Changing dynamics of the drug overdose epidemic in the United States from 1979 through 2016

Abstract

Better understanding of the dynamics of the current U.S. overdose epidemic may aid in the development of more effective prevention and control strategies. We analyzed records of 599,255 deaths from 1979 through 2016 from the National Vital Statistics System in which accidental drug poisoning was identified as the main cause of death. By examining all available data on accidental poisoning deaths back to 1979 and showing that the overall 38-year curve is exponential, we provide evidence that the current wave of opioid overdose deaths (due to prescription opioids, heroin, and fentanyl) may just be the latest manifestation of a more fundamental longer-term process. The 38+ year smooth exponential curve of total U.S. annual accidental drug poisoning deaths is a composite of multiple distinctive subepidemics of different drugs (primarily prescription opioids, heroin, methadone, synthetic opioids, cocaine, and methamphetamine), each with its own specific demographic and geographic characteristics.

Fig. 1.

Mortality rates from unintentional drug overdoses for A) individual drugs, and B) all drugs. Detailed data from individual drugs are only available from 1999 to 2016, while additional data available since 1979 from all drugs [this area is greyed out]. The exponential equation and fit are shown for all drugs. r = overall mortality rate and y = year. [Synth Opioids OTM = Synthetic opioids other than methadone. This category includes fentanyl and its analogues].

Fig. 2.

Heatmaps showing the sub-epidemic by demographics and urbanicity. Total number of deaths in each category from 1999 through 2016 are shown in the upper left corner of each plot. The colors indicate age-adjusted mortality rates per 100K people. [Synth Opioids OTM = Synthetic opioids other than methadone. This category includes fentanyl and its analogues].

Fig. 3.

Geospatial hot-spot analysis by drug and period. The Gi* statistics are standardized using pooled statistics across all drugs and periods. The various shades of red and blue indicate pooled standard deviations above and below the pooled mean, respectively as shown in the legend. The small black circles indicate major cities with population greater than 300K people. None of the regions were less than 2 pooled standard deviations below the pooled average. [Synth Opioids OTM = Synthetic opioids other than methadone. This category includes fentanyl and its analogues].