scholarly journals Changing dynamics of the drug overdose epidemic in the United States from 1979 through 2016

Science ◽  
2018 ◽  
Vol 361 (6408) ◽  
pp. eaau1184 ◽  
Author(s):  
Hawre Jalal ◽  
Jeanine M. Buchanich ◽  
Mark S. Roberts ◽  
Lauren C. Balmert ◽  
Kun Zhang ◽  
...  
Keyword(s):  
Control Strategies ◽  
The United States ◽  
Vital Statistics ◽  
Accidental Poisoning ◽  
Opioid Overdose ◽  
Prescription Opioids ◽  
Drug Poisoning ◽  
Effective Prevention ◽  
Poisoning Deaths ◽  
Accidental Drug Poisoning

Better understanding of the dynamics of the current U.S. overdose epidemic may aid in the development of more effective prevention and control strategies. We analyzed records of 599,255 deaths from 1979 through 2016 from the National Vital Statistics System in which accidental drug poisoning was identified as the main cause of death. By examining all available data on accidental poisoning deaths back to 1979 and showing that the overall 38-year curve is exponential, we provide evidence that the current wave of opioid overdose deaths (due to prescription opioids, heroin, and fentanyl) may just be the latest manifestation of a more fundamental longer-term process. The 38+ year smooth exponential curve of total U.S. annual accidental drug poisoning deaths is a composite of multiple distinctive subepidemics of different drugs (primarily prescription opioids, heroin, methadone, synthetic opioids, cocaine, and methamphetamine), each with its own specific demographic and geographic characteristics.

A public health outbreak management framework applied to surges in opioid overdoses

2017 ◽  
Vol 13 (5) ◽  
pp. 273 ◽  
Author(s):  
Kieran Moore, MD, CCFP (EM), FCFP, MPH, DTM&H, FRCPC ◽  
Maximilien Boulet, BSc ◽  
Julia Lew, BSc ◽  
Nicholas Papadomanolakis-Pakis, BSocSc, MPA
Keyword(s):  
Public Health ◽  
The United States ◽  
Opioid Overdose ◽  
Prescription Opioids ◽  
Outbreak Management ◽  
Management Framework ◽  
Public Health Agencies ◽  
The Past ◽  
Health Agencies ◽  
Related Mortality

Objective: Over the past decade, Canada and the United States have been facing an epidemic of harms from prescription opioids. More recently, opioid-naïve individuals have been exposed to illicit opioids through adulterated combination products. This has resulted in sudden surges of opioid-related mortality. A proactive public health solution is needed to prevent further death. We propose examining these surges in opioid overdoses as outbreaks and investigating them in a similar way to an outbreak of an infectious disease. An epidemiologic investigation model for opioid overdose outbreaks, that could be modified by other public health agencies,is discussed.

Epidemiology of Substance Use Disorders

2020 ◽  
pp. 3-28
Author(s):  
L. Morgan Snell ◽  
Andrew J. Barnes ◽  
Peter Cunningham
Keyword(s):  
The United States ◽  
Opioid Use Disorder ◽  
Opioid Overdose ◽  
Prescription Opioids ◽  
Opioid Epidemic ◽  
Provider Education ◽  
Opioid Use ◽  
Prescribing Practices ◽  
The Us ◽  
Overdose Deaths

Nearly 3 million Americans have a current or previous opioid use disorder, and recent data indicate that 10.2% of US adults have ever misused pain relievers. In 2015, approximately 800,000 individuals used heroin, while 4 million misused prescription opioids. Although use of other drugs such as alcohol and cannabis is more prevalent, opioid use contributes to significant morbidity, mortality, and social and economic costs. While the current US opioid overdose epidemic began with prescription opioids, since 2015, heroin and synthetic opioids (e.g., fentanyl) have driven continued increases in opioid overdose deaths, contributing to a recent decline in overall life expectancy in the United States. Policies to address the opioid epidemic by changing clinical practice include provider education, monitoring prescribing practices, and expanding the clinical workforce necessary to treat opioid use disorders. The opioid epidemic appears to be largely a US phenomenon and a consequence of both structural challenges in the US healthcare system and growing socioeconomic disparities, and thus it will require policies including and beyond delivery system reforms to resolve it.

scholarly journals Emerging and Continuing Trends in Opioid Overdose Decedent Characteristics during COVID-19

2021 ◽  
Author(s):  
Gian-Gabriel P. Garcia ◽  
Erin Stringfellow ◽  
Catherine DiGennaro ◽  
Nicole Poellinger ◽  
Jaden Wood ◽  
...  
Keyword(s):  
North Carolina ◽  
Rhode Island ◽  
Race And Ethnicity ◽  
The United States ◽  
Vital Statistics ◽  
Opioid Overdose ◽  
Cross Sectional ◽  
Death Rates ◽  
Overdose Death ◽  
Overdose Deaths

