June 8, 2017

Drug deaths spiked by largest-ever margin in 2016, report suggests

Daily Briefing

    Deaths from drug overdoses likely exceeded 59,000 in 2016, marking the largest year-to-year increase ever recorded in the country—and making overdose-related deaths the leading cause of death among U.S. residents younger than 50, according to preliminary data compiled by the New York Times

    Learn the 8 steps for deploying clinical pharmacists in ambulatory care

    Methods

    According to the Times' Josh Katz, the publication collected its data by asking health departments in all 50 states as well as the District of Columbia, for their drug overdose statistics. When the state did not have the data, the Times followed up with county medical examiners and coroners' offices to get the information. In a few cases, the Times extrapolated partial results to get end-of-year data for 2016.

    Katz added that while CDC cannot confirm the final numbers for 2016 until December, Robert Anderson, chief of the Mortality Statistics Branch of the National Center for Health Statistics (NCHS) at CDC, reviewed the Times' data, and said they seem reasonable, although he cautioned that it is always difficult to make predictions.

    A worsening problem

    Overall, overdose-related deaths increased an estimated 19 percent between 2015, when 52,404 such deaths were recorded, and 2016—and the situation only appears to be getting worse in 2017, Katz writes. According to Katz, the jump in drug overdose-related deaths is directly linked to the ongoing opioid epidemic in the United States, and is being exacerbated by an influx of fentanyl among drug users.

    According to Katz, fentanyl is often sold as heroin, used to make fake prescription opioids, or mixed into cocaine, spurring an increase in cocaine-related overdose deaths. The most fatal fentanyl analog, Katz continues, is called carfentanil, a tranquilizer used for elephants that is 5,000 times stronger than heroin. People can die from doses smaller than just a few grains of salt, Katz adds. 

    This potency is also making it difficult for first responders to treat people who have overdosed, according to Katz. First responders are reporting that they have to use several doses of naloxone—the anti-overdose medication frequently called by the brand-name Narcan—to reverse an overdose. According to Doyle Burke, the chief investigator at the Warren County coroner's office, "E.M.S. crews are hitting [overdose victims] with 12, 13, 14 hits of Narcan with no effect."

    Geographic variance

    The data showed, that the influx of overdose deaths wasn't universal across the country—it varied by region.

    For instance, several states along the East Coast experienced sharp increases in the number of overdose deaths, including Maryland, Florida, Pennsylvania, and Maine. And in Ohio alone, overdose deaths jumped by more than 25 percent between 2015 and 2016.

    Meanwhile, in many states in the western part of the United States, overdose deaths either leveled off or declined—a variance that could potentially be linked to the distribution of heroin and fentanyl, Katz wrote. Dan Ciccarone, a professor of family and community medicine at the University of California-San Francisco, explained that drug dealers have traditionally sold powdered heroin—which can more easily be mixed with fentanyl—east of the Mississippi River, while they sold Mexican black tar heroin to the west.

    But Ciccarone added that while that differentiation in distribution might have helped curb the overdose death rate in the West, the overall severity of the opioid and heroin use is consistent across the country. So if drug dealers ever opt to begin selling powdered heroin in the West in large quantities, he said, fentanyl likely will hit that area of the country as it has on the East Coast.

    Limitations on the data

    According to Anderson, CDC cannot provide final numbers over the overall increase in overdose deaths because of the process by which those deaths are recorded. 

    He explained that it can take three to six months, and sometimes longer, to compile a toxicology report, which is necessary to assign the cause of death. And it can take even longer for NCHS to assign each death its appropriate ICD-10 code, which differ based on whether an individual died from a drug overdose, from the long-term effects of drug misuse, or whether alcohol or drugs were the underlying cause of death in subjects presenting with traces of both such substances.

    As a result of these delays and potential labeling inconsistencies, while the Times' data showed a significant increase in the number of overdose deaths in 2016, the final estimates could vary from finalized data by "several thousand," Katz wrote (Katz, New York Times, 6/5).

    Learn the 8 steps for deploying clinical pharmacists in ambulatory care

    As the number of medications rises, so does the opportunity for medication errors, such as incorrect dosages, drug interactions, and serious side effects. By some estimates, the U.S. spends as much money correcting these medications problems as we do on the drugs themselves.

    Check out our infographic to learn eight steps for how to deploy clinical pharmacists in outpatient clinics.

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