Opioid overdoses increased by roughly 30% across the US in just 14 months between 2016 and 2017, according to a new report by the US Centers for Disease Control and Prevention (CDC).
The CDC called the data a “wake up call to the fast-moving opioid overdose epidemic”. It recorded 142,000 overdoses in US hospital emergency departments between July 2016 and September 2017.
Although not all overdoses in the study were fatal, they are part of the grim toll opioids have taken. In the US in 2016, illicit and prescription drug overdoses killed 64,000 people.
“Our results through September 2017 show opioid overdoses are increasing across all regions, most states for most men and women and most age groups,” said Dr Anne Schuchat, acting director of the CDC.
“We’re currently seeing the highest overdose death rates ever recorded in the United States.” Schuchat later added: “The infrastructure to fully tackle this problem is fragile.”
The CDC’s Vital Signs study looked at two data sets. The first, the Enhanced State Opioid Overdose Surveillance (ESOOS) program, is a snapshot of emergency department data from 16 states.
Eight of those states included saw “substantial” overdose increases of at least 25%. Two states reported overdoses more than doubled – including in Wisconsin with 109% and Delaware with 105% increases. Another dramatic increase occurred in Pennsylvania, where overdoses went up 81%.
Overdoses also increased in “cities and towns of all types”, the report said. Overdoses are often associated with rural America but metropolitan areas with 1 million or more people saw the steepest increase, at 54%.
While the CDC did not look at the source of opioids, Schuchat said illicit fentanyl-laced heroin is “a very major problem right now”.
Almost 100 people are dying every day across America from opioid overdoses – more than car crashes and shootings combined. The majority of these fatalities reveal widespread addiction to powerful prescription painkillers. The crisis unfolded in the mid-90s when the US pharmaceutical industry began marketing legal narcotics, particularly OxyContin, to treat everyday pain. This slow-release opioid was vigorously promoted to doctors and, amid lax regulation and slick sales tactics, people were assured it was safe. But the drug was akin to luxury morphine, doled out like super aspirin, and highly addictive. What resulted was a commercial triumph and a public health tragedy. Belated efforts to rein in distribution fueled a resurgence of heroin and the emergence of a deadly, black market version of the synthetic opioid fentanyl. The crisis is so deep because it affects all races, regions and incomes
“The heroin and illicit drug supply has gotten even more dangerous than it used to be,” she said, adding that the drugs are so toxic that paramedics and police are at risk of poisoning themselves.
Officials emphasized there was significant variation between jurisdictions. A handful of states, such as Kentucky, saw modest decreases but researchers were only cautiously optimistic. They said it was unclear if decreases were persistent or anomalies.
The CDC also used a second data set, the National Syndromic Surveillance Program (NSSP), which covers 60% of emergency departments in 45 states, to look at regional changes. Researchers said overdose rates in that system increased about 30% in all regions and most states.
To curb the crisis, officials said communities would need more naloxone (which reverses overdoses); better access to mental health services and medication-assisted addiction treatment; harm reduction programs to screen for injection-drug associated diseases such as HIV and hepatitis C; and for physicians to use prescription monitoring services.
The study comes just a week after the White House held a week-long opioid summit. Last week, Donald Trump expressed a desire to “sue” opioid manufacturers, and the attorney general, Jeff Sessions, announced the justice department’s support of local lawsuits. The surgeon general, Jerome Adams, said: “Addiction is a chronic disease, and not a moral failing.”
However, neither Congress nor the White House has appropriated new funding to treat people affected by the opioid crisis, despite pleas from public health officials, some of whom have put a starting price tag at $6bn.
Some changes to health programs, especially the public health insurance program for the poor, Medicaid, may be counterproductive to treating people addicted to opioids.
For example, the Trump administration has approved work requirements for Medicaid coverage in Arkansas, Kentucky and Indiana. Those moves are expected to leave thousands of poor or disabled Americans without health coverage, largely thanks to bureaucratic hurdles.
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