New Patterns Emerging in Opioid Related Mortality Could Lead to More Effective Public Health Policies

New Patterns Emerging in Opioid Related Mortality Could Lead to More Effective Public Health Policies

How has opioid-related mortality changed over time across the United States, and how have the types of opioids associated with these deaths changed? Also, could the answers to these questions prove valuable to public health policies regarding the opioid epidemic?

These were the questions that a team of researchers from Stanford, Harvard and Toronto universities set out to answer, in a study just published in JAMA Network Open.

Their answers indeed may prove valuable for many of the players in the opioid epidemic game, from the White House on down through the states, counties and cities. And there could be real value even further down the chain to committed stakeholders in the treatment industry, such as Novus Medical Detox Centers of Florida, where countless victims of the opioid epidemic begin their journey to a drug-free life.

National CDC database

The study analyzed individual-level data for 351,564 US residents from coast to coast, who died from opioid-related causes, from January 1, 1999, to December 31, 2016. The data is gathered and maintained by the National Center for Health Statistics, an agency of the CDC.

The researchers categorized the types of opioids involved, including 'heroin,' 'all opioids,' 'synthetic opioids,' and 'natural and semi-synthetic opioids'.

Also, the first time in any study we've seen, it assessed what's called 'life expectancy lost' (LEL) - the years lost to an unexpected, untimely death compared to what would have been expected.

Shifting geography, drugs and mortality rates

At the top of the list of findings is the shifting geographic distribution of overdose mortalities.

Since its loose beginnings in the 1990s, the opioid epidemic has been considered a central or mid-Western, rural, and mostly a heroin phenomenon, but also including a large and independent Appalachian sector driven largely by prescription opioids.

By combining changes in opioid-related mortality rates, the opioids involved and the life expectancy lost at age 15 years, by state and by opioid type, the study has revealed a more comprehensive picture.

A pattern of rapid and steady growth in mortality through the 2000s is clear, but it has begun shifting relentlessly eastward and northward, primarily driven by synthetic opioids such as fentanyl.

Hot spots in view

The study clearly shows the shifts from state to state, region to region, and types of opioids most involved.

The District of Columbia led the nation in mortality increases since 2013, more than tripling every year. Eight states - Connecticut, Illinois, Indiana, Massachusetts, Maryland, Maine, New Hampshire, and Ohio - have doubled every year. Florida and Pennsylvania have doubled every 2 years. In fact, the mortality rate has doubled every 2 years in 24 eastern states - the clear indicator of expansion from lower-income, rural states to urban centers.

"The life expectancy lost at age 15 years from opioids is now greater than that lost from deaths due to firearms or motor vehicle crashes in most of the United States," the study added.

Study identifies "hot spots"

Lead researcher Mathew Kiang, ScD, of Stanford, told MedPage Today that most research has focused on either the mortality rate or the rate of change. "We describe both together to identify what we call epidemic hot spots -- areas that have high opioid mortality that is rapidly getting worse," he said. He added that deaths from drugs like fentanyl now outnumber heroin deaths, suggesting that synthetic opioids are contaminating other street drugs such as cocaine and meth.

The value of the study is in the enormously detailed analyses of the opioid epidemic, which we certainly don't have space for here. The researchers have created several novel and instructive interactive graphic features that allow the viewer to drill down into the data, from various viewpoints.

Important for effective policies

"To ensure that state policies are relevant and appropriately targeted, it is vital to identify changes in the geographical distribution of opioid-related deaths and the types of opioids associated with those deaths," the researchers wrote.

"Given the rapid evolution of the epidemic, it is also important to identify which areas have high mortality rates due to historical trends and which areas have newly established high mortality rates likely due to changing illicit opioid markets."

By identifying and characterizing opioid "hot spots" in these terms, policies can be developed to better target the epidemic and meet the real needs of the population.

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