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Update on the Opioid Epidemic in U.S.

Drug overdose deaths, including opioid overdose deaths, continue to increase in the United States, according to new data from the federal government.

The Morbidity and Mortality Weekly Report of the Centers for Disease Control and Prevention (CDC) reports that in 2015 more than 52,000 people died from a drug overdose; of those, 33,091 (63.1 percent) involved a prescription or illicit opioid.

Since 2000, more than 300,000 Americans have lost their lives to an opioid overdose.

CDC’s latest national analyses indicate that the increase in opioid overdose death rates is driven in large part by illicit opioids, like heroin and illicitly manufactured fentanyl, a synthetic opioid. The new data show from 2014 to 2015:

• Death rates for synthetic opioids other than methadone (including drugs such as tramadol and fentanyl, referred to as synthetic opioids) increased 72.2 percent
• Heroin death rates increased 20.6 percent
• Synthetic opioid and heroin death rates increased across all age groups 15 and older, in both sexes, and among all races/ethnicities.
• Methadone death rates declined 9.1 percent
• Natural opioids (including morphine and codeine) and semi-synthetic opioids (including commonly prescribed pain medications such as oxycodone and hydrocodone) were involved in more than 12,700 deaths in 2015; death rates increased 2.6 percent from 2014 to 2015 in this category. However, the increase has slowed compared with the increase from 2013 to 2014.

“Too many Americans are feeling the devastation of the opioid crisis either from misuse of prescription opioids or use of illicit opioids,” said CDC Director Tom Frieden, M.D., M.P.H.

Frieden called for action to help health care providers treat pain safely and treat opioid use disorder effectively, as well as support for law enforcement strategies to reduce the availability of illicit opiates and support states to implement programs that can save lives.

State Analyses

During 2010–2015, the rate of drug overdose deaths in the U.S. increased in 30 states and D.C., remained stable in 19 states, and showed decreasing trends followed by increases in two states. This new report includes state analyses of death certificate data for opioid overdoses in 28 states with reporting of specific drugs involved in an overdose. Data for the 28 states show:

• 16 states had increases in synthetic opioid death rates from 2014-2015. The greatest percent increases in death rates were in New York (135.7 percent), Connecticut (125.9 percent) and Illinois (120 percent).
  • Alternatively, when assessing potential burden by absolute rate changes (reflecting the number of deaths and lives affected in each state, per every 100,000 people), Massachusetts, New Hampshire, Ohio, Rhode Island and West Virginia had the largest rate increases of synthetic opioid deaths from 2014 to 2015.
• 11 states had increases in heroin death rates, with the greatest percent increases in death rates in South Carolina (57.1 percent), North Carolina (46.4 percent) and Tennessee (43.5 percent).
  • Alternatively, when assessing potential burden by absolute rate changes (reflecting the number of deaths and lives affected in each state, per every 100,000 people) Connecticut, Massachusetts, Ohio and West Virginia had the largest rate increases of heroin deaths from 2014 to 2015.
• New Mexico, Oklahoma and Virginia had decreases in rates of death involving natural/semi-synthetic opioids.

This latest CDC report shows significant increases across states in death rates from heroin and synthetic opioid deaths that, when coupled with continuing high numbers of fatal overdoses related to natural/semi-synthetic opioid deaths, further illustrate the continued problem with misuse of prescription opioids and the substantial impact of illicit opioids on this epidemic.

“The need to address the full spectrum of substance misuse as a health issue is ever-present,” said Nora D. Volkow, M.D., director of the National Institute on Drug Abuse. “Science-based solutions to reduce illicit opioid use and improve both health and life outcomes for opioid use disorder need to be implemented so we can start breaking down the barriers preventing effective treatment from reaching the millions of Americans who could benefit.”

Public Health and Safety Response

CDC says its report highlights the continued need for public health and law enforcement to work together to prevent overdose deaths, including these actions:

• Improve opioid prescribing to reduce unnecessary exposure to opioids and prevent addiction by training providers and implementing the CDC Guideline for Prescribing Opioids for Chronic Pain issued in March.
• Improve access to and use of prescription drug monitoring programs.
• Protect people experiencing opioid use disorder by expanding treatment capacity and naloxone distribution.
• Implement harm reduction approaches including naloxone distribution and syringe services.
• Support law enforcement strategies to reduce and to improve detection of the illicit opioid supply by working with state and local public health agencies.