Background: Since COVID-19 erupted in the United States, little is known about how state-level opioid overdose trends and decedent characteristics have varied throughout the country. Objective: Investigate changes in annual overdose death rates, substances involved, and decedent demographics in opioid overdose deaths across nine states; assess whether 2019-2020 trends were emerging (i.e., change from 2019-2020 was non-existent from 2018-2019) or continuing (i.e., change from 2019-2020 existed from 2018-2019). Design: Cross-sectional study using vital statistics data to conduct a retrospective analysis comparing 2020 to 2019 and 2019 to 2018 across nine states. Setting: Alaska, Colorado, Connecticut, Indiana, Massachusetts, North Carolina, Rhode Island, Utah, and Wyoming. Participants: Opioid-related overdose deaths in 2018, 2019, and 2020. Measurements: Annual overdose death rate, proportion of overdose deaths involving specific substances, and decedent demographics (age, sex, race, and ethnicity). Results: We find emerging increases in annual opioid-related overdose death rates in Alaska (55.3% [P=0.020]), Colorado (80.2% [P<0.001]), Indiana (40.1% [P=0.038]), North Carolina (30.5% [P<0.001]), and Rhode Island (29.6% [P=0.011]). Decreased heroin-involved overdose deaths were emerging in Alaska (-49.5% [P=0.001]) and Indiana (-58.8% [P<0.001]), and continuing in Colorado (-33.3% [P<0.001]), Connecticut (-48.2% [P<0.001]), Massachusetts (39.9% [P<0.001]), and North Carolina (-34.8% [P<0.001]). Increases in synthetic opioid presence were emerging in Alaska (136.5% [P=0.019]) and Indiana (27.6% [P<0.001]), and continuing in Colorado (44.4% [P<0.001]), Connecticut (3.6% [P<0.05]), and North Carolina (14.6% [P<0.001]). We find emerging increases in the proportion of male decedents in Colorado (15.2% [P=0.008]) and Indiana (12.0% [P=0.013]). Limitations: Delays from state-specific death certification processes resulted in varying analysis periods across states. Conclusion: These findings highlight emerging changes in opioid overdose dynamics across different states, which can inform state-specific public health interventions.

scholarly journals Trends in drug poisoning deaths, by sex, in Ireland: a repeated cross-sectional study from 2004 to 2017

BMJ Open ◽  
2021 ◽  
Vol 11 (9) ◽  
pp. e048000
Author(s):  
Ena Lynn ◽  
Gráinne Cousins ◽  
Suzi Lyons ◽  
Kathleen E Bennett
Keyword(s):  
Cross Sectional Study ◽  
Prescription Opioids ◽  
Sectional Study ◽  
Cross Sectional ◽  
Drug Poisoning ◽  
Death Rates ◽  
Cns Depressant ◽  
Pharmacy Claims ◽  
Drug Classes ◽  
Poisoning Deaths

ObjectiveTo examine sex differences in age-standardised rates (ASR) of overall and drug-specific drug poisoning deaths in Ireland between 2004 and 2017.DesignRepeated cross-sectional study.SettingDrug poisoning deaths in Ireland.ParticipantsNational Drug-Related Deaths Index and pharmacy claims database (Primary Care Reimbursement Service-General Medical Services) data from 2004 to 2017.Outcome measuresThe primary outcome was trends in drug poisoning death rates by sex. The secondary outcomes were trends in drug poisoning death rates involving (1) any CNS (Central Nervous System) depressants, (2) ≥2 CNS depressants and (3) specific drugs/drug classes (eg, prescription opioids, benzodiazepines, antidepressants, alcohol, cocaine and heroin) by sex. Joinpoint regression was used to examine trends, stratified by sex, in the ASR of drug poisoning deaths (2004–2017), change points over time and average annual percentage changes (AAPCs) with 95% CI.ResultsIncreased ASR for all drug poisoning deaths from 6.86 (95% CI 6.01 to 7.72) per 100 000 in 2004 to 8.08 (95% CI 7.25 to 8.91) per 100 000 in 2017 was mainly driven by increasing deaths among men (AAPC 2.6%, 95% CI 0.2 to 5.1), with no significant change observed among women. Deaths involving ≥2 CNS depressants increased for both men (AAPC 5.6%, 95% CI 2.4 to 8.8) and women (AAPC 4.0%, 95% CI 1.1 to 6.9). Drugs with the highest significant AAPC increases for men were cocaine (7.7%, 95% CI 2.2 to 13.6), benzodiazepines (7.2%, 95% CI 2.9 to 11.6), antidepressants (6.1%, 95% CI 2.4 to 10.0) and prescription opioids (3.5%, 95% CI 1.6 to 5.5). For women, the highest AAPC was for antidepressants (4.2%, 95% CI 0.2 to 8.3), benzodiazepines (3.3%, 95% CI 0.1 to 6.5) and prescription opioids (3.0%, 95% CI 0.7 to 5.3).ConclusionDrugs implicated in drug poisoning deaths vary by sex. Policy response should include prescription monitoring programmes and practical harm reduction information on polydrug use, especially CNS depressant drugs.

