Increasing Death Rates in the United States Linked to Drug Overdose

The United States is currently facing its highest overall death rates in over a century, largely due to drug overdose mortality. The roots of this epidemic can be traced back to a 1986 World Health Organization declaration that proclaimed pain treatment as a universal right. Consequently, guidelines for cancer pain treatment were established, which included the use of opioids. In 1995, the approval of OxyContin as a pain management medication paved the way for widespread opioid prescriptions.

In an effort to examine the trends in drug overdose deaths in the U.S., researchers from Florida Atlantic University’s Schmidt College of Medicine and their collaborators analyzed data from 1999 to 2020. They assessed various factors such as age, gender, race, urbanization, and geography. The findings of their original research, published in The American Journal of Medicine, reveal that drug overdose deaths in the U.S. have more than quadrupled between 1999 and 2020, regardless of race, age, geography, or urbanization.

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Key Findings of the Research:

Between 1999 and 2020, drug overdoses led to 1,013,852 deaths in the United States. The rates of drug overdose deaths increased by a factor of 4.4, rising from 6.9 per 100,000 in 1999 to 30 per 100,000 in 2020. Additionally, the study observed the highest number of drug overdose deaths ever recorded in any 12-month period from May 2022 to May 2023.

When examining specific subgroups, the research identified several notable trends. White individuals and Native Americans or Alaskan Natives experienced the greatest increase in drug overdose deaths by race. Moreover, areas in the Midwest and non-metropolitan regions were more significantly impacted compared to other regions.

“Data from our research suggest that clinical and public health interventions should be targeted to populations and regions experiencing the most drug overdose deaths. Health care providers already have and will continue to play crucial roles in reducing preventable morbidity and mortality from drug overdoses.”

– Jennifer Caceres, M.D., senior author and senior associate dean for student affairs and admissions, FAU Schmidt College of Medicine

The study’s data reveals that between 1999 and 2004, regions such as Appalachia (mainly West Virginia) and the Southwest (primarily Utah) had the highest death rates from opioids. Over the subsequent five years, mortality rates in these areas further increased, and new hotspots emerged in states like Florida. However, from 2011 to 2016, hotspots diminished in Florida due to restrictions on opioid prescriptions. During this period, there was a significant rise in potentially preventable deaths caused by heroin.

Between 2014 and 2018, fentanyl-related deaths surged across the United States, with a slightly less substantial increase in the Midwest. Fentanyl, a synthetic opioid with over 50 times the potency of heroin and 100 times that of morphine, is a major contributor to drug overdose cases. Illicitly manufactured fentanyl has become increasingly prevalent, replacing pharmaceutical forms and intensifying the risk of overdose.

“While we acknowledge the importance of guidelines, health care providers should exercise individual clinical judgement for each patient, and policymakers should consider the well-being of the general public,” stated Allison Ferris, M.D., chair of the Department of Medicine and program director of the internal medicine residency program at FAU Schmidt College of Medicine. “To mitigate the risks associated with overdoses, addiction care should be integrated into all healthcare practices, regardless of specialization, and medical education should emphasize this aspect.”

The authors emphasize the urgent need to promote the widespread distribution and availability of naloxone, an opioid receptor antagonist that rapidly counteracts the effects of opioids, restores normal breathing and heart function, and reverses the potentially fatal consequences of an overdose. Recently, the U.S. Food and Drug Administration approved over-the-counter forms of naloxone, such as intramuscular injections or nasal sprays.

Additionally, the authors stress the importance of implementing targeted interventions that can provide healthcare providers with the necessary tools to effectively assess patients for addiction care and connect them with suitable resources.

“To prevent untimely deaths, public health authorities should collaborate with federal, state, and judicial systems to treat individuals with drug use disorders in the same manner as those with serious chronic illnesses,” advised Charles H. Hennekens, M.D., Dr.PH, co-author of the study and a renowned medical professor. “While death may be inevitable, premature death can be prevented.”

In conclusion, the authors recommend the implementation of analytic studies specifically designed to test hypotheses derived from these descriptive findings. These studies should include case-control and cohort investigations and, if necessary, large-scale randomized trials to reliably detect plausible small-to-moderate effects.

The researchers based their study on data obtained from the U.S. Centers for Disease Control and Prevention’s Wide-ranging Online Data for Epidemiologic Research (WONDER) and Multiple Cause of Death files from the National Center for Health Statistics.

The study’s co-authors include Tarek Ghaddar, a second-year medical student at FAU Schmidt College of Medicine; Maria Mejia, M.D., an associate professor of family and community medicine at Baylor College of Medicine; Srekar M. Ravi, M.D., an FAU Schmidt College of Medicine graduate and resident in medicine at Mayo Clinic in Phoenix; and Robert S. Levine, M.D., a professor of family and community medicine at Baylor College of Medicine and an affiliate professor of population health and social medicine at FAU-Schmidt College of Medicine.