The CDC’s guideline for prescribing opioids provides recommendations for the prescribing of opioid pain medication for patients 18 and older in primary care settings.

A National Safety Council survey released in March found that most doctors– 99 percent — are over-prescribing highly addictive opioid medicines, issuing prescriptions for longer than the three-day period recommended, with 23 percent prescribing at least a month’s worth of opioids. And 74 percent of doctors incorrectly believe morphine and oxycodone, both opioids, are the most effective ways to treat pain, when research shows over-the-counter pain relievers such as ibuprofen and acetaminophen offer the most effective relief for acute pain, according to the CDC.

According to a CDC study in May, consumer out-of-pocket spending on opioids has declined, with insurers picking up more of the tab. This study, “Payments for Opioids Shifted Substantially to Public and Private Insurers While Consumer Spending Declined, 1999-2012,” released in Health Affairs, found the most dramatic change in the financing of opioid pain relievers occurred in the public insurance sector.

Opioid abusers cost employers nearly twice as much ($19,450) in medical expenses on average annually as non-abusers ($10,853), according to an analysis by San Francisco-based Castlight Health Inc., a healthcare data and technology company.

Nearly one out of every three (32 percent) opioid prescriptions, which are subsidized by employers, is being abused, according to the Castlight study, “The Opioid Crisis in America’s Workforce,” which also found that nationally on average 4.5 percent of individuals who have received an opioid prescription are abusers and account for 32 percent of total opioid prescriptions and 40 percent of opioid prescription spending.

Another industry study, by the Workers Compensation Research Institute (WCRI), found “noticeable decreases” in the amount of opioids prescribed per workers’ compensation claim in a majority of 25 states studied.

The WCRI study, “Interstate Variations in Use of Opioids 3d edition,” examined interstate variations and trends in the use of opioids and prescribing patterns of pain medications across 25 states. The study compared the amount of opioids prescribed per claim over two roughly 24-month periods of time ending March 2012 and March 2014.

What’s Being Done

In 2016, the U.S. Department of Health and Human Services sent $53 million in funding to 44 states, four tribes and the District of Columbia to improve access to treatment for opioid use disorders and strengthen drug abuse prevention efforts.

This past summer, Congress passed and President Barack Obama signed into law the Comprehensive Addiction and Recovery Act of 2016. The law creates programs and expands treatment access. The bill authorizes $181 million in new spending; Obama had asked Congress for more than $1 billion.

Much of the responsibility falls on states. According to the National Conference of State Legislatures (NCSL) database of legislation on prescription drugs, 48 states, the District of Columbia and Puerto Rico combined passed 266 related laws during 2015 and thus far in 2016. States have been regulating pain clinics, initiating and strengthening prescription drug monitoring programs, authorizing rescue drugs and enacting good Samaritan and other laws.

Doctors are being urged to consider prescribing alternatives to opioids, but some say finding viable options is not always easy, and they can be costly.

Medical schools nationwide are rethinking how they train tomorrow’s doctors on opioids. Dozens of schools have received federal grants to teach a standard interviewing method that helps screen patients for drug abuse.

The past year saw a glimmer of hope from science. U.S. and German researchers reported they have developed a pain-relieving compound that could in the future replace addictive opioids, one that doesn’t interfere with breathing, which is the main cause of prescription painkiller fatalities. The researchers introduced the compound, called PZM21, in a study published in August in the journal Nature. The drug’s development has been funded by the U.S. National Institutes of Health.

Related:

• National Safety Council Survey of Doctors Prescribing Opioids
• Express Scripts Workers’ Compensation Drug Trend Report
• Could This New Drug Ease America’s Opioid Crisis?
• Opioid Alternatives Can Be Hard-to-Find and Costly
• Obama Signs Bill to Curb Opioid Abuse But Decries Low Funding
• Public, Private Insurers Picking Up More of Opioid Drug Costs
• How Medical Schools Are Altering Their Training to Address Opioid Epidemic
• Employers Pay As 32% of Opioid Prescriptions Are Abused: Report
• AIA Applauds Mass. Gov. Baker’s Signing of Opioid Abuse Legislation
• New York Announces Task Force to Combat Heroin, Opioid Abuse
• Study: In 1st Year, 2 Florida Laws Reduced Amount of Opioids Prescribed