A new report analyzing the drugs involved in fatal overdoses once again emphasized fentanyl’s role in the United States’ opioid crisis and highlighted a point frequently made by public health experts:
Most people who fatally overdose
have more than one drug in their system.
In 2016, about 70 percent of fatal overdoses involving fentanyl or heroin involved another drug as well, and roughly 74 percent of fatal overdoses involving cocaine also involved one or more other drugs.
Most reports on drug overdose deaths only determine what class of drugs were involved.
This is the HUGE problem with the CDC’s overdose statistics: to count as an “opioid overdose” there only has to be some kind of opioid found in the body, even when there are several other drugs found as well.
This is especially problematic because heroin metabolizes to morphine in just hours and is thus seen as a “morphine overdose” instead of the heroin overdose it really is:
From Opiates Drug Information: Heroin is rapidly metabolized (plasma half-life is 3 minutes), first to 6-monoacetylmorphine (6-MAM) and further to morphine. The urinary excretion profile is similar to morphine, in that 7% is excreted as unchanged morphine and 50-60% as glucuronides. Trace amounts of 6-MAM, a specific metabolite of heroin, are also excreted for approximately 6-8 hours following heroin use.
Here is a good graph of how certain opioids are metabolized into others:
The new report, (Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2011–2016) published Wednesday by the National Center for Health Statistics, analyzed the text of death certificates and compared it with National Vital Statistics System data, drilling down to determine the specific drug ― not just the class of drugs ― involved in overdose deaths from 2011 to 2016.
Long overdue, they are finally separating illicit opioids from legal prescriptions. The difference between the two was erased when they were all counted as simply as “opioids”, equating illicit fentanyl and heroin injected on the streets with legitimately prescribed opioids. This is how they were able to blame prescriptions for the “overdose crisis”.
I’m so relieved that this subterfuge is ending and policymakers will no longer be able to ignore the difference (though I’m sure they’ll do their best).
What researchers found mirrored news reports in recent years.
- Oxycodone, which was the most common drug cited in fatal overdoses in 2011,
- was eclipsed by heroin from 2012 to 2015,
- and then fentanyl in 2016.
On average, the U.S. death rate involving fentanyl increased about 113 percent per year from 2013 to 2016.
In most of these cases, the researchers found that more than one drug was used, and from those data they were able to identify the most common combinations of drugs that led to fatal overdoses.
For instance, about 40 percent of cocaine deaths also involved fentanyl.
Hedegaard and her co-authors used the same death certificates that the CDC typically uses for overdose reports but went deeper in their analysis, scouring the records for drug misspellings, chemical names, brand names and street names recorded by coroners and medical examiners.
These are the details that PROP and Kolodny don’t want people to see.
The amount and quality of information on the reports varied widely.
Though reporting by medical examiners and coroners improved over the course of the report, Hedegaard noted, in 2016, 15 percent of drug overdose death certificates still didn’t include any specific drug.
After an in-depth analysis of the information, the researchers also found that certain drugs were more likely to be the cause of death in unintentional overdoses, while others were more likely to be implicated in death by suicide.
In 2016, the street drugs
- heroin and
were most frequently recorded in unintentional fatal overdoses,
while prescription and over-the-counter medicines, including
- hydrocodone and
were most frequently recorded in deaths by suicide.
That’s because street drugs are driving overdoses, not prescriptions!