How the opioid epidemic became America’s worst drug crisis ever, in 7 maps and charts

March 28, 2017 — VOX — With all the other news going on, it can be easy to lose track of this fact. But it’s true: In 2015, more than 52,000 people died of drug overdoses, nearly two-thirds of which were linked to opioids like Percocet, OxyContin, heroin, and fentanyl. That’s more drug overdose deaths than any other period in US history — even more than past heroin epidemics, the crack epidemic, or the recent meth epidemic. And the preliminary data we have from 2016 suggests that the epidemic may have gotten worse since 2015.

This situation did not develop overnight, but it has quickly become one of the biggest public health crises facing America. To understand how and why, I’ve put together a series of maps and charts that show the key elements of the epidemic — from its start through legalpainkillers prescribed in droves by doctors to the recent rise of the highly potent opioid fentanyl.

1) Drug overdoses now kill more people than gun homicides and car crashes combined

To understand just how bad the opioid epidemic has gotten, consider these statistics: Drug overdoses in 2015 were linked to more deaths than car crashes or guns, and in fact killed more people than car crashes and gun homicides combined. Drug overdoses in 2015 also killed more people in the US than HIV/AIDS did during its peak in 1995. So just as HIV/AIDS lives in the American mind as a horrible epidemic, the current opioid epidemic should too.

2) Drug, painkiller, heroin, and other opioid overdose deaths are still on the rise

It took years of increasing deaths to get to this point, but the opioid epidemic has only gotten worse over time. The result is horrifying: Between 1999 and 2015, more than 560,000 people in the US died to drug overdoses — a death toll larger than the entire population of Atlanta.

The epidemic has by and large been caused by the rise in opioid overdose deaths. First, opioid painkiller overdoses began to rise, as doctors began to fill out a record number of prescriptions for the drugs in an attempt to treat patients’ pain conditions. Then, people hooked on painkillers began to move over to heroin as they or their sources of drugs lost their prescriptions. And recently, more people have begun moving to fentanyl, an opioid that’s even more potent and cheaper than heroin. The result is a deadly epidemic that so far shows no signs of slowing down.

Not every state in America has been equally impacted by the opioid epidemic. States like West Virginia, New Hampshire, Rhode Island, and Ohio have been hit particularly hard, suffering far more deaths than even their neighbors on an annual basis. And the epidemic has generally been concentrated along the Rust Belt and New England — due in large part, it seems, to the enormous number of painkiller prescriptions that doctors doled out in those areas.

By and large, the drug overdose epidemic has hit white Americans the hardest

The drug overdose epidemic hasn’t hit people of all racial groups equally either, with white Americans suffering far more overdose deaths than their black and Latino peers. As the chart above shows, this is a shift from before the 2000s, when past drug crises tended to hit black, urban communities much harder.

3) Americans consume more opioids than any other country

This is perhaps the most important chart to understand why America in particular is suffering from the epidemic: Simply put, the US consumes far more opioid painkillers than any other country in the world. When a country collectively consumes more of a deadly, addictive drug, it’s obviously going to have more deaths as a result of those drugs.

But the reality is that, at some level, some patients struggling with chronic pain may just have to learn to live with the pain. This may sound cruel, but it’s something that’s asked of patients dealing with other chronic conditions when medicine just has no good answers. For example, a patient with heart disease might be told that she needs to eat less or adjust her activity level — potentially ruining her interests or hobbies — to avoid a heart attack as she becomes older.

“You can’t use the pills to extend your limits. You have to accept that there’s some things you just won’t be able to do anymore,” Lembke told me. “People are very resistant to that idea. I think that speaks to some of the core hope for at least Americans that they should really be able to keep doing what they were doing in their 20s, and that somehow a doctor should be able to fix them and make that happen, instead of accepting that maybe that’s something that they just can’t do anymore.”

4) Opioid users moved from painkillers to heroin, because heroin is so cheap

As governments and regulators cracked down on painkillers, however, many people addicted to the drugs didn’t just stop using. Many instead resorted to another opioid to fill their habit: heroin. A 2014 study in JAMA Psychiatry found many painkiller users were moving on to heroin, and a 2015 CDC analysis found people who are addicted to prescription painkillers are 40 times more likely to be addicted to heroin. Not all painkiller users went this way, and not all heroin users started with painkillers, but painkiller use played a big role in leading more people to heroin.

The main reason for this: Heroin is extremely cheap in the black market, despite law enforcement efforts for decades to push up the price of drugs by cracking down on the illicit supply. In fact, over the past few decades, the price of heroin in the US has dramatically dropped — to the point that it’s not only cheaper than opioid painkillers sold in the black market, but frequently even candy bars.

But heroin is also more potent and, therefore, deadlier than opioid painkillers. So even though not every painkiller user went to heroin, just enough did to cause the big spike in heroin overdose deaths that America has seen over the past few years. So now more people die of overdoses linked to heroin than die of overdoses linked to commonly prescribed painkillers.

That doesn’t mean cracking down on painkillers was a mistake. It appeared to slow the rising number of painkiller deaths, and may have prevented doctors from prescribing the drugs — or letting them proliferate — to new generations of people who’d develop drug use disorders. So the crackdown did lead to more heroin deaths, but it will hopefully prevent future populations of drug users, who could have suffered even more overdose deaths.

5) Fentanyl has become a growing problem as well

As if the rise in heroin deaths wasn’t bad enough, over the past few years there has been evidence of another opioid that’s even more potent than heroin leading to more drug overdose deaths: fentanyl. Sometimes drug users purposely seek out this drug. But often it’s laced in other substances, like heroin and cocaine, without the users knowing it, leading to an overdose.

So while cutting access to opioids might in the long term stop the creation of new generations of people with drug use disorders, in the shorter term the country needs to devise solutions for how to get people to stop using drugs and how to make their drug use less deadly and dangerous. That’s where drug treatment, including medication-assisted treatment that replaces dangerous opioid use with safer opioids like buprenorphine, and harm reduction efforts, such as clean needle exchanges, can help.

6) Anti-anxiety drugs are involved in more overdoses as well

National Institute on Drug Abuse

Opioid painkillers aren’t the only legal drug that’s killing more people. Federal data shows that benzodiazepines, such as Xanax and Valium, are also increasingly involved in overdose deaths.

This speaks to another aspect of the drug overdose epidemic: It’s not always just one drug killing people. Very often, people use multiple drugs, from painkillers to cocaine to alcohol. This is especially bad because different drugs can heighten other drugs’ risk of overdose. Alcohol and benzodiazepines, for instance, are known to compound the overdose risk of opioids.

The data speaks to this: Most benzodiazepine overdoses have involved opioids in the past few years, as the chart above shows. And the Centers for Disease Control and Prevention previously found that 31 percent of opioid painkiller overdose deaths in 2011 were also linked to benzodiazepines.

7) Most people who meet the definition for a drug use disorder don’t get treatment

While drug treatment may be the true solution to the opioid epidemic, the reality is it remains inaccessible to a lot of people. According to 2014 federal data, at least 89 percent of people who met the definition for having a drug use disorder didn’t get treatment. And that’s likely an underestimate: Federal household surveys leave out incarcerated and homeless individuals, who are more likely to have serious, untreated drug problems.

http://www.vox.com/science-and-health/2017/3/23/14987892/opioid-heroin-epidemic-charts