• Dr. Scott McClelland

Drug Overdose

I took some time to visit the website of the Center for Disease Control and Prevention to read the weekly Morbidity and Mortality Weekly Report (MMWR) of 3/30/18 which included the article “Overdose Deaths Involving Opioids, Cocaine, and Psychostimulants”. I am going to cut and paste some data from it that will surely deepen your concern about the epidemic and the impact on so many human lives. Every death involves multiple family members and those who respond and attempt to resuscitate victims of this tragic time in our country’s history.

In the United States, 63,632 drug overdose deaths occurred in 2016; the age-adjusted rate of overdose deaths increased significantly (21.5%) from 16.3 in 2015 to 19.8 in 2016. Opioids were involved in 42,249 (66.4%) drug overdose deaths (13.3 per 100,000 population) in 2016, representing a 27.9% rate increase from 2015. These increases primarily were driven by deaths involving synthetic opioids, for which the rate doubled from 2015 to 2016. Rates of overdose deaths involving prescription opioids and heroin increased by 10.6% and 19.5%, respectively, and rates of overdose deaths involving cocaine and psychostimulants increased by 52.4% and 33.3%, respectively.

From 2015 to 2016, opioid-involved deaths increased in males and females and among persons aged ≥15 years, whites, blacks, Hispanics, and Asian/Pacific Islanders. The largest relative rate change occurred among blacks (56.1%). The largest absolute rate increases of opioid-involved deaths and deaths involving synthetic opioids occurred among males aged 25–44 years and persons aged 25–34 years. However, deaths involving synthetic opioids increased in every subgroup examined. Rates involving prescription opioids, heroin, cocaine, and psychostimulants increased for both sexes, whites, blacks, and most age groups. Counties in large central and fringe metro areas experienced the largest absolute increases in deaths involving prescription and synthetic opioids, heroin, and cocaine; micropolitan areas experienced the largest increase in rates involving psychostimulants.

Opioid death rates differed across the 31 states and DC, with synthetic opioids driving increases in many states. Although several states experienced increases across drug categories, in many, the changes from 2015 to 2016 were not significant. Rates of deaths involving synthetic opioids ranged from 0.9 to 30.3 per 100,000, with the largest rates and increases concentrated in eastern states. New Hampshire (30.3 per 100,000), West Virginia (26.3), and Massachusetts (23.5) had the highest synthetic opioid death rates. Twenty states and DC experienced increases in overdose death rates involving synthetic opioids, with 10 experiencing increases by ≥100%; the largest such increase (392.3%) occurred in DC, followed by Illinois (227.3%) and Maryland (206.9%). Many states with large increases in synthetic opioid death rates also had large increases in rates involving other drug categories (e.g., Maryland, Virginia, and DC), including any opioid, prescription opioids, heroin, and cocaine.

Thirteen states and DC experienced significant increases in heroin-involved death rates, whereas a significant decrease (56.9%) occurred in New Hampshire. In 2016, the highest rates were in DC (17.3 per 100,000), West Virginia (14.9), and Ohio (13.5). The rates of prescription opioid– involved overdose deaths significantly increased in seven states and DC, with the highest rates in West Virginia (19.7), Maryland (13.1), Maine (12.5), and Utah (12.5). The highest cocaine- involved overdose death rates occurred in DC (13.5), Rhode Island (10.7), and Ohio (10.1), with 15 states and DC experiencing a significant increase from 2015. Significant increases in overdose death rates from heroin, prescription opioids, and cocaine occurred primarily in states in the eastern part of the country. Fourteen states experienced significant increases in psychostimulant-involved overdose death rates. The highest rates were in midwestern and western states: Nevada (7.5), New Mexico (7.1), and Oklahoma (7.1).

It is overwhelming to think about what it will take to stop this craziness. In my opinion this is a national emergency. I say that only from the immensity of the problem. The natural response at the highest levels is usually to up law enforcement strategies to intercept and catch the purveyors of this evil, which is good but it will do little for those who are addicted and need treatment. Hopefully it will slow down the numbers of people becoming addicted. From what I see there is a lack of coordinated attack of this enemy by the community that involves the judicial system, law enforcement, first responders, and the multiple treatment facilities which includes hospitals (medical, mental, and detox), public health facilities, and private treatment centers/clinics. I know there must be communities out there who are waging a coordinated attack. It would be most useful if the government would at least seek out and identify those communities and provide the information for others to examine and cut short the invention of their own wheel.

#addiction #opioids #overdose #heroine #cocaine

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