New data show continuing opioid epidemic in the United States

Illicit opioids contribute to drastic increases in opioid overdose deaths across states

Drug overdose deaths, including opioid overdose deaths, continue to increase in the United States, according to new data published today in CDC’s Morbidity and Mortality Weekly Report.

In 2015 more than 52,000 people died from a drug overdose; of those, 33,091 (63.1 percent) involved a prescription or illicit opioid. Since 2000, more than 300,000 Americans have lost their lives to an opioid overdose.

“Too many Americans are feeling the devastation of the opioid crisis either from misuse of prescription opioids or use of illicit opioids,” said CDC Director Tom Frieden, M.D., M.P.H. “Urgent action is needed to help health care providers treat pain safely and treat opioid use disorder effectively, support law enforcement strategies to reduce the availability of illicit opiates, and support states to develop and implement programs that can save lives.”

CDC’s latest national analyses indicate that the increase in opioid overdose death rates is driven in large part by illicit opioids, like heroin and illicitly manufactured fentanyl, a synthetic opioid. The new data show from 2014 to 2015:

Death rates for synthetic opioids other than methadone (including drugs such as tramadol and fentanyl, referred to as synthetic opioids) increased 72.2 percent

Heroin death rates increased 20.6 percent

Synthetic opioid and heroin death rates increased across all age groups 15 and older, in both sexes, and among all races/ethnicities.

Methadone death rates declined 9.1 percent

Natural opioids (including morphine and codeine) and semi-synthetic opioids (including commonly prescribed pain medications such as oxycodone and hydrocodone) were involved in more than 12,700 deaths in 2015; death rates increased 2.6 percent from 2014 to 2015 in this category.  However, the increase has slowed compared with the increase from 2013 to 2014.

State analyses of drug overdoses deaths

During 2010–2015, the rate of drug overdose deaths in the U.S. increased in 30 states and DC, remained stable in 19 states, and showed decreasing trends followed by increases in two states. This new report includes state analyses of death certificate data for opioid overdoses in 28 states with consistent and high quality reporting of specific drugs involved in an overdose.  Data for the 28 states show:

16 states had increases in synthetic opioid death rates from 2014-2015. The greatest percent increases in death rates were in New York (135.7 percent), Connecticut (125.9 percent) and Illinois (120 percent).

Alternatively, when assessing potential burden by absolute rate changes (reflecting the number of deaths and lives affected in each state, per every 100,000 people), Massachusetts, New Hampshire, Ohio, Rhode Island, and West Virginia had the largest rate increases of synthetic opioid deaths from 2014 to 2015.

11 states had increases in heroin death rates, with the greatest percent increases in death rates in South Carolina (57.1 percent), North Carolina (46.4 percent), and Tennessee (43.5 percent).

Alternatively, when assessing potential burden by absolute rate changes (reflecting the number of deaths and lives affected in each state, per every 100,000 people) Connecticut, Massachusetts, Ohio, and West Virginia had the largest rate increases of heroin deaths from 2014 to 2015.

New Mexico, Oklahoma, Virginia had decreases in rates of death involving natural/semi-synthetic opioids.

Today’s report shows significant increases across states in death rates from heroin and synthetic opioid deaths, coupled with continuing high numbers of fatal overdoses related to natural/semi-synthetic opioid deaths further illustrate the continued problem with misuse of prescription opioids and the substantial impact of illicit opioids on this epidemic.

“The need to address the full spectrum of substance misuse as a health issue is ever-present,” said Nora D. Volkow, M.D., director of the National Institute on Drug Abuse. “Science-based solutions to reduce illicit opioid use and improve both health and life outcomes for opioid use disorder need to be implemented so we can start breaking down the barriers preventing effective treatment from reaching the millions of Americans who could benefit.”

Need for coordinated public health and public safety response

Today’s report highlights the continued need for public health and law enforcement to work together to prevent overdose deaths, including these actions:

Improve opioid prescribing to reduce unnecessary exposure to opioids and prevent addiction by training providers and implementing the CDC Guideline for Prescribing Opioids for Chronic Pain.

Improve access to and use of prescription drug monitoring programs.

Protect people experiencing opioid use disorder (OUD) by expanding OUD treatment capacity and naloxone distribution.

Implement harm reduction approaches including naloxone distribution and syringe services.

Support law enforcement strategies to reduce and to improve detection of the illicit opioid supply by working with state and local public health agencies.

CDC’s Overdose Prevention in States initiatives include funding for state-level public health efforts in 44 states and Washington, D.C., to implement key surveillance and prevention activities addressing both prescription and illicit opioids. CDC works with states, communities, and prescribers to prevent opioid misuse and overdose by tracking and monitoring the epidemic; helping states scale up effective programs; and equipping health care providers with tools and guidance needed to make informed clinical decisions. In March 2016, CDC released the Guideline for Prescribing Opioids for Chronic Pain to provide recommendations for the prescribing of opioid pain medication for patients 18 and older in primary care settings. Learn more at www.cdc.gov/drugoverdose.

“The increase in overdose deaths is tangible evidence of the real impact of substance use disorder on millions of Americans and underscores the importance of the Administration’s continued focus on prevention, treatment and recovery services.” said Kathryn E. Martin, acting Assistant Secretary for Planning and Evaluation at HHS.  “The President recently signed legislation to implement his plan to invest $1 billion in helping communities combat this epidemic.  And the Affordable Care Act expands mental and substance use disorder benefits and protections for more than 60 million Americans. These steps are essential to helping to turn the tide of this epidemic.”

The Obama Administration has undertaken a series of initiatives to address the opioid crisis. On December 13, 2016, the President signed the 21st Century Cures Act, which implements his Budget proposal to provide $1 billion in new funding to combat the opioid crisis. In addition, HHS has made addressing the opioid overdose epidemic a high priority, implementing an evidence-based initiative in 2015, focused on three priority areas: informing opioid prescribing practices, increasing the use of naloxone, and expanding Medication-Assisted Treatment.  HHS continues to coordinate with agencies across the Department to ensure effective implementation of the initiative’s programs and policies, improve prescribing practices, reduce overdose deaths, and support the millions of Americans in recovery.

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES