CDC: Opioid overdose epidemic ‘continues to worsen’ in country

The country’s opioid overdose epidemic “continues to worsen” due to the “continuing increase in deaths involving synthetic opioids,” according to a multi-year review of state data by the Centers for Disease Control and Prevention.

The analysis of drug and opioid-related overdose deaths in the country shows a substantial decrease in such deaths from heroin between 2016 and 2017 in Massachusetts, a decrease in such deaths related to prescribed opioids during that time period in the state but, like elsewhere in the country, an increasing death rate likely driven by illicitly-manufactured fentanyl as well as related synthetic opioids.

The review reflects the impact of what states like Massachusetts have been seeing in recent years and now appears to be spreading west of the Mississippi to continue to fuel the country’s opioid overdose crisis despite efforts to diminish it – the growing presence of IFM among street drugs that recently prompted Gov. Charlie Baker  to request $5 million to help police catch dealers selling the extremely potent narcotic.

As noted on the CDC website, opioids, which can be derived naturally from the opium poppy or manufactured, that is chemically synthesize, in a lab, are a class of drugs used to reduce pain.

The CDC defines the term “illicit” as the non-medical use of a variety of drugs that are prohibited by law.

The report calls the overdose epidemic” increasingly complex” due to the “co-involvement of prescription and illicit drugs.”

Natural opioids include morphine and codeine and semi-synthetic opioids include drugs such as oxycodone, according to the study’s categories; prescription opioids  include methadone, natural and semi-synthetic opioids; synthetic opioids, other than methadone, include drugs such as tramadol and fentanyl and heroin, an illicit opioid synthesized from morphine that has no medical application in the United States.

While overdose deaths involving all opioids and synthetic opioids increased from 2016 to 2017, according to the report, heroin- and prescription-opioid-involved deaths remained stable though seven and four times higher, respectively, in 2017 than in 1999.

According to the report, drug overdoses resulted in 70,237 deaths in 2017 – a 10 percent increase from 2016 – with opioids involved in 67.8 percent or some 47,600 of these deaths, a 12 percent increase from 2016, and synthetic opioids involved in 59.8 percent of the opioid-related deaths, a 45.2 percent increase from 2016.

Some deaths involved more than one type of drug, as noted in the report, which looked at changes in death rates from 2016 to 2017 involving all opioids and opioid subcategories.

Massachusetts had 1,990 overdose deaths from opioids in 2016 or 29.7 per 100,000, according to the report’s data; 1,913 in 2017 or 28.2 per 100,000. Some 630 of these involved heroin in 2016 or 9.5 per 100,000, and 466 in 2017 or 7.0 per 100,000. Some 351 involved prescription opioids in 2016 or 4.9 per 100,000; 321 or 4.6 per 100,000, 2017. Overdose deaths from synthetic opioids other than methadone in 2016 were 1,550 or 23.5 per 100,000; 1,649 or 24.5 per 100,000 in 2017.

Twenty-three states and the District of Columbia, according to the CDC review, experienced significant increases in synthetic opioid-involved overdose death rates in 2017, including eight states west of the Mississippi River.

The largest relative rate increase at 122.2 percent occurred in Arizona, followed by North Carolina, 112.9 percent, and Oregon, 90.9 percent.

The highest synthetic opioid-involved overdose death rates in 2017 were in West Virginia at 37.4 per 100,000, Ohio, 32.4 per 100,000, and New Hampshire, 30.4 per 100,000, according to the study.

As noted in the article, drug overdoses in the United States between 1999 and 2017 resulted in 702,568 deaths with 399,230 or 56.8 percent, involving opioids.

The article reviewed data beginning in 2013, which is considered the start of the third wave in the rise of opioid-related overdose deaths in the country and what some have called the “even deadlier” wave.

The first wave began in the 1990s with the prescribing of opioids for pain control and the second in 2010 with increased overdose death rates from heroin.

The third wave is associated with significant increases in overdose deaths involving synthetic opioids and in particular illicitly-manufactured fentanyl which is 30 to 50 times more potent by weight than the heroin it is often disguised as when sold on the street.

IMF is also clandestinely sold in combination with cocaine as well as in counterfeit  tablets to resemble certain benzodiazepine sedatives as well as certain semi-synthetic opioids like oxycodone.

Death rates involving cocaine and psychostimulants increased 34.4 percent – from 3.2 to 4.3 per 100,000 – and 33.3 percent – from 2.4 to 3.2 per 100,000 – respectively, from 2016 to 2017, according to the study, while rates remained stable for deaths involving prescription opioids at 5.2 per 100,000 and heroin at 4.9 per 100,000.

Massachusetts was one of five states cited in the report for “significant decreases” in heroin-involved overdose deaths in 2017 compared to 2016. The highest heroin-involved overdose death rates in 2017 were in the District of Columbia at 18.0 per 100,000, West Virginia at 14.9 per 100,000 and Connecticut at 12.4 per 100,000.

The highest prescription opioid-involved death rates in 2017 were in West Virginia at 17.2 per 100,000, Maryland at 11.5 per 100,000, and Utah at 10.8 per 100,000, according to the report.

Opioid-overdose death rates differed across the states examined in the study with the highest relative increases said to occur in North Carolina, Ohio, and Maine.

From 2013 to 2017, drug overdose death rates increased in 35 of 50 states and District of Columbia, according to the report. During this time, 15 of 20 states that met drug specificity criteria had significant increases in overdose death rates involving synthetic opioids.

From 2016 to 2017, according to the report, opioid-involved deaths:

• Increased for both sexes.

• Increased among all people in all age groups over the age of 25.

• Increased among white, black, and Hispanic people.

• Had the largest absolute death rate increase in males 25-44.

• The largest percent change increases in opioid-involved death rates were among blacks (25.2 percent) and adults over age 65 (17.2 percent).