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Opioids

Understanding the opioid epidemic, and how the CDC, states, communities and healthcare providers are working to combat it.

What are opioids?

According to Johns Hopkins Medicine, opioids are a class of drugs naturally found in the opium poppy plant and that work in the brain to produce a variety of effects, including the relief of pain with many of these drugs. Opioids can be prescription medications often referred to as painkillers, or they can be so-called street drugs, such as heroin.

Many prescription opioids are used to block pain signals between the brain and the body and are typically prescribed to treat moderate to severe pain. In addition to controlling pain, opioids can make some people feel relaxed, happy or “high,” and can be addictive. Additional side effects can include slowed breathing, constipation, nausea, confusion and drowsiness.

The epidemic by the numbers

According to the Centers for Disease Control & Prevention, from 1999–2018, almost 450,000 people died from an overdose involving any opioid, including prescription and illicit opioids.1 The number of drug overdose deaths decreased by 4% from 2017 to 2018, but the number of drug overdose deaths was still four times higher in 2018 than in 1999.2 Nearly 70% of the 67,367 deaths in 2018 involved an opioid. From 2017 to 2018, there were significant changes in opioid-involved death rates:

  • Opioid-involved death rates decreased by 2%.
  • Prescription opioid-involved death rates decreased by 13.5%.
  • Heroin-involved death rates decreased by 4%.
  • Synthetic opioid-involved death rates (excluding methadone) increased by 10%.

This rise in opioid overdose deaths can be outlined in three distinct waves, the CDC said:

  1. The first wave began with increased prescribing of opioids in the 1990s, with overdose deaths involving prescription opioids (natural and semi-synthetic opioids and methadone) increasing since at least 1999.3
  2. The second wave began in 2010, with rapid increases in overdose deaths involving heroin.4
  3. The third wave began in 2013, with significant increases in overdose deaths involving synthetic opioids, particularly those involving illicitly manufactured fentanyl.5,6,7 “The market for illicitly manufactured fentanyl continues to change, and it can be found in combination with heroin, counterfeit pills, and cocaine,” the CDC said.8

Combating the epidemic through collaboration

Collaboration is essential for success in preventing opioid overdose deaths, according to the CDC. Its work focuses on:

  • Monitoring trends to better understand and respond to the epidemic.
  • Advancing research by collecting and analyzing data on opioid-related overdoses and improving data quality to better identify areas that need assistance and to evaluate prevention efforts.
  • Building state, local and tribal capacity by equipping states with resources, improving
    data collection, and supporting use of
    evidence-based strategies.
  • Supporting providers, healthcare systems, and payers with data, tools, and guidance for evidence-based decision-making to improve opioid prescribing and patient safety.
  • Partnering with public safety officials and community organizations, including law enforcement, to address the growing illicit
    opioid problem.
  • Increasing public awareness about prescription opioid misuse and overdose and to make safe choices about opioids.

The CDC has built the Overdose Data to Action (OD2A), a 3-year cooperative agreement through which CDC funds health departments in 47 states, Washington DC, two territories, and 16 cities and counties for surveillance and prevention efforts. Funds awarded as part of this agreement will support state, territorial, county, and city health departments in obtaining high quality, more comprehensive, and timelier data on overdose morbidity and mortality and using those data to inform prevention and response efforts.

Recipients will be able to do a number of surveillance activities to monitor and gather data about the scope and nature of the overdose problem under the new cooperative agreement:

  • Collect and disseminate emergency department data on suspected overdoses categorized as “all drug,” “all opioid,” “heroin,” and “all stimulant.”
  • Collect and disseminate descriptions of drug overdose death circumstances using death certificates, toxicology reports, and medical examiner/coroner reports.
  • Implement innovative surveillance activities to support interventions. These activities help increase comprehensiveness of surveillance data and allow jurisdictions to tailor their surveillance efforts to specific needs.

For more information, visit:www.cdc.gov/drugoverdose/epidemic/index.html.

References

1. Wide-ranging online data for epidemiologic research (WONDER). Atlanta, GA: CDC, National Center for Health Statistics; 2020. Available at http://wonder.cdc.gov.

2. Wilson N, Kariisa M, Seth P, et al. Drug and Opioid-Involved Overdose Deaths—United States, 2017-2018. MMWR Morb Mortal Wkly Rep 2020;69:290-297.

3. Centers for Disease Control and Prevention (CDC). Vital signs: overdoses of prescription opioid pain relievers—United States, 1999–2008. MMWR MorbMortal Wkly Rep. 2011 Nov 4; 60(43):1487-1492.

4. Rudd RA, Paulozzi LJ, Bauer MJ, Burleson RW, Carlson RE, Dao D, Davis JW, Dudek J, Eichler BA, Fernandes JC, Fondario A. Increases in heroin overdose deaths—28 states, 2010 to 2012. MMWR MorbMortal Wkly Rep. 2014 Oct 3; 63(39):849.

5. Gladden RM, Martinez P, Seth P. Fentanyl law enforcement submissions and increases in synthetic opioid-involved overdose deaths—27 states, 2013–2014. MMWR MorbMortal Wkly Rep. 2016; 65:837–43.

6. O’Donnell JK, Gladden RM, Seth P. Trends in deaths involving heroin and synthetic opioids excluding methadone, and law enforcement drug product reports, by census region—United States, 2006–2015. MMWR MorbMortal Wkly Rep. 2017; 66:897–903.

7. O’Donnell JK, Halpin J, Mattson CL, Goldberger BA, Gladden RM. Deaths involving fentanyl, fentanyl analogs, and U-47700—10 states, July–December 2016. MMWR Morb Mortal Wkly Rep. 2017; 66:1197–202.

8. Drug Enforcement Administration. 2019 National Drug Threat Assessment. Drug Enforcement Administration Strategic Intelligence Section, U.S. Department of Justice. Published December 2019. Accessed March 17, 2020 from https://www.dea.gov/sites/default/files/2020-01/2019-NDTA-final-01-14-2020_Low_Web-DIR-007-20_2019.pdf

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