Synthetic Opioids Overtake Prescription Opioids as Driver of Overdose Deaths in 2016

In 2016, synthetic opioids eclipsed prescription opioids as the most common drug involved in overdose deaths in the United States, a new report in JAMA said Tuesday.

The authors, from the Substance Abuse and Mental Health Services Administration (SAMHSA), part of the National Institute of Drug Abuse, said the findings underscore the rapidly increasing involvement of synthetic opioids in the drug overdose epidemic and in recent increases in overdose deaths involving illicit and psychotherapeutic drugs.

There were 63,632 overdose deaths in the United States in 2016. Of those, 42,249, or nearly 46%, were due to the use of any opioid—synthetic opioids, heroin, or prescription opioids, the report said. Synthetic opioid overdoses alone were 19,413, or 22.7% of overdose deaths.

In 2010, there were 38,329 overdose deaths, with 21,089 coming from any opioid, and 3007 from synthetic opioids alone.

Of the synthetic opioid-related overdose deaths in 2016, most—nearly 80%—involved other drugs or alcohol. The most common coinvolved substances were another opioid (47.9%), heroin (29.8%), cocaine (21.6%), prescription opioids (20.9%), benzodiazepines (17%), alcohol (11.1%), psychostimulants (5.4%), and antidepressants (5.2%).

The report said the actual numbers are, in all likelihood, higher because of limitations in the information on death certificates—for example, certificates that did not list the type of drug(s) involved in the overdose, an omission due to lack of toxicological testing, or failure to record test results.

The news of increased overdose deaths driven by synthetic opioids comes a few weeks after another report said that the number of prescriptions for opioids has been dropping steadily in recent years, with prescription morphine use hitting a peak in 2011.

In addition, Medicare beneficiaries are using fewer opioids, as well, and fewer are using heavy amounts in such a way that trigger monitoring alerts for safety (more than 120 morphine milligram equivalents a day from more than 3 prescribers and from more than 3 pharmacies). The cumulative change in total Medicare beneficiaries meeting criteria for oversight monitoring has dropped 76% between 2011 and 2017. However, some doctors are concerned that restrictions on opioid prescribing are starting to affect care for cancer patients or chronic pain patients, or could even send them to illicit ways to get relief.

The authors of the report, and a SAMHSA spokesperson, said the increase in deaths have come from substantial increase in the availability of illicitly made fentanyl and fentanyl analogs since 2013. Coupled with a lack of awareness about the contaminated illicit drug supply and unpredictability in what synthetic opioids are showing up in the illicit drug supply are what is driving the increase, they said.

“Widespread public health messaging is needed, and clinicians, first responders, and lay persons likely to respond to an overdose should be trained on synthetic opioid risks and equipped with multiple doses of naloxone,” the authors wrote. “These efforts should be part of a comprehensive strategy to reduce the illicit supply of opioids and expand access to medication-assisted treatment for opioid addiction.”

Reference

Jones CM, Einstein EB, Compton WB, Changes in synthetic opioid involvement in drug overdose deaths in the United States, 2010-2016. [published online May 1, 2018]. JAMA. 2018;319(17). doi:10.1001/jama.2018.2844.