Death Rate From Synthetic Opioids Soars, Driven by Fentanyl

America’s opioid epidemic shows no signs of letting up—driven by fentanyl, the death rate for synthetic opioids other than methadone skyrocketed by 72.2% from 2014 to 2015. Heroin death rates climbed 20.6%, putting the overall number of deaths from opioids at 33,091 for 2015, or 63% of all drug overdose deaths.

The CDC reported the grim statistics today in its Morbidity and Mortality Weekly Report.

So destructive is the grip of opioids—which start with prescription drugs and lead to illicit forms like heroin—that deaths from these drugs helped push 2015 US life expectancy down 0.1 a year to 78.8 for the first time in a generation.

The CDC has responded in the past year with a Guideline for Prescribing Opioids for Chronic Pain, with efforts to boost access to and use of prescription monitoring programs, and by supporting law enforcement efforts to limit the illicit opioid supply. Local efforts have included efforts to increase training and access to naloxone (Narcan), to reverse the effects of overdose, but this has been hampered by price increases. (Information on prescribing guidelines in primary care and emergency practice can be found here.)

However, the new MMWR finds that efforts to curtail use of prescription opioids, and to reduce reliance on methadone, have been offset by the rise of illegal forms, especially fentanyl. The report states, opioid death rates increased from 2014 to 2015, up 15.6%; overall, drug overdose deaths rose 11.4% from the prior year, beating 2014’s count which was already the worst on record. From 2010 to 2015, overdose deaths were up in 30 states and stable in 19. In 2 states, overdoses were decreasing, but spiked at the end of the period.

“The number of deaths involving opioids other than methadone have been associated with the number of drug products obtained by law enforcement testing positive for fentanyl, but not with fentanyl prescribing rates,” the report finds.

In raw numbers, the problem with opioid deaths is worst among white men ages 25 to 44, and this group saw the percentage largest increase in deaths in the past year at 8.8%. The South has a higher number of deaths, but pockets of the Northeast are seeing bigger year-over-year increases, with New Hampshire standing out—consistent with the reports that candidates heard during the 2016 presidential campaign.

Among women, the highest number of deaths still come among those aged 45 to 64 years. But younger women—those aged 25 to 44—saw a 6.7% jump in the death rate that researchers said was statistically significant.

A small portion of the reported increase may be due to better testing and reporting of specific drugs, the CDC found. States still vary in reporting the specific drug on death certificates when an overdose death occurs, but rates are improving.

The report states that the Drug Enforcement Agency recently identified “prescription drugs, heroin, and fentanyl as the most significant drug-related threats in the United States,” and that the problem of “nonmedical use” of prescription drugs continues to be a huge problem.

“It is important to focus efforts on expanding opioid disorder treatment capacity, including medication-assisted treatment and including linkage into treatment,” the report concludes.

Reference

Rudd RA, Seth P, David F, Scholl L, Increases in drug and opioid-involved overdose death—United States, 2010-2015 [published online December 16, 2016]. Morb Mort Wkly Rpt. 2016; 65. DOI: http://dx.doi.org/10.15585/mmwr.mm655051e1.