More Americans died of drug overdoses in 2016 than the number of Americans who died during the entirety of the Vietnam War, and nearly two-thirds of those deaths involved opioids.
A new report released Thursday by the Centers for Disease Control and Prevention (CDC) found the number of opioid-related overdoses rose by nearly 28 percent between 2015 and 2016. In 2016, 63,632 Americans died of drug overdoses.
About two-thirds of those overdose deaths were caused by opioids, CDC said. A little under a third were caused by prescription opioids, a quarter by heroin, and about a third by synthetic opioids other than methadone — most of which were likely caused by fentanyl, an extremely potent synthetic opioid mostly manufactured in China.
“The ongoing and worsening drug overdose epidemic requires immediate attention and action,” wrote CDC epidemiologists Puja Seth, Lawrence Scholl, Rose Rudd and Sarah Bacon.
The numbers show that the epidemic gripping America is getting worse, and suggest that what had been a crisis that mainly struck white Americans in rural and exurban areas is now killing thousands of black and Hispanic-Americans in urban settings.
Overdose deaths in large metropolitan areas jumped by more than a third. Among African-Americans, the number of opioid overdoses rose by more than half. Among whites, overdose deaths rose by more than a quarter. Overdoses killed 33,450 in 2016.
In Washington, D.C., alone, overdose deaths doubled between 2015 and 2016, the CDC data found. Opioid death rates are highest in West Virginia, where overdoses killed 43 in every 100,000 residents. New Hampshire and Ohio had overdose rates north of 30 per 100,000 residents, among the 31 states that reported their data to CDC.
“No area of the United States is exempt from this epidemic,” said Anne Schuchat, CDC’s principal deputy director. “We all know a friend, family member or loved one devastated by opioids.”
Opioid deaths have risen among all age groups over 15 years old; among both men and women; among every racial category; and in urban, suburban and rural communities alike.
Experts watching the overdose epidemic say the crisis is driven by two factors, neither of which has been contained.
One is the rising number of opioid prescriptions, and the subsequent rise in heroin use by those who become addicted. That crisis began, and continues to rage, in rural areas and especially among blue-collar whites.
The other is the later rise in fentanyl and other synthetic opioids, which can be much more deadly than prescription opioids. That crisis represents the most rapidly growing threat: overdoses caused by synthetic opioids, which CDC said mostly come from illicitly manufactured fentanyl. Such deaths more than doubled between 2015 and 2016.
“We often talk about the opioid epidemic as a singular epidemic. But if you look at it it’s actually two distinct epidemics going on simultaneously,” Jon Zibbell, a senior health scientist at the public health nonprofit RTI International, told The Hill earlier this month. “In some states, prescription opioids were driving the epidemic. In other states, illicit opioids are driving the epidemic. And in some states it’s both.”
The CDC researchers described the crisis as forming in three waves: The first wave began in the 1990s, when prescription opioids first hit the market. The second wave began to crest in 2010, when heroin deaths spiked. The third wave began in 2013, with the introduction of fentanyl and similar illegal drugs.
Fentanyl is so potent that thousands of doses can be sent through the mail in a single business-size envelope.
The Trump administration has highlighted the opioid crisis several times, calling the fight against it a priority for the White House. The CDC is funding state-level public health efforts in 45 states, and most states have implemented some reforms that either limit the size and length of prescriptions or crack down on doctors and pharmacies that prescribe too many opioids.
“I actually think we’re making good progress on the prescription side of things,” Zibbell said. “Where there’s no end in sight is the illicit stuff, heroin but also fentanyl.”
But there are few signs that the crisis is abating. Earlier this month, CDC released data that showed emergency room visits for suspected opioid overdoses increased by 30 percent between July 2016 and September 2017, an indication that the number of overdoses is still rising.
Rick Blondell, vice chair for addiction medicine at the Jacobs School of Medicine and Biomedical Sciences at the University of Buffalo, said the opioid crisis is an epidemic of our own making. Prescription rates have skyrocketed, fueled in part by hospitals and doctors trying to treat chronic pain rather than the underlying symptoms.
“Long-term, it’s going to be 20 years before we dig ourselves out of the hole that we made,” Blondell said. “Some aspects of [the crisis] are getting worse.”