Drug Abuse Deaths and the Associated Press

The CDC Report on Increases in Drug and Opioid Overdose Deaths

First of all, let's make note of the fact that the CDC report is not 200 words long, but 3200 words long. In movie-speak, that means that when the media reported on the story, they left most of it on the cutting room floor. So, what got dumped? As it turns out: the details. And as they say, the Devil is in the details. In broad terms, according to the report, the rate for drug overdose deaths has increased approximately 140% since 2000, driven largely by opioid overdose deaths. This epidemic isn't being driven by illicit drugs, but by a surge in the use of prescription opioid painkillers. According to government statistics, nearly 1.9 million Americans now abuse or are dependent on legal opioids. On the slightly positive side, after increasing steadily every year since the 1990s, deaths involving the most commonly prescribed opioid pain relievers declined slightly in 2012 and remained steady in 2013, showing some signs of progress. Unfortunately, that pause was brief as drug overdose deaths jumped significantly in the last year of the study--from 2013 to 2014. In fact, in 2014, 19,000 people fatally overdosed on prescription painkillers, which represents a 16 percent increase over 2013. Increases in opioid overdose deaths were the main factor in the increase in drug overdose deaths. The death rate from the most commonly prescribed opioid pain relievers (natural and semisynthetic opioids) increased 9%. Concomitantly, the death rate from heroin increased 26%, and the death rate from synthetic opioids, a category that includes illicitly manufactured fentanyl and synthetic opioid pain relievers other than methadone, increased 80%. Nearly every aspect of the opioid overdose death epidemic worsened in 2014. And then there's heroin. In fact, heroin overdose deaths have been sharply increasing since 2010. Surprisingly, as we will discuss later, heroin overdose deaths may not mean quite what you think they mean.

Now, as bad as those broad statistics are, the details behind this epidemic of drug overdose deaths are even worse. Since 2000, the rate of deaths from drug overdoses has increased 137%, including a 200% increase in the rate of overdose deaths involving both opioid pain relievers and heroin. During 2014, a total of 47,055 drug overdose deaths occurred in the United States. From 2013 to 2014, the largest increase in the rate of drug overdose deaths involved synthetic opioids, other than methadone (i.e., fentanyl and tramadol), which nearly doubled from 1.0 per 100,000 to 1.8 per 100,000. Meanwhile, as already stated, heroin overdose death rates increased by 26% from 2013 to 2014 and have more than tripled since 2010, from 1.0 per 100,000 in 2010 to 3.4 per 100,000 in 2014.

As the CDC report explained, from 2000 to 2014, nearly half a million persons in the United States died from drug overdoses. But it gets worse. The killer statistic is that more people died from drug overdoses in the United States in 2014 than during any previous year on record. In 2014, there were approximately one and a half times more drug overdose deaths in the United States than deaths from motor vehicle crashes or gun violence.4 Let that sink in for a moment. Again, we're talking about prescription pain relievers and heroin as the main drugs associated with these overdose deaths, and, surprise, those heroin deaths are likely connected to prescription pain relievers, not to junkies on the street. In summary, the 2014 data demonstrates that the United States' opioid overdose epidemic includes two distinct but interrelated trends: a 15-year increase in overdose deaths involving prescription opioid pain relievers and a recent surge in illicit opioid overdose deaths, driven largely by heroin.

But what does that mean?

Drug overdose deaths involving heroin have continued to climb sharply, with heroin overdoses more than tripling in 4 years. This increase mirrors large increases in heroin use across the country and has been shown to be closely tied to opioid pain reliever misuse and dependence. Past misuse of prescription opioids is the strongest risk factor for heroin initiation and use, specifically among persons who report past-year dependence or abuse.5 As it turns out, the increased availability of heroin, combined with its relatively low price and high purity (compared with diverted prescription opioids) appear to be major drivers of the upward trend in heroin use and overdose.6 Finally, illicit fentanyl is often combined with heroin or sold as heroin. Illicit fentanyl might be contributing to recent increases in drug overdose deaths involving heroin. Therefore, increases in illicit fentanyl-associated deaths might represent an emerging and troubling feature of the rise in illicit opioid overdoses that has been driven by heroin.

Bottom line: we're not talking about your typical junkies now, but average people (your friends, neighbors, and co-workers) migrating from prescription pain killers prescribed by their doctors to addiction and then to heroin--and dying as a result.

The Backstory Available to Anyone Who Looked

In the old days, when reporters actually worked stories and practiced journalism, they would have run with the CDC report (heck, they would have actually looked at the CDC report itself rather than merely copying the AP summary of that report) and dug into the story behind it--perhaps even turning it into a series of reports exposing the underbelly of what has grown to become one of the leading causes of death in the United States. But that's when reporters were paid to actually ask questions.

Today, not so much.

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