Fentanyl Driving Overdose Deaths in the US, CDC Says

The CDC reported the number of drug overdose deaths per year increased 54% from 2011 to 2016, with the synthetic drug fentanyl involved in most overdoses in 2016, although actual numbers of all overdose deaths may be underreported. The report also showed how multiple drugs are typically involved in overdose deaths.

The report examined data from the 2011 to 2016 National Vital Statistics System-Mortality files, which were linked to electronic files containing text from death certificates. The report used enhanced search techniques, and the CDC said some of the increases in overdose deaths may stem from improvements in how localities report deaths. According to the CDC, reporting of deaths with at least 1 specific drug mentioned in the text of the certificate improved from 73% of drug overdose deaths in 2011 to 85% in 2016; however, not all of the huge increases can be attributed to increased reporting.

In this study, the death certificates were searched for text in 3 fields: the cause of death, significant conditions contributing to the death, and a description of how it occurred. Other information was also used to determine the drug’s role in the death. The numbers that the CDC reported however, could be lower than the true number, because the study only included deaths where the drug was specifically mentioned in the text on the death certificate. The CDC said the work shows why it is so important to have accurate reporting on death certificates.

Similarly, a study from earlier this year said that because of how information is recorded on death certificates, the number of official overdose deaths may be underreported.

The fact that illict fentanyl, which is 80 to 100 times more powerful than morphine, is a driver of overdose deaths has been known for some time to those working in the field of substance use disorders and pain management, said a community pharmacist in New Jersey who owns a pharmacy with a focus on treating both issues. “The CDC announcement makes the public more aware of the people suffering from opioid use disorder and what they’re actually dying from,” said James DeMicco, PharmD, an adjunct professor at Long Island University College of Pharmacy and owner of J&J Pharmacy.

The rate of drug overdose deaths involving fentanyl doubled each year from 2013 through 2016, from 0.6 per 100,000 in 2013, to 1.3 in 2014, to 2.6 in 2015, and to 5.9 in 2016.

In 2011, prescription oxycodone was the drug most commonly linked to overdose deaths, followed by heroin from 2012 to 2015. Cocaine was a steady constant, consistently ranking second or third each year.

In addition, the rate of heroin deaths more than tripled between 2011 and 2016, as did deaths involving methamphetamine.

Overdose deaths are usually a “polysubstance event,” DeMicco said, and the CDC report noted that the 10 most frequently mentioned drugs—fentanyl, heroin, hydrocodone, methadone, morphine, oxycodone, alprazolam, diazepam, cocaine, and methamphetamine—were often found in combination with each other:

• Two in 5 cocaine deaths also had fentanyl involvement
• 34% of cocaine deaths involved heroin
• 32% of fentanyl deaths mentioned heroin
• More than 20% of methamphetamine deaths mentioned heroin

DeMicco’s independent pharmacy practice focuses on both pain management and substance use disorders, as it is located in a medical building with specialists in both of those fields. He was careful to make a distinction between the 2 issues in an interview with The American Journal of Managed Care^®.

The report is timely, he said, noting the complex nature of addiction with environmental, genetic and other factors. “People suffer and they use whatever is available,” DeMicco said.

“My patients with opioid use disorder aren’t chronic pain patients gone wrong, and my chronic pain patients who go without their opioids—yes, they might be physically dependent on them, so they’re going to feel unwell without them. They’re not going to go and seek illicit substances and use them regardless of consequences. They’re just going to suffer in pain and some of them commit suicide when they’re unable to function anymore,” said DeMicco, who said he has lost at least one such patient to suicide.