THE COUNCIL OF STATE GOVERNMENTS CAPITOL RESEARCH AUGUST 2017 HEALTH POLICY Opioid Deaths Quadruple Since 1999 Since 1999, the number of overdose deaths involving opioids (including prescription opioids and heroin) has quadrupled, accounting for six out of every 10 drug overdose deaths. Current estimates show that 91 Americans die each day from an opioid overdose, according to the Centers for Disease Control and Prevention, or CDC 1. Opioid deaths are increasing at alarming rates across the states. And while state policies to reduce the availability of prescription opioids are working to reduce overdose deaths, heroin and synthetic opioid overdoses are beginning to climb. 2 Fast Facts About the Impact of Opioids in the United States The economic burden of prescription opioid misuse is estimated to be $78.5 billion per year, including health care costs, lost productivity, addiction treatment and criminal justice involvement. 3 Opioid Overdose Deaths Compared to All Drug Overdose Deaths from 1999 to 2015 60,000 50,000 ALL DRUG DEATHS 40,000 30,000 OPIOID DEATHS 20,000 10,000 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 NOTES: Total opioid overdose deaths reported in the United States exclude opioid deaths in North Dakota in 2012, 2006, and 2005. In these years, data are not available for the states due to suppression constraints and are therefore excluded from the U.S. total and the corresponding percentage of all drug overdose deaths. SOURCES: Kaiser Family Foundation analysis of Centers for Disease Control and Prevention, or CDC, National Center for Health Statistics. Compiled from Multiple Causes of Death 2005-2015 on CDC WONDER Online Database, released in 2016.
About 80 percent of people who use heroin first misused prescription opioids. 4 In 2015, 33,091 people died from an opioid overdose. 5 In 1999, opioid overdose deaths accounted for 48 percent of all drug overdose deaths. In 2015, the percentage of opioid deaths increased to 63 percent. 6 Two million people were diagnosed with prescription opioid use disorder in 2015. 7 Opioid Overdose Death Rates in the States Forty-six states and the District of Columbia experienced an increase in total opioid overdose deaths and an increase in the rate of opioid overdose deaths per 100,000 people from 1999 to 2015. (No data available in 1999 for Nebraska, North Dakota, South Dakota and Wyoming.) In terms of total opioid overdose deaths, the five states with the highest number of deaths in 2015 were Massachusetts (1,550); Florida (1,838); California (2,018); New York (2,166); and Ohio (2,698). These figures are strongly connected to population, but there are states with higher populations reporting fewer deaths than these states in 2015. The five states with the lowest number of opioid overdose deaths in 2015 were South Dakota (27); North Dakota (34); Wyoming (46); Montana (48); and Nebraska (55). Regarding the rate of increase in opioid deaths, some different states are revealed. The five states showing the highest rate increases for opioid deaths from 1999 to 2015 were West Virginia (18.7 times higher rate in 2015); Ohio (16 times higher rate in 2015); Kentucky (15 times higher rate in 2015); Iowa (11.2 times higher rate in 1999 Opioid Overdose Death Rates by State The rates represent the number of opioid overdose deaths per 100,00 people. NO DATA AVAILABLE RATE OF 0.5-5 RATE OF 5.1-10 RATE OF 10.1-15 2015 Opioid Overdose Death Rates by State The rates represent the number of opioid overdose deaths per 100,00 people. RATE OF 0.5-5 RATE OF 5.1 TO 10 RATE OF 10.1 TO 15 RATE OF 15.1 TO 20 RATE OF 20.1 TO 25 RATE OF 25.1 TO 30 RATE OF 30.1 TO 34.2 SOURCES: Kaiser Family Foundation analysis of Centers for Disease Control and Prevention, or CDC, National Center for Health Statistics. Multiple Cause of Death 1999-2015 on CDC WONDER Online Database, released in 2016. NSD stands for No Sufficient Data, with four states having no sufficient data in 1999 for opioid overdose deaths. Rates calculated by The Council of State Governments using the crude number of opioid deaths per 100,000 people for each state based on its mid-year population from the U.S. Census Bureau.
