By Roger Chriss, PNN Columnist
This week the National Safety Council released a report claiming that “for the first time on record, your odds of dying from an accidental opioid overdose are greater than dying in a motor vehicle crash.”
“The opioid crisis in the United States has become so grim that Americans are now likelier to die of an overdose than in a vehicle crash,” The Times reported.
This is incorrect. The average American is vastly more likely to die in a car crash than of an opioid overdose. The reason is simple: the typical American does not have any opioids to overdose on.
Good practice in epidemiology and public health research is to look at the “population at risk.” This population represents those people who would be counted if they are affected by whatever risk is being studied.
The population at risk for opioid overdose consists of people exposed to opioids, intentionally or otherwise. Within this population are people with varying degrees of risk, from low-risk in the form of a single dose of opioid medication in a hospital to high-risk in the form of heroin injection.
By contrast, the population at risk for car crash death is people who are exposed to car rides, whether as drivers or passengers. Needless to say, this is a very broad population that includes most Americans.
These two populations are not the same. There is some overlap between the two, but that does not mean they can be lumped together for the purpose of a generalized conclusion. Instead, epidemiological investigations look at a target population, that is to say the group of people about which conclusions will be drawn.
Again, these are distinct populations. The target population for reducing car crash fatalities is not the same as the target population for reducing opioid overdose fatalities.
As a result, a general comparison between the odds of dying of an opioid overdose versus a car crash is not statistically meaningful. Moreover, such comparisons misconstrue risk management and may lead to poor allocation of resources.
For instance, in 2017 there were 2,008 fatal overdoses with Benadryl and 1,250 with tramadol, according to the CDC. But this does not mean that Benadryl is more dangerous than tramadol. Far more people use Benadryl than tramadol, and usually without a prescription or monitoring. Ranking one as inherently more dangerous than the other would not lead to good public health policy.
Further, the risk of opioid overdose rises when people use other substances like alcohol, benzodiazepines or cocaine. Similarly, the risk of fatal car crashes rises when driving under the influence or other risky driving behaviors are involved. Because most people do not do these things, they are at the low end of the range of risk in the population at risk.
State laws like California’s AB 2760 requiring naloxone co-prescribing may help reduce opioid overdoses, but only if they reach people at greater risk. And resources committed to people at low risk may be taking resources away from people at high risk.
So although the National Safety Council’s report may be technically accurate, it is flawed and misleading. Most people are much more likely to die in a car crash because they are exposed to that risk on a regular basis. Only a small number of people are more likely to die of an opioid overdose, and risk reduction strategies need to be directed to them.
The NSC is a nonprofit that promotes itself as a "data-driven organization," but this is not the first time it has provided misleading information about opioids. As PNN has reported, an NSC memorial to opioid victims that toured the country last year overestimated the number of Americans who overdosed on prescription opioids by about 25 percent.
Good public health policy involves assessing the relative risks for the population at risk and adopting effective harm reduction policies. Sweeping statements that confuse a population at risk with the population at large can only lead to bad policies. And we’ve seen enough of those.
Roger Chriss lives with Ehlers Danlos syndrome and is a proud member of the Ehlers-Danlos Society. Roger is a technical consultant in Washington state, where he specializes in mathematics and research.
The information in this column should not be considered as professional medical advice, diagnosis or treatment. It is for informational purposes only and represents the author’s opinions alone. It does not inherently express or reflect the views, opinions and/or positions of Pain News Network.