Sep 20, 2018

U.S. drug overdose deaths grew exponentially in 38 years

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Adapted from Jalal et al., 2018, “Changing dynamics of the drug overdose epidemic in the United States from 1979 through 2016”; Chart: Chris Canipe/Axios

Deaths in America from drug overdoses have been growing exponentially for years — with an almost eerily consistent growth rate of about 9% per year for the past 38 years, despite the different types of drug epidemics and user demographics, scientists report in a new study published Thursday in Science.

Why it matters: Some experts tell Axios this is an urgent call to action, as the U.S. drug epidemic is more complicated and entrenched than expected.

"The study shows that about 300,000 people died from all drug overdoses in a period of 15 years. In the next 5 years, we'll see another 300,o00 people die, unless we do something drastically different."
— Robert Pack, professor, Eastern Tennessee State University (ETSU), who was not part of the new study

What they did: Study author Donald Burke, dean of the University of Pittsburgh's Graduate School of Public Health, says they examined patterns of "unintentional drug poisoning" from death certificates during the period from 1979–2016 in the National Vitals Statistics System.

What they found: While Burke says the researchers were not surprised at modern-day drug overdose rates, they were startled to find that the problem began so long ago and rose at such a consistent rate throughout the decades.

  • Drug overdose deaths doubled about every 8 years.
  • It's actually a composite of multiple sub-epidemics. For instance, cocaine was the highest cause of death in 1999, but in 2016 it was synthetic opioids like fentanyl.

Threat level: While the types of drugs, users and geography changed through the years, the consistency of the growth rate shows Americans need to address the underlying causes behind the problem, Burke tells Axios.

  • If those issues are not addressed, he says the trend, which has shown about a 99% accuracy in anticipated trajectory so far, will continue even if the current epidemic of prescription opioids, heroin and fentanyl abuse is diminished.

The big questions: Experts say this study offers important data that will shift the focus for further research, particularly into examining the drivers behind these trends. One big question is why America has had this issue for so long, and with far greater intensity than other countries.

  • Burke, for example, questioned whether so-called 'diseases of despair, which include drug and alcohol poisoning and are often found in people suffering from a lack of purpose or widening income disparity, are driving the long-term increase.
  • Others told Axios they're also re-evaluating what's behind these trends.
"What's holding all these diverse sub-epidemics together?... Why are we failing so badly at prevention?" asks Pack, who's also executive director at ETSU's Center for Prescription Drug Abuse and Treatment.
"We have to look at what is it that's different about this place and this time, compared to what's happening elsewhere," says Richard Frank, a professor of health economics at Harvard University, who was not part of the new study.

More study details:

  • Almost all geographical locations, with the exception of some north Central states, have been a hot spot for drugs at one time or another.
  • Heroin hotspots have changed from being prominent in large cities to being distributed more widely, especially in the Northeast and the Southwest.
  • "Heroin used to be an African-American urban thing, and now it's a white rural thing," Frank says.
  • Fentanyl tends to be centered in opioid hotspots, especially in the Appalachian and Northeast regions.
  • Prescription opioid hotspots initially were prominent in the Southwest and Appalachia but subsequently spread to the West, Oklahoma, Florida and New England.
  • Cocaine hotspots have also centered around large cities but have diffused more broadly in recent years.
  • Methadone was the only drug that peaked during the study period and then declined.

Next steps: The three experts say this study presents evidence there is a great need for further research and funding to stop the crisis. "This is a very compelling call to action," Pack says.

  • One method could be through state grants via the 21st Century Cures Act or other mechanisms, which would be key to "tailor response to local conditions," Frank says.
  • Pack says one of the primary things that needs to be figured out "is how to get evidence-based prevention programs that are sustainable at a community level."
  • Burke says more research is also needed on the push factors, including things like improved communications and supply chains, efficiencies in drug manufacturing, and expanding drug markets, which lead to lower prices and higher drug purities.

Caveats: Burke points out that one issue with the study is that the accuracy of the death certificates depends on coroner's offices regarding testing for multiple drugs and entering correct codes.

Go deeper:

Editor's note: This story has been corrected to note that overdose deaths have had a consistent growth rate of about 9% (not acceleration rate).

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