Big Increase, Geographic Spread of Synthetic Opioid-Related Deaths

On December 21, 2018, the CDC published a report that found that U.S. overdose death rates linked to synthetic opioids, likely from illicitly manufactured fentanyl (IMF), increased more than 45 percent from 2016 to 2017, while death rates from heroin and prescription opioids – still far too high – remained stable. More than 702,000 Americans have died from drug overdoses from 1999 to 2017 – about 10 percent of them in 2017 alone.


“The drug overdose epidemic continues to evolve, with the involvement of many types of drugs including opioids, cocaine, and psychostimulants,” said Debra Houry, M.D., M.P.H., director of the CDC’s National Center for Injury Prevention and Control. “This underscores the urgency for more timely and localized data to inform public health and public safety action.”


Opioids were involved in over two-thirds of overdose deaths in 2017. Of the 35 jurisdictions reporting data sufficient for analysis, 23 states and the District of Columbia saw increased rates of death linked to synthetic opioids. IMF likely drove the 1.5-fold increase in deaths involving synthetic opioids from 2016 to 2017.


Previously, deaths involving synthetic opioids mainly occurred east of the Mississippi River. The latest available data now show eight states west of the Mississippi had significant increases in such deaths: Arizona, California, Colorado, Minnesota, Missouri, Oregon, Texas, and Washington.


While overdose deaths involving synthetic opioids expanded, heroin- and prescription-opioid-involved deaths remained stable from 2016 to 2017. However, overdose death rates involving heroin and prescription opioids were, respectively, seven and four times higher in 2017 than in 1999.


The rate of drug overdose deaths in 2017 was 21.7 per 100,000 population. The rate increased by nearly 10 percent from 2016. The rates of overdose deaths involving cocaine increased by more than 34 percent. The rate of overdose deaths involving psychostimulants increased by more than 33 percent.


Opioid death rates differed across the states examined in this study, with the highest relative increases occurring in North Carolina, Ohio, and Maine. From 2016 to 2017, opioid-involved death rates increased for both sexes; increased among all people in all age groups over the age of 25; and increased among white, black, and Hispanic people. Males aged 25 to 44 had the largest absolute death rate increase. The largest percent change increases in opioid-involved death rates were among blacks (25.2 percent) and adults over age 65 (17.2 percent).


The report reinforced the continued need for response strategies including increasing naloxone availability, educating patients and providers about safe prescribing practices, providing patients with linkage into treatment, and fostering greater collaboration between public health and public safety. All of these strategies may reduce the syndemic of infectious diseases and opioid overdoses, also known as a synergistic epidemic, the aggregation of two or more concurrent or sequential epidemics in a population with biological interactions, which exacerbate the prognosis and burden of disease.


See the CDC Announcement


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