What about the opioid epidemic?

May 1, 2021

Pill in hand
Photo credit: Klesta

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From 1999 to 2019, nearly 500,000 people have died from an opioid overdose. Yet we seem to have made significant strides in addressing this epidemic of opioid drug use.

For one, we're starting to hold people accountable for causing the crisis. In November, Purdue Pharma was ordered to pay $8.3 billion for illegal marketing practices related to its highly addictive opioid drug Oxycontin. Four healthcare companies are close to a $26 billion settlement for their role in the production and marketing of opioid drugs, while Walmart is being sued by the U.S. Department of Justice for filling hundreds of thousands of improper opioid prescriptions.

The federal government has also added its support over the last decade. During the Obama presidency, Congress approved bills that granted $1 billion to helps states improve drug monitoring and access to treatment programs, improve access to naloxone and the provision of treatment to incarcerated people, develop a strategy to address neonatal abstinence syndrome, facilitate the safe disposal of unused prescription drugs.

Purdue ad
Purdue Pharma advertisement for Oxycontin (1998).
During Trump's time in office, bills were signed to improve access to substance use disorder treatment, reduce the entry of fentanyl and other synthetic opioids into the country, improve opioid detection equipment at the borders, and fund research on opioid addiction. Obama observed Prescription Opioid and Heroin Epidemic Awareness Week, Trump declared the opioid crisis a public health emergency, and both administrations issued federal guidelines, executive actions, and raised awareness.

The Biden administration has now added its own contributions, including an ambitious plan to contribute $125 billion toward addressing the crisis over the next decade. And just last week, his administration changed the rules around prescribing buprenorphine, a medication used to treat addiction, to allow medical providers to prescribe without undergoing additional training.

Then COVID happened

Since January 2020, when the first COVID-19 case was diagnosed in the United States, the public health community (and the national) has shifted its attention toward the new virus. The COVID pandemic has since swept the globe, transforming lives, upending society, and taking with it more than three million lives.

But how has the opioid epidemic evolved in that same time? Have legal victories and government funding stemmed the impact of the opioid crisis? Has COVID impacted drug use, or our ability to provide health services to those with substance use disorders?

Empty pill bottles
Photo credit: Chris Yarzab

The U.S. Centers for Disease Control releases finalized data on drug-related deaths once per year. But making these datasets takes time: first, determining a death was because of drugs can sometimes require lengthy investigations. Identifying which specific drug was involved takes time. At the end, CDC must receive all of the death certificates from every state and territory, conduct quality assurance checks, code all of the deaths, and compile everything into one release. As a result, these annual data releases usually take around two years to finalize (meaning that data are right now only available through 2019). This makes up-to-date tracking difficult.

Fortunately, the CDC also releases provisional data on drug deaths, which are released on just a six month lag. Statistical methods are applied to these data to produce a 'predicted' count of drug deaths, to account for underreporting. Although data are estimates and should not be considered final, they nonetheless give an important early glimpse into more recent trends.

Number of drug overdose deaths (2015 - 2020)

Source: U.S. Centers for Disease Control and Prevention. National Center for Health Statistics. Twelve-month rolling sum of provisional drug overdose death counts (through September 2020) are converted to monthly values, with an adjustment for the historical difference between provisional and final data. Final estimates are taken from CDC Wonder (available through December 2019).

We did a rough calculation to convert provisional annual data to monthly deaths. In general, the number of drug-related deaths has remained around relatively stable between 2017 and 2019, fluctuating around 5,800 per month.

" In Louisiana, Kentucky, and West Virginia, deaths increased more than 45% in a year "

But in 2020, we find a striking increase in drug-related deaths. Starting in the summer of 2019, the number of monthly drug-related deaths climbed from 6,011 people (in September 2019) to 7,745 (September 2020) -- a 29% increase over the past year.

Some states have seen extremely sharp increases in drug deaths. In Louisiana, Kentucky, and West Virginia, deaths have increased by more than 45% in the last year. In the District of Columbia, the death rate has jumped 60%.

Several states seem to be entering a second wave of drug-related deaths, reversing some degree of public health success. In West Virginia, Pennsylvania, and Ohio, some of the hardest-hit states in the opioid crisis, drug deaths were dropping in 2018, before starting to climb rapidly in 2019.

Per-capita drug overdose deaths, by state (2015 - 2020)

Source: U.S. Centers for Disease Control and Prevention. National Center for Health Statistics. Twelve-month rolling sum of provisional drug overdose death counts (through September 2020) are converted to monthly values, per 100,000 population. Population data are taken from the U.S. Census release of annual estimates of resident population (NST-EST2019-01).

Why are drug-related deaths increasing? It could be driven by the COVID-19 pandemic. Lockdown measures in many states have impacted the ability of people with substance use disorders to access health services. The personal burden of the pandemic, like stress, fear, and isolation, can lead to relapse, suicide attempts, violence, and overdose. Social distancing measures can lead to people using drugs alone, placing them at higher risk for a fatal overdose. And COVID itself may be contributing to drug use and misuse: some patients with long-lasting symptoms are receiving inappropriate prescriptions for addictive pain pills.

As is clear in CDC provisional overdose data, the opioid and drug use crisis did not end when COVID-19 appeared. And despite the efforts from public health practitioners, the federal government, communities, and families, we still have not done enough. The next challenge will be ensuring that one public health crisis does not set back progress on all the others.

Want to see for yourself? All our data are on GitHub.

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