Yesterday the CDC released a report of provisional drug overdose deaths for the 12-month period of December 2020 – December 2021. Although the data is preliminary with many states having incomplete data reporting, a few alarming trends can be seen in the publication.
U.S. deaths due to drug overdose rose 15% in the past 12 months, reaching the highest level on record. Annual deaths have more than doubled since 2015.
Every state in the U.S. except Wyoming showed an increase, however increases were not equal among the states. Alaska showed a 75% increase in the past 12 months.
The chart below provides a breakdown of deaths by drug. Based on the preliminary data available, the CDC reported that fentanyl was involved in the highest number of deaths (brown line). Deaths involving methamphetamines were a distant second (gray line), and cocaine third (pink line), but each still increased. Meanwhile, deaths involving heroin decreased. (blue line)
What does it look like?
Numerous states report increases in counterfeit tablets now including fentanyl. The DEA reports:
Counterfeit pills are nearly identical to actual prescription medications. The majority of counterfeit pills resemble oxycodone 30mg pills (M30s), but can also mimic hydrocodone, alprazolam (Xanax), Adderall, and other medications. There are indications that drug trafficking organizations are specifically targeting kids and teens by creating counterfeit pills in a variety of shapes and bright colors to appeal to that age group. Counterfeit M30 pills can vary in color from white to blue. The best way to avoid counterfeit medication is to take only medications prescribed by a licensed medical professional and dispensed by a registered pharmacist
U.S. Drug Enforcement Agency
What Can We Do?
In addition to counseling patients, teens, friends, neighbors, and family to avoid street drugs due to the potential for accidental overdose, liberal use of naloxone nasal sprays may save lives.
According to the CDC:
- Bystanders were present in almost 40% of overdose deaths involving opioids.
- 80% of overdose deaths occurred inside a home.
- Good Samaritan laws are in place in most states to protect those who are overdosing and anyone assisting them in an emergency from arrest, charges, or a combination of these. Learn about the laws in your state.
- Naloxone is available in all 50 states. In most states, a prescription is not required.
- Many community programs exist offering free naloxone.
If an education program does not exist in your community, the CDC offers numerous tools to help you start one. Additionally, reducing stigma around addiction and increasing access to medication-assisted treatment of opioid use disorder play critical roles in preventing unnecessary deaths due to drug overdose.
Sam Ashoo, MD, FACEP, is board certified in emergency medicine and clinical informatics. He serves as EB Medicine’s editor-in-chief of interactive clinical pathways and FOAMEd blog, and host of EB Medicine’s EMplify podcast. Follow him below for more…
It seems like synthetic opioids combine prescribed and elicit forms – I would think at this point those two could be separated some how similar to heroin and other elicit drugs – it would be much more telling re the opioid crisis if they were – the third graph indicates that there was a decrease from expected but again if number of prescribed opioids vs all synthetic opioids were separated into groups by kind it would be much more informative for prescribers – it seems like that information is intentionally withheld to inflate the crisis rather than giving prescribers information they can use! Withholding opioids as a blanket practice has harmed more patients than overdoses have in my practice partners habits! If they know that synthetic fentanyl is in adulterated drugs they could use prescribing practice to inform use re prescribed medications vs adulterated deaths which would be much more informative yet that information is conveniently absent!
You raise several good points. It would certainly be helpful to split the illegal from the legal synthetic opioids. I don’t believe this is intentional misrepresentation. I believe it is a limitation of the data received from each state. Remember that autopsy data reveals the presence of a drug, not how it was acquired. The CDC spends a little time explaining the difficulties in obtaining the data on their page. They also discuss the differentiation between the projected and actual reported numbers. Most of the discrepancy has to do with incomplete data reporting from each state. On the CDC website, the state map is interactive and provides actual vs projected numbers for each. It also displays if the data is incomplete. All 50 states are listed as having incomplete data reporting for this time frame. But, there is still enough to make some valuable conclusions. Check out their page for more details by clicking on the “Source: CDC” under each graph above.
You are also correct that the pendulum swing to prescribing zero opioids for patients is harmful. I have also seen similar problems in my practice with the strict limitations imposed by legislation. Ideally we would have something more balanced yet equally safe. Time will tell.