By Pat Anson, Editor
Deaths from drug overdoses soared by 21 percent last year in the United States, with fentanyl and heroin now playing a bigger role in the overdose crisis than prescription pain medication, according to a new report from the Centers for Disease Control and Prevention.
The report estimates that 63,600 Americans died from drug overdoses last year, up from 52,400 in 2015. The soaring overdose rate helped lower U.S. life expectancy for the second consecutive year. A baby born last year is expected to live 78 years and 7 months, about two months less than a child born in 2014.
"If we don't get a handle on this, we could very well see a third year in a row. With no end in sight," CDC researcher Robert Anderson told the Associated Press.
About two-thirds of the drug deaths in 2016 involved opioids, a broad category that includes not only pain medication, but heroin and synthetic opioids such as fentanyl that are increasingly available on the black market. Fentanyl is up to 100 times more potent than morphine.
Fentanyl and its chemical cousins were blamed for over 19,000 deaths last year, followed by heroin (15,500 deaths) and prescription painkillers (14,500 deaths).
In the chart below, fentanyl is included in the category of "synthetic opioids other than methadone," while "natural and semisynthetic opioids" includes pain medications such as oxycodone and hydrocodone.
The CDC’s new report may actually underestimate the number of people dying from fentanyl and heroin. CDC researchers relied on data from International Classification of Disease (ICD) codes on death certificates, which merely list the drugs that are present at the time of death -- not the actual cause of death.
A more reliable way to list the cause of death is through toxicology blood tests, which often find that multiple drugs are involved in overdoses. Florida, Massachusetts, Pennsylvania and several other states that conduct their own toxicology reports have found that fentanyl, heroin and anti-anxiety medications are responsible for far more overdoses than prescription opioids. A recent study found that fentanyl or fentanyl analogues were involved in over half of the overdoses in 10 states.
Another recent study of emergency room admissions found that heroin overdoses exceeded those from prescription opioids by almost a 2 to 1 margin.
President Trump's opioid commission recognized the need to improve the CDC’s drug overdose data when it released its final report last month.
"The Commission recommends the Federal Government work with the states to develop and implement standardized rigorous drug testing procedures, forensic methods, and use of appropriate toxicology instrumentation in the investigation of drug-related deaths. We do not have sufficiently accurate and systematic data from medical examiners around the country to determine overdose deaths, both in their cause and the actual number of deaths,” the commission found.
Although its own research shows that fentanyl and heroin are causing more overdoses than opioid medication, the CDC continues to focus on painkillers as the root cause of the overdose crisis. As PNN has reported, a public awareness campaign recently launched by the CDC only warns about the risks of prescription opioids, while completely ignoring the growing scourge of heroin and fentanyl.
But there is little evidence that awareness campaigns or prescription guidelines are reducing opioid addiction and overdoses, according to a recent op-ed in The New England Journal of Medicine.
"National trends show that we do not yet understand how to stem the tide of opioid overdoses by changing physicians’ prescribing practices. Although the volume of opioid prescriptions has fallen by 12% since its peak in 2012, the rate of overdose deaths continues to increase faster than ever, driven by an influx of potent synthetic opioids such as fentanyl. How and when decreased prescribing will translate into fewer deaths is unclear," wrote lead author Michael Barnett, MD, assistant professor of health policy management at the Harvard T.C. Chan School of Public Health.
"In the meantime, there is a real danger that aggressive opioid-prescribing policies could drive more people to use more dangerous injection opioids or force patients to live with inadequately treated pain. We simply do not know which policies will strike the right balance between promoting safe opioid use and avoiding unintended consequences."