Rising Opioid Overdose Deaths – the Story is More Complex

At first glance, the news sounds depressingly repetitive – another year of rising opioid overdose deaths in Maryland in 2017. Looking more deeply, however, into the details, I find the story becomes more complex. Here are some of the points that caught my attention:

• Total alcohol and drug overdose deaths
  • The number of drug and alcohol-related intoxication deaths occurring in Maryland increased in 2017 for the seventh year in a row, reaching an all-time high of 2282 deaths. This represented a 9% increase from 2016 but was substantially less than the 66% increase that occurred between 2015 and 2016, which was the largest single-year increase that has been recorded.
  • Ages: Deaths of those aged 25-34 years surpassed those aged 45-54 years old. The number of deaths among those aged <25 years decreased.
  • Race: Deaths increased by 12% among Whites, 11% among Hispanics, 5% among Blacks
  • Gender: Deaths are nearly 2.5 times higher among men than women but increased by 14% among women compared with 7% among men.
  • Geography. Several counties had declines (Allegany, Charles, Kent, Somerset, Washington, Wicomico, and Worcester)
• Opioid-related deaths
  • Responsible for 88% of all overdose deaths.
  • Increased by 8%, substantially less than the 70% increase of the previous year.
  • Large increases in fentanyl-related deaths (42%) were responsible for the overall rise in opioid-related deaths.
  • Heroin-related deaths declined by 11%. Most of the deaths occurred in combination with other substances, especially fentanyl (78%).
  • Prescription-opioid related deaths decreased by 1%.
• Cocaine-related deaths began rising in 2014 increased 110% between 2015 and 2016 and increased 49% between 2016 and 2017. 71% percent were in combination with fentanyl, and 50% in combination with heroin.
• Benzodiazepine-related deaths have generally been increasing since 2007. Deaths increased in 2017 by 16% and were largely the result of combination with an opioid.
• Alcohol-related deaths decreased by 11% in 2017. 61% occurred in combination with fentanyl, and 39% occurred in combination with heroin.

What the Overdose Death Numbers Tell Us

Here are some of my thoughts about what these overdose death numbers indicate:

• Some positive results are occurring as a result of considerable efforts made to reduce the overprescribing of prescription opioids, which was the trigger that set off the opioid problem. This progress has been overshadowed by the appearance of fentanyl.
• Benzodiazepines have been a problem for several years, but this has been hidden in the shadows of the opioid problem which gets more headlines because of the fatalities.
• Cocaine is re-emerging as a problem and the old habit of combining it with opioids (“speedballing”) is even more dangerous because of the advent of fentanyl.
• I welcome the decrease in alcohol-related deaths but do not know what to make of this.

The full report from the Maryland Department of Health has many more details and I invite you to look at them.

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