Provisional Data Predict Overdose Death Rates Will Fall for First Time in Decades

Offering cautious optimism, provisional data from the CDC indicate that drug overdose deaths in the United States are on the verge of declining for the first time in decades.

While the final figure is still being determined, the provisional data predict a total of 69,096 drug overdose deaths for a 12-month period ending November 2018, compared with the predicted 72,287 for the 12-month period ending November 2017. If the trend continues through December 2018, it would be the first time annual drug overdose death rates have dropped since the 1990s. In the 3 decades since, drug overdoses have killed approximately 870,000 people.

Indications of declining overdose death rates first emerged in October 2018, when the CDC reported a decline of 2.8% in the number of overdose deaths in the 12-month period ending in March 2018 compared with the 12 months ending in September 2017. However, at the time, public health experts wanted against drawing conclusions based on half a year’s worth of data.

Between 1999 and 2017, the age-adjusted drug overdose mortality rate increased from 6.1 per 100,000 to 21.7 per 100,000, increasing an average of 10% each year from 1999 through 2006, by 3% per year from 2006 through 2014, and by 16% per year from 2014 through 2017. According to CDC data, that rate dropped to 20.7 deaths per 100,000 for the 12 months ending in the second quarter of 2018.

While some states are predicted to see significant drops in drug overdose deaths between November 2017 and November 2018, other states are expected to see their rates continue to climb. Ohio, which had a predicted 4017 overdose deaths in November 2017, is expected to have 5234 overdose deaths in November 2018, representing a 23.3% decrease. Meanwhile, Missouri is expected to see a 15.3% increase (1415 vs 1632) and New Jersey is expected to see a 11.6% increase (2660 vs 2969).

Despite the expected decrease, the United States is not yet out of the woods, with use of methamphetamine on the rise and overdose deaths from synthetic opioids continuing to increase. There will be a predicted 32,159 deaths from synthetic opioids in the 12 months ending in November, up from the predicted 29,092 deaths in the 12 months ending November 2017.

"The provisional drug overdose data does indicate that it is likely we will see a small decline from 2017 to 2018. Provisional data for the 12 months ending November 2018 show a decline of a little more than 3000 deaths compared with the 12-month period ending November 2017. So, it seems that we may have reached a peak in the epidemic," said Robert N Anderson, PhD, chief, Mortality Statistics Branch, National Center for Health Statistics, CDC, in an email to The American Journal of Managed Care^®. "That said, the number of deaths for 2018 is still predicted to be nearly 70,000. That is a lot of people dying much too young. Even if the decline holds once the data are final, it is too soon to declare victory."

Anderson also emphasized that the data are still provisional: "Some cases have not yet been fully investigated or adjudicated, so our data are incomplete. However, our predictive models that take into account the incompleteness of the data tend to perform pretty well, and these models do indicate a small decline. Also, it is really impossible to predict what will happen for the next few years. This may just be a lull in the epidemic or some new deadly drug will be introduced that exacerbates the situation. Hence, our cautious optimism with regard to the provisional data."

However, the provisional data are encouraging. One possibility for the predicted decline in drug overdose deaths could be expanded access to naloxone, which counteracts opioid overdoses. In April 2018, Surgeon General Jerome M. Adams, MD, issued a call for more people to carry naloxone. Shortly after, the FDA approved the first generic nasal spray version of naloxone (Narcan).

States have also tried to increase access to naloxone. On June 18, New Jersey offered the drug for free at pharmacies across the state with no prescription needed. Earlier this week, New Jersey became the first state in the country to authorize paramedics to administer buprenorphine (Suboxone) to patients immediately after reviving them from an opioid overdose using naloxone. The treatment model, according to health officials, will allow for treatment of withdrawal symptoms that can result from a naloxone revival and can also serve as an immediate transition to longer-term treatment. Paramedics with licenses to prescribe controlled substances will have to undergo a separate training program ranging from 8 to 24 hours in order to prescribe the drug.