In 2014, 47,055 people in the United States died from drug overdoses – more deaths than attributed to this cause in any previous year on record, according to data from the National Vital Statistics System.
Opioids, primarily prescription pain relievers and heroin, were the main drugs associated with overdose deaths. In 2014, opioids were involved in 28,647 deaths, or 61% of all drug overdose deaths, Rose A. Rudd of the Centers for Disease Control and Prevention and her colleagues wrote (MMWR. 2015 Dec 18;64[Early release]:1-5).
The rate of opioid overdoses has tripled since 2000; the 15-year trend data implicate prescription opioid pain relievers and a recent surge in illicit opioid overdose deaths, driven largely by heroin.
From 2013 to 2014, synthetic opioids other than methadone (e.g., fentanyl and tramadol) drove the largest increase in the rate of drug overdose deaths. The rate nearly doubled from 1 per 100,000 persons to 1.8 per 100,000 persons. In 2014, the rate of drug overdose deaths involving natural and semisynthetic opioids (for example, morphine, oxycodone, and hydrocodone) was 3.8 per 100,000. The rate of drug overdose deaths involving methadone, a synthetic opioid classified separately from other synthetic opioids, was similar in 2013 and 2014.
The five states with the highest rates of drug overdose deaths in 2014 were West Virginia (35.5 deaths per 100,000), New Mexico (27.3), New Hampshire (26.2), Kentucky (24.7), and Ohio (24.6).
States with statistically significant increases in the rate of drug overdose deaths from 2013 to 2014 included Alabama, Georgia, Illinois, Indiana, Maine, Maryland, Massachusetts, Michigan, New Hampshire, New Mexico, North Dakota, Ohio, Pennsylvania, and Virginia.
The rates were noted in all adult age groups. From 2013 to 2014, statistically significant increases in drug overdose death rates were seen for both males and females, persons aged 25-34 years, 35-44 years, 55-64 years, and 65 years and older. Based on ethnicity, increases were seen in non-Hispanic whites and non-Hispanic blacks. Based on residency, increases were most common in the Northeast, Midwest, and South.
The authors noted three limitations of the data: First, the substances tested for and circumstances under which toxicologic tests are performed vary by jurisdiction; in 2013 and 2014, 22% and 19% of drug overdose deaths, respectively, did not include information on the death certificate about the specific types of drugs involved, and the percent of overdose deaths with specific drugs identified on the death certificate varies widely by state. Second, an increase from 2013 to 2014 in reporting of specific drugs involved in drug overdose deaths might have contributed to some of the observed increases in drug overdose death rates involving different types of opioids. Finally, some heroin deaths might be misclassified or underreported because morphine and heroin are similarly metabolized.
Efforts to encourage safer prescribing of opioid pain relievers should be strengthened, according to the authors. CDC has developed a draft guideline for the prescribing of opioids for chronic pain to address this need. The guideline is available at www.cdc.gov/drugoverdose/prescribing/guideline.html.
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