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Understanding the Epidemic

Drug overdose deaths in the United States hit record numbers in 2014

At least half of all opioid overdose deaths involve a prescription opioid. HHS/CDCMore people died from drug overdoses in 2014 than in any year on record. The majority of drug overdose deaths (more than six out of ten) involve an opioid.1 And since 1999, the rate of overdose deaths involving opioids (including prescription opioid pain relievers and heroin) nearly quadrupled.2 From 2000 to 2014 nearly half a million people died from drug overdoses. 78 Americans die every day from an opioid overdose.

We now know that overdoses from prescription opioid pain relievers are a driving factor in the 15-year increase in opioid overdose deaths. Since 1999, the amount of prescription opioids sold in the U.S. nearly quadrupled,2 yet there has not been an overall change in the amount of pain that Americans report.3,4 Deaths from prescription opioids—drugs like oxycodone, hydrocodone, and methadone—have also quadrupled since 1999.5

Heroin use is trending up

From 2002–2013, past month heroin use, past year heroin use, and heroin addiction have all increased among 18-25 year olds.6 The number of people who started to use heroin in the past year is also trending up. Among new heroin users, approximately three out of four report abusing prescription opioids prior to using heroin.7 The increased availability, lower price, and increased purity of heroin in the US have been identified as possible contributors to rising rates of heroin use.8,9 According to data from the DEA, the amount of heroin seized each year at the southwest border of the United States was approximately 500 kg during 2000–2008. This amount quadrupled to 2,196 kg in 2013.10

Heroin-related deaths more than tripled between 2010 and 2014, with 10,574 heroin deaths in 2014. The largest increase in overdose deaths from 2013 to 2014 was for those involving synthetic opioids (other than methadone), which rose from 3,105 deaths in 2013 to 5,544 deaths in 2014. One of these synthetic opioids, illegally-made fentanyl, drove the increase.1 It was often mixed with heroin and/or cocaine as a combination product—with or without the user’s knowledge.

What can be done?

We need to improve prescribing of opioids, expand treatment of addiction, and reduce access to illegal opioids.

  • Improve opioid prescribing to reduce exposure to opioids, prevent abuse, and stop addiction.
  • Expand access to evidence-based substance abuse treatment, such as Medication-Assisted Treatment, for people already struggling with opioid addiction.
  • Expand access and use of naloxone—a safe antidote to reverse opioid overdose.
  • Promote the use of state prescription drug monitoring programs, which give health care providers information to improve patient safety and prevent abuse.
  • Implement and strengthen state strategies that help prevent high-risk prescribing and prevent opioid overdose.
  • Improve detection of the trends of illegal opioid use by working with state and local public health agencies, medical examiners and coroners, and law enforcement.

 

References

  1. Centers for Disease Control and Prevention. Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014. MMWR 2015; 64;1-5.
  2. Centers for Disease Control and Prevention. Morbidity and Mortality Weekly Report. Available from URL:http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6043a4.htm?s_cid=mm6043a4_w#fig2. Accessed August 17, 2015.
  3. Chang H, Daubresse M, Kruszewski S, et al. Prevalence and treatment of pain in emergency departments in the United States, 2000 – 2010. Amer J of Emergency Med 2014; 32(5): 421-31.
  4. Daubresse M, Chang H, Yu Y, Viswanathan S, et al. Ambulatory diagnosis and treatment of nonmalignant pain in the United States, 2000 – 2010.  Medical Care 2013; 51(10): 870-878.
  5. CDC. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2016. Available at http://wonder.cdc.gov
  6. Centers for Disease Control and Prevention. Demographic and Substance Use Trends Among Heroin Users — United States, 2002–2013. MMWR 2015; 64(26):719-725
  7. Muhuri PK, Gfroerer JC, Davies C. Associations of nonmedical pain reliever use and initiation of heroin use in the United States. CBHSQ Data Review, 2013.
  8. Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The changing face of heroin use in the United States: a retrospective analysis of the past fifty years. JAMA Psychiatry 2014;71:821–6.
  9. Jones CM. Heroin use and heroin use risk behaviors among nonmedical users of prescription opioid pain relievers — United States, 2002–2004 and 2008–2010. Drug Alcohol Depend 2013;132:95-100.
  10. US Department of Justice Drug Enforcement Administration. National Drug Threat Assessment Summary. DEA-DCT-DIR-002-15 2014.
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