Overdose deaths from opioids — both prescription opioids and heroin — reached an all-time high in 2014, according to the CDC.
Following a relative plateau around 16,000 deaths per year, prescription opioid overdose deaths shot up 16% in 1 year to 18,893 dealths in 2014 Rose Rudd, MSPH, of the CDC, and colleagues reported in Morbidity and Mortality Weekly Report.
Heroin deaths also continued to jump, reaching 10,574 that year, up from about 8,000 in 2013. The latest rate is nearly three times the heroin overdose rate in 2010, the CDC said.
CDC director Tom Frieden, MD, MPH, said in a statement that the increase is “alarming,” and he called for greater prevention, treatment, and law enforcement efforts.
The largest increase in opioid overdose deaths involved synthetic opioids such as oxycodone and hydrocodone (methadone was excluded), Rudd and colleagues said. These drugs were involved in 5,500 deaths in 2014, nearly twice as many as the year before.
And many of these overdoses are believed to involve illicitly-made fentanyl, the agency said. While it’s hard to distinguish between prescription and illicit fentanyl, reports from states and drug seizure data have shown that a substantial proportion of the increase in synthetic opioid deaths is related to wider availability of this illicit fentanyl, the agency said.
Illicit fentanyl is also combined with heroin or sold as heroin, which might be contributing to the rise in overdose deaths from heroin as well, the researchers said.
The Office of National Drug Control Policy, which held its first of several community forums on opioid misuse this week, echoed the CDC’s concern that the rise in fentanyl-related deaths comes predominantly from increases in illicitly manufactured fentanyl.
Jane Ballantyne MD of the University of Washington, agreed that the increase in illicit fentanyl is a contributor, as is the price drop in other illicit opioids such as black-tar heroin from Mexico.
And as physicians and public health officials have succeeded in persuading doctors to prescribe fewer opioids, those who are seeking them — particularly those already dependent on opioids — may be turning to other, more dangerous sources, Ballantyne said.
“Although efforts to reduce reliance on opioids for the treatment of chronic pain did reduce abuse and death initially, that reduction is probably overwhelmed by the thousands of people who have already become dependent on opioids through pain treatment,” Ballantyne said. “Their condition is likely to worsen as they age, they will need higher doses, and if they don’t get them from doctors they will turn to illicit sources which are even more dangerous.”
Ballantyne added that the medical community should continue to recognize that opioids aren’t the solution for chronic pain, and “recognize that those already dependent on opioids need help, which probably includes opioid maintenance.”
Overall drug overdose deaths rose to 47,055 from 43,982 the year before. The majority of these deaths (61%) involved an opioid, the CDC said, and misuse of prescription opioids is the greatest predictor of heroin misuse.
Both the CDC and ONDCP called for better prevention efforts and greater access to treatment for patients with addiction, particularly medication-assisted therapy, as well as stepped-up law enforcement efforts to curb use.
Both agencies also promoted greater use of the opioid overdose reversal agent naloxone, which is now available in many forms, including an auto-injector called Evzio and an official on-label nasal spray formulation, Narcan.