The Centers for Disease Control (CDC) released a study this February analyzing the precipitous increase in drug overdose deaths from 1999 to 2015. They found that the highest rate of increase was among 55 to 64-year-olds. Heroin overdoses were more frequent in younger age groups and prescription pain overdoses in older groups. The regional distribution was highest in the Northeast, Appalachia, and Western states, but not along the Pacific Coast.
With so much attention and effort being devoted to opioid use disorders, why are high overdose rates persisting? Part of the answer, suggested by Wilson Compton of the National Institute on Drug Abuse, is that we are witnessing not one opioid epidemic but rather a sequence of three. The first dated from the 1990s and was triggered by the over-prescription of opioid pain medication by physicians. The second emerged around 2010 due to the shift from pain pills to heroin, and the third appeared around 2013, related to the appearance of illicitly manufactured synthetic opioids such as fentanyl. The CDC reports on this most recent development can be found on the Centers’ web page.
Secondly, are efforts to address these sources having any success? I believe they are. The number of prescription opioid problems has been declining in response to interventions including the clamping down on some of the more egregious pharmaceutical marketing practices and the education of physicians on a balanced approach to pain management. Last year, the CDC released 12 voluntary guidelines to improve pain management by clinicians, and some states have used these guidelines as the basis for new laws restricting how opioid medications are prescribed.
In addition, there is evidence that increased access to buprenorphine and the availability of methadone programs for heroin addicts are resulting in decreased overdose deaths. This was first demonstrated on a nationwide basis in France and later in Baltimore. An article last month in the prestigious British Medical Journal and an accompanying editorial, summarized studies supporting these conclusions. Despite misunderstandings, ideologically based resistance, and misuse of these medications, the preponderance of evidence is that overdose rates would be even worse if these medications were not available
As for the synthetic high-potency opioids, I am still on the lookout for useful ideas.