Changing dynamics of the drug overdose epidemic

Changing dynamics of the drug overdose epidemic in the United States from 1979 through 2016 | Science – 21 Sep 2018

This article shows how the “opioid epidemic” is just another in a series of “sub-epidemics” of illicit drug overdoses. The graph combining the various drugs most abused over the years shows that drug overdoses, in general, are rising exponentially in the U.S.

We lack a detailed analysis of the opioid epidemic in the context of the larger drug epidemic that reveals the complex and evolving dynamics of drug use in the United States

This manuscript examines mortality patterns of all accidental (unintentional) drug poisonings as reported through the U.S. National Vital Statistics System from 1979 through 2016.  

We describe the overall pattern of drug overdose deaths in the United States and reveal specific aspects of these deaths by drug, demography, and geography; we refer to these patterns as subepidemics.

The overdose epidemic is a composite of multiple subepidemics

Fig. 1 Mortality rates from unintentional drug overdoses.

(A and B) Mortality rates for (A) individual drugs and (B) all drugs. Detailed data for individual drugs are only available from 1999 to 2016, although additional data for all drugs are available since 1979 (this area is grayed out). The exponential equation and fit are shown for all drugs. (Synth Opioids OTM: synthetic opioids other than methadone. This category includes fentanyl and its analogs.)

Since 2010, the mortality curves for all drug types have been increasing, except for methadone and for unspecified drugs and narcotics. Each drug’s mortality curve shows some variability. For example, the mortality rate from prescription opioids decreased slightly in 2012, whereas the mortality rates from heroin and synthetic opioids have been increasing rapidly.

These trends may be related because several epidemic interventions may have reduced the impact of prescription opioids around 2010, including the reformulation of OxyContin in 2010

Although these changes may have reduced the overdose deaths from prescription opioids, it is possible that they may have led some opioid-dependent persons to switch to illicit opioids, such as heroin and fentanyl

Economic factors may also have contributed to the transition from prescription opioids to heroin; heroin is increasingly more available, easier to use through non-oral routes, and becoming purer and less expensive than prescription opioids

In addition, the subsequent sharp increase in fentanyl overdose deaths after 2013 is consistent with law enforcement data showing increased seizures of illicitly manufactured fentanyl

Several other fluctuations observed in the drug-specific mortality curves may also, in retrospect, be explainable.

For example,

• in 2006, a spike in overdose deaths in the United States associated with fentanyl was traced to a production laboratory in Mexico
• Similarly, the decline in methadone deaths after 2007 may be attributed to the removal of methadone from the preferred drug list by state Medicaid programs, which used to be major sources of methadone prescriptions for pain management
• The rise and fall of cocaine-related overdose deaths in the United States appears to be linked to production and supply in Colombia

Although opioids are the major offenders, drugs other than opioids, such as cocaine and methamphetamine, now also contribute substantially to the rising counts of overdose deaths in the United States

Mortality curves from individual drugs do not show regular or predictable growth patterns. Nonetheless, we observed that the annual sum of all drug overdose mortality rates follows a remarkably smooth mathematical trajectory.

Figure 1B [above] plots changes in the total accidental poisoning mortality rate, from all drugs. Note that the total mortality rate per year is less than the sum of the mortality rates reported for individual drugs, owing to listing of more than one drug on the death certificate in many individual cases

This is how the CDC (supposedly unintentionally) over-counted opioid overdoses for so long by serving statistics that counted multiple overdoses when multiple drugs were detected in a single individual.

With this exponential growth, the doubling time is approximately 9 years. Of particular interest is the observation that the first half of this long-term smooth exponential growth curve predates the current opioid epidemic.

The drug-specific subepidemics differ significantly with respect to their time course, geographic spread, and demographic groups affected.

The increase in drug poisoning mortality in 2016 is due to increased mortality from multiple drug-specific subepidemics: synthetic opioids (most likely fentanyl) among males, whites, and those in urban counties; heroin among young adults; prescription opioids among the middle-aged and blacks; and cocaine and methamphetamine among a wider age range, males, and whites.

Simply put, the data show that we’re having an “addiction/suicide/overdose epidemic”, not an “opioid epidemic”.

The efforts to restrict pain medications is misguided in multiple ways, but it’s becoming more and more clear that opioids are just a transitory phase of a much larger societal problem.

Below is the abstract of the research:

Changing dynamics of the drug overdose epidemic in the United States from 1979 through 2016. – PubMed – NCBI – Sept 2018

 Abstract

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.

Plus, we must also keep in mind:

Many Opioid Deaths are Suicides