Drug overdose deaths involving opioids in the U.S., by type of opioid, 2000-2014. Graphic: CDC

14 March 2016 (CDC) – CDC looks at four categories of opioids:

  1. Natural opioid analgesics, including morphine and codeine, and semi-synthetic opioid analgesics, including drugs such as oxycodone, hydrocodone, hydromorphone, and oxymorphone;
  2. Methadone, a synthetic opioid;
  3. Synthetic opioid analgesics other than methadone, including drugs such as tramadol and fentanyl; and
  4. Heroin, an illicit (illegally-made) opioid synthesized from morphine that can be a white or brown powder, or a black sticky substance.

How the data are calculated

CDC’s standard analysis approach has combined the natural, semi-synthetic, and synthetic opioid categories (including methadone) when reporting deaths involving opioid analgesics, also referred to as prescription opioids. Using this method, in 2014 there were almost 19,000 deaths involving prescription opioids, equivalent to about 52 deaths per day. This is an increase from approximately 16,000 in 2013.1  A significant portion of the increase in deaths was due to deaths involving synthetic opioids other than methadone, which includes fentanyl. Law enforcement agencies have reported recent increases in seizures of illegally-made (non-pharmaceutical) fentanyl.2 It is presumed that a large proportion of the increase in deaths is due to illegally-made fentanyl.1 Unfortunately, information reported about overdose deaths does not distinguish pharmaceutical fentanyl from illegally-made fentanyl. Given the recent surge in illegally-made fentanyl, the CDC Injury Center is analyzing synthetic opioids (other than methadone) separately from other prescription opioids. This new analysis can provide a more detailed understanding of the increase in different categories of opioid deaths from previous years. Using this analysis, in 2014 there were more than 14,000 deaths involving this more limited category of prescription opioids (an increase in this category of 693 since 2013), equivalent to about 40 deaths per day.1 Changing the way deaths are analyzed seems to result in a decrease in deaths involving prescription opioids. But, this new number is likely an undercount of deaths related to prescription opioids, because it does not include deaths that are associated with pharmaceutical fentanyl, tramadol, and other synthetic opioids that are used as pain relievers.

What this means

Regardless of the analysis strategy used, prescription opioids continue to be involved in more overdose deaths than any other drug, and all the numbers are likely to underestimate the true burden given the large proportion of overdose deaths where the type of drug is not listed on the death certificate. The findings show that two distinct but interconnected trends are driving America’s opioid overdose epidemic: a 15-year increase in deaths from prescription opioid overdoses, and a recent surge in illicit opioid overdoses driven mainly by heroin and illegally-made fentanyl. Both of these trends worsened in 2014.3

References

  1. CDC. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2016. Available at http://wonder.cdc.gov.
  2. Centers for Disease Control and Prevention. CDC Health Advisory: Increases in Fentanyl Drug Confiscations and Fentanyl-related Overdose Fatalities. HAN Health Advisory. October 26, 2015. http://emergency.cdc.gov/han/han00384.asp
  3. Centers for Disease Control and Prevention. Increases in Drug and Opioid Overdose Deaths — United States, 2000–2014. MMWR 2015; 64;1-5.

Injury Prevention & Control: Opioid Overdose