2015); and Michigan (10.8 times higher rate in 2015). The five states showing the lowest rate increases for opioid deaths from 1999 to 2015 were California (1.2 times higher rate in 2015); Washington (1.6 times higher rate in 2015); New Mexico (1.6 times higher rate in 2015); Nevada (1.7 times higher rate in 2015); and Hawaii (1.7 times higher rate in 2015). Types of Opioids Causing Overdose Deaths is Changing Over the last 15 years, one emerging trend is the increase in synthetic opioids and heroin as the cause of overdose deaths. For many years, prescription opioids made up a larger percentage of opioid deaths, but heroin and synthetic opioids have overtaken prescription opioids in terms of overdose deaths in recent years. In 1999, heroin or synthetic opioids (other than methadone, which is primarily used to treat opioid addiction), were named in approximately 33 percent of opioid overdose deaths. Fast forward to 2015, synthetic opioids or heroin were identified in approximately 68 percent of all opioid overdose deaths. Data from the CDC show a steep rise in synthetic opioid and heroin overdose deaths in the last few years, just as prescription opioid overdose deaths are starting to level out. In a recent analysis of retail-filled opioid prescriptions, QuintilesIMS showed that retail prescriptions decreased almost 15 percent in the U.S. from 2013 to 2016. 8 For the first time ever, drug overdoses are the leading cause of death for Americans under 50 years old, 9 and every year the death toll is climbing, increasing the burden on states. Policymakers are being called upon to offer solutions. Emily McCarthy, Graduate Fellow, emily.mccarthy@csg.org Opioid Overdose Deaths By Type, United States 1999-2015 15,000 NATURAL AND SEMISYNTHETIC OPIOIDS (E.G. OXYCODONE, HYDROCODONE) 12,000 9,000 HEROIN 6,000 METHADONE 3,000 SYNTHETIC OPIOIDS, OTHER THAN METHADONE 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 DEFINITIONS: Natural and Semisynthetic Opioids A category of prescription opioids that includes natural opioid analgesics (e.g. morphine and codeine) and semisynthetic opioid analgesics (e.g. drugs such as oxycodone, hydrocodone, hydromorphone, and oxymorphone). Synthetic Opioids, other than Methadone A category of opioids including drugs such as tramadol and fentanyl. Synthetic opioids are commonly available by prescription. Fentanyl is legally made as a pharmaceutical drug to treat pain, or illegally made as a non-prescription drug and is increasingly used to intensify the effects of other drugs, such as heroin. Methadone a synthetic opioid prescribed to treat moderate to severe pain or to reduce withdrawal symptoms in people addicted to heroin or other narcotic drugs. Heroin an illicit (illegally-made) opioid synthesized from morphine. SOURCES: Kaiser Family Foundation analysis of Centers for Disease Control and Prevention, or CDC, National Center for Health Statistics. Data compiled from Multiple Causes of Death 1999-2015 on CDC WONDER Online Database, released in 2016. Natural and semisynthetic opioid overdose deaths reported for the United States exclude North Dakota in 2013, 2012, and 2011, and the District of Columbia in 2010 and 2008. THE COUNCIL OF STATE GOVERNMENTS 3
