The U.S. Centers for Disease Control and Prevention (CDC) now posts its overdose statistics monthly, after an approximately seven month lag. For the rolling 12-month period ending October 31, 2017, there were 68,400 overdose deaths from all drugs (including non-opioids), or 187 per day. That number currently reflects a rise of 12 percent over the 12-month period that ended October 31, 2016. But these most up-to-date numbers are “provisional,” presumed to be underestimates, and are still being adjusted. Finalized numbers for 2017 are expected to be available in December 2018, according to the CDC.
The most up-to-date final statistics for overdose deaths in the U.S. are for 2016, and come from the CDC’s National Center for Health Statistics.
That year there were 63,632 drug overdose deaths of all kinds (including non-opioids), or 174 per day, which is three times the rate of drug overdose in 1999, and up 21 percent from 2015. This is more than the number of soldiers who died in the Vietnam War: 58,200. It is also more than the highest annual death toll from AIDS at the height of that epidemic (about 50,000 in 1995). Overdose is widely reported to be the leading cause of death for Americans under 50.
Of these, about 66 percent of the total overdose deaths, or 42,249, involved opioids (of any kind), or about 116 per day. This exceeds the total motor vehicle traffic deaths (40,327 that year) and appears to exceed the total number of deaths from firearms (33,594 in 2014, including both homicides and suicides). The opioid epidemic is believed to have contributed to shortening of the average American lifespan in 2015 and 2016. (It was the first drop since 1993, during the AIDS epidemic.)
Between 1999 and the end of 2016, 632,331 Americans died from drug overdoses, of which at least 351,630 were opioid-related, according to the CDC.
Opioid overdose deaths were five times higher in 2016 than in 1999, while sales of prescription opioids quadrupled over that period.
The opioid deaths in 2016 broke down as follows:
|Opioid Present||Number of Overdoses||% of Opioid ODs||% of Total Drug ODs|
|“Natural or Semi-Synthetic” (including most prescription pills, like oxycodone, hydrocone, oxymorphone, hydromorphone).||14,487||34%||23%|
|“Synthetics excluding methadone” (mainly believed to be illicitly trafficked fentanyl)||19,413||46%||31%|
As reflected in the graph below, the CDC found that while overdoses involving prescription opioids have continued to rise at a rate of about 3 percent annually since 2009, overdoses from synthetics—mainly fentanyl—have been skyrocketing since 2013, rising at an average annual rate of 88 percent. Heroin has also been surging since 2010.
Caveats: The drug categories are not mutually exclusive, since many overdoses involve the presence of multiple drugs—i.e., the autopsy may pick up traces of heroin, fentanyl, prescription opioids, cocaine, and prescription non-opioids, all at once. In addition, these figures come from death certificates drawn up by medical examiners and coroners whose practices vary state by state and, in some instances, county by county. Some do not check for all drugs, and some may not check for any.
According to the CDC, as of the end of 2016, the states worst hit by the epidemic were West Virginia (52 deaths per 100,000); Ohio (39.1); New Hampshire (39); the District of Columbia (38.8); and Pennsylvania (37.9).
The lowest state-wide rates of overdose death were Nebraska (6.4 deaths per 100,000); South Dakota (8.4); Texas (10.1); North Dakota (10.6); and Iowa (10.6).
Opioid Use Disorder
In 2016, an estimated 2.1 million Americans age 12 or older suffered from Opioid Use Disorder, according to the National Survey on Drug Use and Health conducted by the Substance Abuse and Mental Health Administration (SAMHSA). About 1.8 million suffered from Pain Reliever Use Disorder.
By one measure used by the CDC, opioid prescribing in the United States peaked in 2010. It has declined since then, apparently in response to changes in treatment guidelines and the institution of prescription drug monitoring programs in many states or counties. Still, as of 2015, it remained three times as high as it was in 1999. The 2015 level in the U.S. was also four times higher than it was that same year in Europe. Measured in terms of “morphine milligram equivalents” (MME)—a way of taking into account the differing strengths of different prescription opioids—prescribing peaked at 782 MME per capita in 2010, and had come down to 640 MME per capita in 2015. In 1999 the level stood at 180 MME per capita.
By an alternative measure, also used by the CDC, prescribing rates peaked in 2012. That year there were 255 million prescriptions dispensed, or 83.1 per 100 persons. By 2016 the number had declined to 214 million prescriptions, or 66.5 per 100 persons. Despite the progress, researchers warned that some counties had prescribing rates in 2016 that were seven times higher than the national average.
In 2017, opioid prescriptions, measured by MME, fell another 12 percent in 2017, the largest annual drop on record, according to the IQVIA Institute. The highest doses of prescription opioids declined 33% over the past two years.
Economic Impact of the Crisis
Estimates of the economic burden of the opioid epidemic vary enormously. The most frequently cited are the following:
$78.5 billion in 2013, and published in Medical Care in 2016, by three CDC researchers.
$504 billion in 2015, or 2.8 pe of GDP, per a November 2017 report by the White House Council of Economic Advisors. Its sum is so much higher because it includes in an estimate of the economic cost of the opioid overdose fatalities.
$115 billion in 2017, per a report by the nonprofit health care consulting firm Altarum on February 13, 2018. Researchers also found that costs exceeded $1 trillion between 2001 and 2017, and predicted that another $500 billion would be incurred by 2020. These figures were cited by U.S. Attorney General Jeff Sessions in February 2018.