US opioid overdoses rise by 30% in one year

BMJ 2018; 360 doi: (Published 12 March 2018) Cite this as: BMJ 2018;360:k1157
  1. Owen Dyer
  1. Montreal

An increased government focus on the US opioid crisis has not yet slowed the epidemic’s growth, according to new data from the Centers for Disease Control (CDC).

Emergency department visits for suspected opioid overdoses rose by 30% from July 2016 to September 2017, this month’s Vital Signs bulletin from the CDC reported.1

The rise was driven by a continued climb in overdoses from street drugs, which now outnumber those from prescription opioids. Fentanyl accounts for a growing share of the black market, having surpassed both heroin and prescription opioids as the leading cause of fatal overdose in 2015.

The opioid epidemic has left its rural roots and is now growing fastest in cities. Rates of increase were similar across both genders and all age groups.

Regionally, overdoses are rising fastest in the Midwest, up by 70% across the region, with the biggest spikes seen in Illinois and Wisconsin.

Modest declines were seen, however, in the two regions most associated with the epidemic: rural New England and the area sometimes referred to as “the great black spot,” which roughly corresponds to the coal country of West Virginia, Kentucky, and southern Ohio.

The latest figures tally overdoses but not deaths from overdose. The proportion of overdoses that end in death would normally be expected to fall as access to naloxone improves, but working against this factor is the increasing preponderance of fentanyl, by far the deadliest opioid.

Figures released on 8 March for Canada’s largest province, Ontario, showed 1053 opioid related deaths from January to October 2017, compared with 694 during the same period in 2016. Emergency department visits for suspected overdose were up 41%. These figures led the province to announce that naloxone nasal spray will be made available free of charge in Ontario pharmacies from the end of this month.

New US research questioning the benefits of naloxone triggered social media debate about the “moral hazard” of the overdose antidote, and whether its availability encourages riskier behaviours. Researchers from the universities of Virginia and Wisconsin wrote that the introduction of naloxone access laws was associated with a rise in emergency department visits for overdose and in opioid related theft, but no decline in mortality. They argued that increased access to naloxone brought an increase in mortality.2

A study published on 6 March in the Journal of the American Medical Association that followed 240 Veterans Administration patients with chronic back pain or hip or knee osteoarthritis pain found that after 12 months, opioid therapy brought no greater reduction in reported pain than did acetaminophen (paracetamol) and other non-steroidal anti-inflammatory drugs.3

The exponential growth of long term opioid treatment for chronic pain at the beginning of this century is widely seen as the genesis of the current opioid crisis.


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