Drug overdose deaths in the United States have now fallen for six straight months, according to the CDC’s most recent data, dropping 2.8 percent from their peak.
Similarly, the subset of those deaths attributable to opioid drugs has steadily declined over the same period, falling 2.3 percent.
These modest, but steady, declines are reflected in “provisional” data published by the Centers for Disease Control and Prevention, which are subject to adjustment as additional data come in.
Fatalities from heroin overdose (a component of the total opioid death tally) have now been falling for an even longer stretch—eight straight months. They are down 6.9 percent from their peak.
Fatalities from the most common forms of prescription opioids*—like oxycodone and hydrocodone—have, likewise, declined for eight consecutive months. They’re now 7.2 percent below their highest level.
On the other hand, deaths associated with the deadly synthetic opioid fentanyl**—50 times more powerful than heroin—continue to rise.
But even as fentanyl deaths continue to rise, the steepness of their climb has flattened over the last six months.
That has allowed the combined drops in heroin and prescription drug fatalities to outpace the rising fentanyl deaths, bringing down the total drug overdose numbers. That, in turn, has resulted in the first monthly declines in the three years for which the CDC has been tracking these monthly figures.
“Still too soon to say,” says Andrew Kolodny, MD, co-director of the Opioid Policy Research Collaborative at Brandeis University’s Heller School, “but it sure looks like we may finally have crested. If overdose deaths in 2018 drop or stay about the same as 2017, I believe it will be the first time since 1995 that opioid overdose deaths didn’t increase.”
Rather than publishing monthly death tolls—data that might be misleading due to seasonal variations—the CDC publishes death tolls for rolling 12-month periods. Each new period’s data become available after a six-month lag. For instance, the data released last week concern the period from April 1, 2017 to March 30, 2018.
CDC Provisional Drug Overdose Death Data (interactive graph at https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm)
Looking at the opioid death toll in particular, 48,400 died during the most recent period, down 1.3 percent from calendar year 2017, when 49,038 died, and down 2.3 percent from the peak stretch ending in September 2017, when 49,541 died.
(interactive graph at https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm)
(All these figures are “predictions,” or statistical projections, based on the hard data the CDC has received and analyzed to date. The agency warns that “true declines or plateaus . . . cannot be ascertained until final data become available.” Figures for 2017 will become final in December, but figures for 2018 won’t become final until late 2019.)
In the data released last week, a remarkable 20 states showed year-over-year reductions in overdose death, including such fentanyl-ravaged locations as the District of Columbia, Kentucky, Ohio, Massachusetts, New York, Pennsylvania, Vermont, and, again, Rhode Island.
DC’s deaths were down 14 percent; Vermont’s, 11.9 percent; Rhode Island’s, 9.7 percent.
CDC Data on Percent Change in 12-Month Drug Overdose Death Totals By State
(interactive map available at https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm)
Kolodny says it’s hard to know what’s causing the overdose decline…
It’s not a decline of overdoses, it’s a decline in overdose *deaths* because Narcan is widely available now and more people are surviving overdoses.
…, but that it’s certainly a combination of factors. “More cautious prescribing is helping to reduce opioid prescription deaths, but I think the most important factor is treatment—particularly with buprenorphine. I think more Americans are accessing effective treatment.”
That’s particularly nice for all the people, like Kolodny himself, who hold stock in companies that manufacture and sell buprenorphine (usually as Suboxone, a combination of buprenorphine, a synthetic opioid, and naloxone, an antagonist).
it’s hard to read much positive into the decline in heroin deaths, given the continuing increase in fentanyl deaths.
When people die from heroin that’s been laced with fentanyl, he writes, coroners and medical examiners are probably now reporting those as fentanyl deaths, rather than heroin deaths.
This gives an indication of how much of what we know is determined by how things are counted. Even a slight change in methodology can change the resulting data to point in almost the opposite direction.
So, when we see all these numbers, we have to count on the prejudices of the counters and methodologist deciding how to count the numbers, because it’s clear that you can prove almost anything by choosing the right methodology of running your research.
In fact, the rise in fentanyl deaths (1,448 more in the most recent 12-month period than in the one that ended six months earlier) is still outpacing the decline in heroin deaths over the same period (1,095 fewer).
On the other hand, Humphreys says, “the drop in prescription opioid deaths is particularly encouraging.” It suggests, he believes, that we may be beginning to feel the benefits from the reductions in opioid prescribing.
Why is this encouraging?
What it really means is that more pain patients are not getting their prescriptions. Prescription pain relievers aren’t even contributing much to the epidemic anymore.
I have often talked about this in terms of stock and flow,” he writes.
- By “flow” he means the new influx of opioid use disorder cases that develop when people are exposed to opioids they obtained either directly from a doctor or from someone else who got them from a doctor.
- By “stock” he means those who are already addicted to prescription opioids
But people aren’t addicted to *prescription* opioids, they’re addicted to illicit opioids.
To end an epidemic, you must both treat those who are sick (the stock), and try to stop new cases from breaking out (the flow).
So sending people home from heart surgery without opioids is the answer?