As US Life Expectancy Drops, Unintentional Opioid Deaths Increase

Newly released statistics published in JAMA illustrate a sharp increase in unintentional US opioid deaths.

The percentage of unintentional opioid deaths rose from 73.8% in 2000 to 90.6% in 2017 (P <.001) out of all deaths related to the drugs, according to a study published Tuesday.¹

Specifically, the number of unintentional opioid related deaths rose from 2.2 to 13.21 per 100,000 people between 2000 and 2017 (trend: 9.19 [95% CI, 7.91-10.46]).

During that same time, opioid-related suicides rose from 0.27 to 0.58 per 100,000 people (trend: 0.30 [95% CI, 0.21-0.38]).

Researchers used codes from the International Statistical Classification of Diseases and Related Health Problems, Tenth Revision to determine which drug overdose deaths involved opioids and whether they were unintentional, suicide, or undetermined. All of the data reflect death rates of adults aged 15 and older.

In 2017 alone, there were 47,506 opioid deaths, excluding homicides.

Due to the sensitive nature of suicide classifications, statistics differentiating self-imposed and undetermined deaths can be murky. However, “undetermined overdose deaths tend to more closely resemble suicides than unintentional deaths,” researchers said.

Although the percentage of opioid-related suicides decreased from 9% to 4% from 2000 to 2017, “the rate of opioid-related suicides as well as unintentional deaths significantly increased” during this time.

According to researchers, compared to those who died from undetermined intents, victims of opioid-induced suicide “tended to be older (mean age, 51.7 vs 42.7 years), female (56.3% vs 34.9%), and white (89.1% vs 75.5%) (all P <.001).”

These numbers correspond with a wider trend of decreasing life expectancy in the United States. A separate study published by JAMA notes that “Between 1959 and 2016, US life expectancy increased from 69.9 years to 78.9 years but declined for 3 consecutive years after 2014.”²

Currently, the US ranks 38^th in the world for life expectancy and multiple factors have contributed to the decline. According to JAMA researchers, the main culprits behind the decline are overdoses, suicides, and organ system diseases.

Individual states have taken matters into their own hands to directly address overdose deaths, a potentially preventable root cause of decreased life expectancy.

This week Iowa announced it will mail free naloxone, or Narcan, kits to residents after they complete a video consultation with a pharmacist. Narcan, a drug designed to reverse opioid overdoses, has become a popular weapon against the epidemic.

According to an article from Iowa Public Radio, the program is meant to eliminate any barriers to accessing the drug.

The opioid initiatives director at the state Department of Public Health, Kevin Gabbert said in a statement, “What we're doing is we're trying to make sure that any individual, any Iowan, that wants to have a Narcan kit because they're concerned about someone who uses opioids has one… The problem is a cost per prescription could be upwards of $150 for a two pack or for a two-dose kit. For many individuals, it's a significant cost.”

The state suffered 138 deaths from opioid overdoses in 2018, which is down from the 2017 total of 207.

The administration of naloxone has a high reversal rate of 93%, according to data collected in Massachusetts, which makes it an appealing option for public health officials and first responders.

In addition, many states have brought lawsuits against opioid manufacturers pressuring them to pay for damages caused by negligent business practices and constant endorsement of addictive opioids.

Michigan, a state that suffered over 2000 opioid-related deaths last year, plans to file a lawsuit in the near future, joining a growing list of states hit the hardest from the epidemic.

References

1. Olfson M, Rossen LM, Wall MM, Houry D, Blanco C. Trends in intentional and unintentional opioid overdose deaths in the United States, 2000-2017. JAMA. 2019;322(23): 2340-2342. doi: 10.1001/jama.2019.16566.

2. Woolf SH, Schoomkaer H. Life Expectancy and Mortality Rates in the United States, 1959-2017. JAMA. 2019;322(20):1996-2016. doi:10.1001/jama.2019.16932.