Reframing the Prevention Strategies of the Opioid Crisis: Focusing on Prescription Opioids, Fentanyl, and Heroin Epidemic

2018 ◽  
Vol 1 (21;1) ◽  
pp. 309-326 ◽  
Author(s):  
Laxmaiah Manchikanti
Keyword(s):  
United States ◽  
The United States ◽  
Opioid Overdose ◽  
Prescription Opioids ◽  
Opioid Epidemic ◽  
Synthetic Opioids ◽  
Opioid Crisis ◽  
Electronic Reporting ◽  
Number Of Patients ◽  
Overdose Deaths

The opioid epidemic has been called the “most consequential preventable public health problem in the United States.” Though there is wide recognition of the role of prescription opioids in the epidemic, evidence has shown that heroin and synthetic opioids contribute to the majority of opioid overdose deaths. It is essential to reframe the preventive strategies in place against the opioid crisis with attention to factors surrounding the illicit use of fentanyl and heroin. Data on opioid overdose deaths shows 42,000 deaths in 2016. Of these, synthetic opioids other than methadone were responsible for over 20,000, heroin for over 15,000, and natural and semisynthetic opioids other than methadone responsible for over 14,000. Fentanyl deaths increased 520% from 2009 to 2016 (increased by 87.7% annually between 2013 and 2016), and heroin deaths increased 533% from 2000 to 2016. Prescription opioid deaths increased by 18% overall between 2009 and 2016. The Drug Enforcement Administration (DEA) mandated reductions in opioid production by 25% in 2017 and 20% in 2018. The number of prescriptions for opioids declined significantly from 252 million in 2013 to 196 million in 2017 (9% annual decline over this period), falling below the number of prescriptions in 2006. In addition, data from 2017 shows significant reductions in the milligram equivalence of morphine by 12.2% and in the number of patients receiving high dose opioids by 16.1%. This manuscript describes the escalation of opioid use in the United States, discussing the roles played by drug manufacturers and distributors, liberalization by the DEA, the Food and Drug Administration (FDA), licensure boards and legislatures, poor science, and misuse of evidencebased medicine. Moreover, we describe how the influence of pharma, improper advocacy by physician groups, and the promotion of literature considered peer-reviewed led to the explosive use of illicit drugs arising from the issues surrounding prescription opioids. This manuscript describes a 3-tier approach presented to Congress. Tier 1 includes an aggressive education campaign geared toward the public, physicians, and patients. Tier 2 includes facilitation of easier access to non-opioid techniques and the establishment of a National All Schedules Prescription Electronic Reporting Act (NASPER). Finally, Tier 3 focuses on making buprenorphine more available for chronic pain management as well as for medication-assisted treatment. Key words: Opioid epidemic, fentanyl and heroin epidemic, prescription opioids, National All Schedules Prescription Electronic Reporting Act (NASPER), Prescription Drug Monitoring Programs (PDMPs)

scholarly journals Trends in Drug Poisoning Deaths Among Adolescents and Young Adults in the United States, 2006–2015

2019 ◽  
Vol 80 (2) ◽  
pp. 201-210
Author(s):  
Bina Ali ◽  
Deborah A. Fisher ◽  
Ted R. Miller ◽  
Bruce A. Lawrence ◽  
Rebecca S. Spicer ◽  
...  
Keyword(s):  
United States ◽  
Young Adults ◽  
The United States ◽  
Adolescents And Young Adults ◽  
Drug Poisoning ◽  
Poisoning Deaths

scholarly journals The Opioid Epidemic and Children's Living Arrangements in the United States, 2000-2018

2021 ◽  
Author(s):  
Mònica L. Caudillo ◽  
Andrés Villarreal ◽  
Philip N. Cohen
Keyword(s):  
Living Arrangements ◽  
Fixed Effects ◽  
Local Level ◽  
The United States ◽  
Vital Statistics ◽  
Opioid Overdose ◽  
Opioid Epidemic ◽  
Family Structures ◽  
Health And Wellbeing

The opioid epidemic has had devastating effects for the health and wellbeing of the U.S. population. However, we know little about how it has affected the structure of families where children are raised. Using the 5 percent sample of the 2000 Census, 2005-2018 American Community Survey (ACS) data and restricted Vital Statistics we assess the effect of the opioid epidemic at the local level on the rates of children living under different types of family arrangements: two married parents, two cohabiting parents, mother only, father only, or another configuration. Local fixed-effects models show that a greater intensity of the opioid epidemic, as measured by a higher opioid-overdose death rate, is associated with a lower rate of children living with two married parents, and a higher rate of children living with two cohabiting parents, with only a father, and with adults other than their parents. The opioid epidemic appears to increase the rates of children living in family structures that tend to be less stable, which has potential long term implications for the wellbeing of future generations.

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