For the first time since 1990, the number of annual drug overdose deaths in the US has declined. The 5 per cent fall reported by the Centers for Disease Control and Prevention (CDC) is almost entirely due to a drop in deaths from prescription opioid painkillers. Does this mean the opioid crisis has peaked?
The early data predicts that there were 68,500 drug overdose deaths in the US in 2018, down from 72,000 the previous year. “The preliminary CDC data showing a drop in overdose deaths is certainly encouraging, but it is too early to determine whether this represents a true shift in overdose trends,” says Tisamarie Sherry, at the policy think tank Rand Corporation in California.
But it is unknown whether overdose deaths will continue to fall, says Sherry. “The CDC data shows that overdose deaths from fentanyl, synthetic opioids, cocaine and methamphetamines are still increasing, which is an ominous sign.”
Drug overdose deaths in the US related to prescription opioids rose from just over 3,400 in 1999 to about 17,000 in 2017. This dramatic upwards trend reflects a nation-wide epidemic of opioid use and abuse. Recent data from the US Drug Enforcement Agency revealed that between 2006 and 2012, 76 billion oxycodone and hydrocodone pain pills – two common prescription opioids – were distributed in the US. That’s about 460 pills per person.
The epidemic has hit US states differently, and these new numbers bear that out. Deaths continued to rise in some eastern states where the use of illicit fentanyl, a highly potent synthetic opioid, is spreading. But deaths are dropping in some midwestern states where local governments have expanded treatments for addiction and monitoring of prescriptions.
Even with this recent reduction in overdoses, the death toll from drugs in the US is still high, with tens of thousands of people overdosing on opioids each year. The recent decrease may be due to increased availability of naloxone – which blocks the effects of opioids and is used by emergency medical practitioners to reverse an overdose – and better training to use it.
If emergency treatment, rather than reduced drug use, is largely behind the fall, this would mean an increasing number of US adults are living with substance abuse disorders. Prescribing restrictions mean many of these are likely being pushed towards using street drugs.
“Some well-intentioned policies may have unintended consequences,” says Sherry. “For example, our recent research on prescription opioid use found that while the rate of new opioid prescriptions has fallen in recent years – which we generally believe is a good thing – a large number of physicians have stopped initiating opioids altogether,” she says.
While that may sound like a good thing, “it’s not clear whether that degree of opioid hesitancy does more good or harm to patients with severe pain.”
This isn’t the first time the rate of opioid deaths has slowed for a year. They appeared to stall in 2011 and 2012, but the death rate then shot back up as fentanyl made its way into the US. Fentanyl deaths in 2018 continued to rise, but grew at a slower rate than the past several years. So, it’s fair to be only cautiously optimistic when it comes to a possible break in the wave of opioid-related deaths.
These new numbers are still being finalised, and may increase when the final CDC report is published later this year. They also do not include deaths related to infection from intravenous drug use.
Furthermore, renewed attempts to overturn President Obama’s Affordable Care Act are currently underway. Should these succeed, many people who currently receive legal pain relief may end up turning to illegal drugs if they lose their health insurance. Celebrating the end of the opioid epidemic would be extremely premature.
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