5 Updates on Trends in Drug Overdose Deaths in the United States

In the past 3 decades, drug overdoses have killed approximately 870,000 people. Since first wave of the opioid epidemic began in the 1990s, the epidemic has expanded to include other synthetic, illicit drugs, including heroin and fentanyl. As new CDC data and other studies offer updates on the epidemic, here are 5 things to know.

1. Rates have dropped for the first time since 1990

Provisional data released by the CDC in July indicate that drug overdose deaths have dropped for the first time since 1990. Between the 12-month period ending December 2017 and the 12-month period ending December 2018, there was a 5.1% decline in overdose deaths, dropping from 72,000 overdose deaths to 68,000.

In June, provisional data for the 12-month period ending in November 2018 compared with the 12-month period ending in November 2017 hinted that deaths would fall. At the time, Robert N. Anderson, PhD, chief of the Mortality Statistics Branch of the National Center for Health Statistics at the CDC, said in an email to The American Journal of Managed Care^® (AJMC^®) that the data suggests the epidemic had reached its peak in the United States.

“That said, the number of deaths for 2018 is still predicted to be nearly 70,000,” he added. “That is a lot of people dying much too young. Even if the decline holds once the data are final, it is too soon to declare victory.”

2. Not all states are seeing drops in overdose deaths

The CDC data were encouraging for some states that have historically been hit hardest by the epidemic. For example, drug overdose deaths in Ohio dipped 22.4% from 5155 to 4002 between the 12-month period ending December 2017 and the 12-month period ending December 2018. Rates in Pennsylvania dropped 19.6% from 5600 to 4503 during the same time period.

But while the nation as a whole is headed toward a drop in overdose deaths, not all states are seeing decreases. Missouri and Rhode Island experienced the biggest increases in overdose deaths between the 12-month period ending December 2017 and the 12-month period ending December 2018 (16.3% and 16.7% respectively). In Missouri, drug overdose deaths increased from 1406 to 1635 and from 342 to 399 in Rhode Island.

Other states that saw increases include California, South Carolina, Vermont, Louisiana, and Arizona.

3. Urban areas see higher overdose death rates than rural areas

CDC data released this week revealed geographic shifts in where the epidemic is having the biggest impact. In 2016 and 2017, urban counties saw higher drug overdose death rates compared with rural areas (22.0 vs 20.0 per 100,000, respectively). These increased rates were seen across overdose deaths involving heroin (5.2 vs 2.9), synthetic opioids other than methadone (9.3 vs 7.0), and cocaine (4.6 vs 2.4).

The age-adjusted rate of drug overdose deaths in urban counties jumped from 6.4 per 100,000 in 1999 to 22.0 in 2017 while the rate in rural counties increased from 4.0 to 20.0 during the same period.

The data also revealed gender differences in drug overdose death rates. For men, the age-adjusted rate of drug overdose deaths was higher in urban counties than in rural counties (29.9 vs 24.3). Meanwhile, the rate of drug overdose deaths for women was higher in rural areas than in urban areas (15.5 vs 14.2).

4. Synthetic opioids continue to drive overdose death rates

While rates of heroin, cocaine, and natural opioid overdose deaths have started to level out, overdose death rates involving synthetic opioids like fentanyl, which is 50 to 100 times more potent than morphine, have continued to increase. In the 12-month period ending December 2018, synthetic opioid overdose deaths increased to over 31,000 compared with the approximately 29,000 reported in the 12-month period ending December 2017.

Since the 12-month period ending December 2015, deaths have increased from approximately 9000 to the 31,473 in the 12-month period ended December 2018.

Rates of overdose deaths involving fentanyl specifically doubled each year from 2013 through 2016, from 0.6 per 100,000 in 2013, to 1.3 in 2014, to 2.6 in 2015, and to 5.9 in 2016. While death rates involving fentanyl have increased significantly across both men and women, 3 times as many men as women are dying from the synthetic opioids.

5. Heroin overdose rates are higher among the Medicaid population

A study published in the July issue of AJMC^® analyzed 2010 to 2014 IBM MarketScan Databases and calculated annual heroin overdose rates, finding that rates were persistently higher among the Medicaid population than the commercially insured, except among those aged 15 to 24 years.

However, rates increased faster among the commercially insured during the time period. While heroin overdose death rates increased 94.3% among the Medicaid population, rates increased by 270% among the commercially insured. Overdose rates were consistently higher among male enrollees, regardless of insurance type. In 2014, rates of heroin overdose among male and female enrollees were 10.5 and 4.1 per 100,000 commercial enrollees, respectively, and 34.9 and 28.0 per 100,000 Medicaid enrollees, respectively.

The study findings also showed that nearly all enrollees with heroin overdose had at least 1 healthcare encounter in the 6 months prior to their first overdose.