Regardless of the analysis strategy used, prescription opioids continue to be involved in more overdose deaths than any other drug, and all the numbers are likely to underestimate the true burden given the large proportion of overdose deaths where the type of drug is not listed on the death certificate. The findings show that two distinct but interconnected trends are driving America’s opioid overdose epidemic: a 15-year increase in deaths from prescription opioid overdoses, and a recent surge in illicit opioid overdoses driven mainly by heroin and illegally-made fentanyl. Both of these trends worsened in 2014.
Overdose deaths involving prescription opioids have quadrupled since 1999, and so have sales of these prescription drugs. From 1999 to 2014, more than 165,000 people have died in the U.S. from overdoses related to prescription opioids.
Opioid prescribing continues to fuel the epidemic. Today, at least half of all U.S. opioid overdose deaths involve a prescription opioid. In 2014, more than 14,000 people died from overdoses involving prescription opioids.
Most Commonly Overdosed Opioids
The most common drugs involved in prescription opioid overdose deaths include:
- Oxycodone (such as OxyContin®)
- Hydrocodone (such as Vicodin®)
Among those who died from prescription opioid overdose between 1999 and 2014:
- Overdose rates were highest among people aged 25 to 54 years.
- Overdose rates were higher among non-Hispanic whites and American Indian or Alaskan Natives, compared to non-Hispanic blacks and Hispanics.
- Men were more likely to die from overdose, but the mortality gap between men and women is closing.
Overdose is not the only risk related to prescription opioids. Misuse, abuse, and opioid use disorder (addiction) are also potential dangers.
- In 2014, almost 2 million Americans abused or were dependent on prescription opioids.
- As many as 1 in 4 people who receive prescription opioids long term for non-cancer pain in primary care settings struggles with addiction.
- Every day, over 1,000 people are treated in emergency departments for misusing prescription opioids.
Fentanyl is a synthetic (man-made) opioid that is 50x more potent than heroin and 100x more potent than morphine. There are two types of fentanyl:
- Pharmaceutical fentanyl, which is primarily prescribed to manage acute and chronic pain associated with advanced cancer.
- Non-pharmaceutical fentanyl, which is illegally made, and is often mixed with heroin and/or cocaine—with or without the user’s knowledge—in order to increase the drug’s effect.
Illegally made fentanyl is mixed with heroin and other drugs, often in the Midwest, Northeast and Southern regions of the United States. More than 80% of fentanyl confiscations in 2014 occurred in 10 states in these regions:
|Rank||State||Number of Fentanyl Confiscations|
Heroin is a synthetic, highly addictive opioid that can produce intense feelings of euphoria.
Heroin use has been increasing in recent years among men and women, most age groups, and all income levels. Some of the greatest increases have occurred in demographic groups with historically low rates of heroin use: women, the privately insured, and people with higher incomes. In particular, heroin use has more than doubled in the past decade among young adults aged 18 to 25 years.
Heroin-Related Overdose Deaths
As heroin use has increased, so have heroin-related overdose deaths:
•Heroin-related overdose deaths have more than tripled since 2010.
•From 2013 to 2014, heroin overdose death rates increased by 26%, with more than 10,500 people dying in 2014.
•In 2013, non-Hispanic whites aged 18 to 44 years had the highest rate for heroin overdose death (7.0 per 100,000).