid rise in heroin overdose deaths follows nearly two decades of increasing drug overdose deaths in the United States, primarily driven by OPR drug overdoses. The number of persons using OPR non-medically on a frequent basis also has grown. From 2002-2004 to 2008–2010, past year heroin use increased among persons reporting frequent nonmedical use of OPR, from 62.0 to 94.7 per 1,000. Moreover, the only increases in past year heroin use were observed among persons who reported past year nonmedical use of OPR.
In a sample of heroin users in a treatment program, 75% of those who began opioid abuse after 2000 reported that their first regular opioid was a prescription drug. In contrast, among those who began use in the 1960s, more than 80% indicated that they initiated their abuse with heroin. Persons who initiated heroin use after 2000 have reported that heroin often is more readily accessible, less expensive, and offers a more potent high than prescription opioids.
For more details, see the Scalpel Weekly News for October 13, 2014.
To Sign Up for the FREE Scalpel Weekly News giving you the latest FDA, CDC, and DOJ alerts, warnings, and announcements, and curated medical litigation cases, CLICK HERE
By Sarah Kelman, JD, and the experts and editors at Medical Law Perspectives.
For more information on painkiller risks and liability issues, see the Medical Law Perspectives, January 2014 Report: Prescription Painkillers: Risks for Patients, Pharmacists, and Physicians
For more information on physician liability when prescribing drugs, see the Medical Law Perspectives, May 2013 Report: Drugs, Dosage, and Damage: Physician Liability for Prescribing or Administering Medication