The Opioid Epidemic at the End of 2018:  Are We Making Progress?

Dec 11, 2018 9:31:00 AM by Mario Ramirez, MD

For those of us involved in the opioid epidemic as caregivers, patient advocates, and researchers, there was an interesting moment earlier this year when a series of news stories noted some optimism in the fight against overdose deaths. 

In mid-October, Health and Human Services Secretary Alex Azar commented on preliminary data from the U.S. Centers for Disease Control and Prevention that suggested “that the U.S. may be ‘beginning to turn the tide’ on the opioid crisis.[1]”  “The seemingly relentless trend of rising overdose deaths seems to be finally bending in the right direction…We are so far from the end of the epidemic, but we are perhaps at the end of the beginning.[2]” 

Because so much of the news surrounding the epidemic is often negative, this was a welcome change to the narrative.  It was particularly notable in light of last year’s declaration by President Trump that the opioid epidemic was a public health emergency, as well as Congress’ recent approval of the Support for Patients and Communities Act in October.  The hope was that these interventions were starting to make a difference in the trends that have worsened year after year for the past 20 years.  But, after analyzing the final CDC data, we wanted to take a deeper dive into the data to help give our readers a better sense for where progress is being made and where significant areas of concern remain.

What Does the Data Actually Show?

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 Recognizing that the data only extends to March 2018, the final four months do show a slight bend in the curve.  In 2017, overdose deaths peaked around 72,000 and the data suggests a slight decrease during early 2018.  This “bend” is what prompted the positive comments from Secretary Azar in October.  Writing in Vox News, however, German Lopez sounded an important point of caution by noting that the positive trends from October 2017 to March 2018 represent a short time frame in an epidemic that has been decades in the making, and also noted that drug overdose deaths leveled off from 2011-2012 before accelerating as high potency synthetic opioids flooded the market afterwards1

How Do the Figures Change Across Opioid Classes

Unfortunately, the overall downward trend does not tell the whole story.  Although prescription opioid and heroin use decreased, CDC data shows that deaths from synthetic fentanyl remains an area of considerable growth.

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Furthermore, there is a geographic distribution in fentanyl overdose deaths that partially reflects trends in heroin use.  According to a New York Times article, heroin sold west of the Mississippi River is often of the black tar form that is more difficult to mix with synthetic fentanyl while East Coast supplies are often the white processed powder variant that can be more easily mixed[3].  We should prepare then, for a potential change in these statistics if heroin distribution changes or users develop ways to mix black tar heroin with synthetic fentanyl.

Another question for consideration is whether overdose deaths from cocaine and other stimulants will increase if opioid supplies decrease.  With tighter prescriber practices aimed at limiting prescription supply and increased law enforcement activity aimed at decreasing illicit sources of fentanyl, it is possible that users may divert to other drugs leading to a second wave of the epidemic.

Where is Progress Being Made and Why?

When we look across the Midwest and Appalachia, two areas of the country hit hardest by the opioid epidemic, there have been decreases in the number of opioid related deaths in some areas.  Some counties in Ohio, Indiana, and Kentucky have made considerable progress, for example.  Ambulance and ER visits are down by as much as 60% in some of these countries compared to last year.3 

As others have noted, however, this progress may only represent a small win while the much larger addiction problem remains untouched.[4]  These figures likely represent the increased prescription and use of naloxone antidotes, increased use of buprenorphine and other MAT approaches, and improved access to addiction resources of prisoners and other populations at risk for drug abuse.  What they do not represent, however, is a solution to the underlying problem that American’s have with addiction itself.4  What these interventions have done is create a mechanism by which to either rescue people who have already overdosed (in the instance of naloxone use), or tried to treat those already in the throes of addiction.  It has not solved the problem of why Americans are using drugs in higher and higher amounts each year.

What Does this Say About the Opioid Epidemic Itself?

It remains too early to cast definitive judgment on what the CDC data says about early 2018.  This data may be the earliest signs of progress being made.  But, this small decrease should not detract from several critical statistics:

  • The number of reported drug overdose deaths from April 2017 to April 2018 increased by 1.1 percent nationally[5]
  • Drug overdoses still claimed over 72,000 lives annually through 2017
  • Deaths from drug overdoses exceeded that from HIV, car crashes, or gun deaths.3

As a result, drug overdose deaths contributed to a significant recent decline in U.S. life expectancy from 78.7 years to 78.6 years from 2016 to 2017.  This alarming statistic should force us all to reconsider how much progress remains to be made in the fight against drug overdoses. 

AffirmHealth will continue to monitor the statistics and deliver updates as they become available. To stay up to date or catch up on previous topics, check out some of our other blogs

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[1] https://www.vox.com/science-and-health/2018/10/24/18015532/opioid-epidemic-overdose-deaths-2018-alex-azar-trump

[2] https://www.politico.com/story/2018/10/23/opioid-crisis-health-secretary-932332

[3] https://www.nytimes.com/2018/08/15/upshot/opioids-overdose-deaths-rising-fentanyl.html

[4] https://tonic.vice.com/en_us/article/438x5n/its-too-early-to-celebrate-progress-on-the-opioid-epidemic

[5] https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm

 

The information presented on or through this website is made available solely for general information purposes and is not intended to substitute for professional, medical or legal advice. We do not warrant the accuracy, completeness, or usefulness of this information. Any reliance you place on such information is strictly at your own risk. We disclaim all liability and responsibility arising from any reliance placed on such materials.

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