Opioid Deaths in the States Growth from 1999 to 2015 STATE OPIOID DEATHS, 1999 ALL DRUG DEATHS, 1999 4 THE COUNCIL OF STATE GOVERNMENTS 1999 2015 PERCENT OF ALL DRUG DEATHS DUE TO OPIOIDS IN 1999 OPIOID DEATHS PER 100,000 PEOPLE IN 1999 OPIOID DEATHS, 2015 ALL DRUG DEATHS, 2015 PERCENT OF ALL DRUG DEATHS DUE TO OPIOIDS IN 2015 OPIOID DEATHS PER 100,000 PEOPLE IN 2015 ALABAMA 37 169 22% 0.8 282 736 38% 5.8 ALASKA 27 46 59% 4.4 86 122 70% 11.7 ARIZONA 229 511 45% 4.8 671 1,274 53% 9.8 ARKANSAS 28 113 25% 1.1 203 392 52% 6.8 CALIFORNIA 1,474 2,662 55% 4.4 2,018 4,659 43% 5.2 COLORADO 164 349 47% 4.0 495 869 57% 9.1 CONNECTICUT 151 310 49% 4.6 685 800 86% 19.1 DELAWARE 32 50 64% 4.2 133 198 67% 14.1 D.C. 28 48 58% 5.4 98 125 78% 14.6 FLORIDA 402 997 40% 2.7 1,838 3,228 57% 9.1 GEORGIA 83 283 29% 1.1 858 1,302 66% 8.4 HAWAII 30 80 38% 2.5 62 169 37% 4.4 IDAHO 31 64 48% 2.5 90 218 41% 5.4 ILLINOIS 483 825 59% 4.0 1,381 1,835 75% 10.8 INDIANA 46 191 24% 0.8 535 1,245 43% 8.1 IOWA 14 53 26% 0.5 170 309 55% 5.4 KANSAS 25 89 28% 0.9 150 329 46% 5.2 KENTUCKY 52 197 26% 1.3 885 1,273 70% 20.0 LOUISIANA 28 188 15% 0.6 287 861 33% 6.1 MAINE 27 67 40% 2.2 238 269 88% 17.9 MARYLAND 487 629 77% 9.4 1,087 1,285 85% 18.1 MASSACHUSETTS 326 488 67% 5.3 1,550 1,724 90% 22.8 MICHIGAN 121 460 26% 1.2 1,309 1,980 66% 13.2 MINNESOTA 57 136 42% 1.2 338 581 58% 6.2 MISSISSIPPI 15 87 17% 0.5 150 351 43% 5.0 MISSOURI 100 276 36% 1.8 692 1,066 65% 11.4 MONTANA 16 41 39% 1.8 48 138 35% 4.7 NEBRASKA NSD* 39 NSD* NSD* 55 126 44% 2.9 NEVADA 153 227 67% 8.5 419 619 68% 14.5 NEW HAMPSHIRE 40 54 74% 3.3 380 422 90% 28.6 NEW JERSEY 323 557 58% 4.0 862 1,454 59% 9.6 NEW MEXICO 180 266 68% 10.3 351 501 70% 16.9 NEW YORK 621 959 65% 3.4 2,166 2,754 79% 11.0 NORTH CAROLINA 159 366 43% 2.1 1,171 1,567 75% 11.7 NORTH DAKOTA NSD* 12 NSD* NSD* 34 61 56% 4.5 OHIO 164 467 35% 1.5 2,698 3,310 82% 23.2 OKLAHOMA 89 178 50% 2.7 427 725 59% 10.9 OREGON 120 210 57% 3.6 331 505 66% 8.2 PENNSYLVANIA 320 990 32% 2.7 1,362 3,264 42% 10.6 RHODE ISLAND 35 58 60% 3.5 254 310 82% 24.1 SOUTH CAROLINA 48 147 33% 1.2 554 761 73% 11.3 SOUTH DAKOTA NSD* 17 NSD* NSD* 27 65 42% 3.1 TENNESSEE 89 344 26% 1.6 1,038 1,457 71% 15.7 TEXAS 351 1,087 32% 1.8 1,287 2,588 50% 4.7 UTAH 141 205 69% 6.6 448 646 69% 15.0 VERMONT 15 29 52% 2.5 79 99 80% 12.6 VIRGINIA 201 366 55% 2.9 820 1,039 79% 9.8 WASHINGTON 353 555 64% 6.1 692 1,094 63% 9.7 WEST VIRGINIA 33 75 44% 1.8 629 725 87% 34.2 WISCONSIN 83 212 39% 1.6 622 878 71% 10.8 WYOMING NSD* 20 NSD* NSD* 46 96 48% 7.8 UNITED STATES 8,050 16,849 48% 3.0 33,091 52,404 63% 10.3
Table SOURCES: Kaiser Family Foundation analysis of Centers for Disease Control and Prevention, or CDC, National Center for Health Statistics. Multiple Cause of Death 1999-2015 on CDC WONDER Online Database, released in 2016. NSD stands for No Sufficient Data, with four states having no sufficient data in 1999 for opioid overdose deaths. Rates calculated by The Council of State Governments using the crude number of opioid deaths per 100,000 people for each state based on its mid-year population from the U.S. Census Bureau. REFERENCES 1 Understanding the Epidemic. (2016, December 16). Retrieved July 26, 2017, from https://www.cdc.gov/drugoverdose/epidemic/index.html. 2 Opioid Overdose. (2017, February 09). Retrieved July 26, 2017, from https://www.cdc.gov/drugoverdose/data/analysis.html. 3 Florence CS, Zhou C, Luo F, Xu L. The Economic Burden of Prescription Opioid Overdose, Abuse, and Dependence in the United States, 2013. Med Care. 2016;54(10):901-906. doi:10.1097/ MLR.0000000000000625. 4 Carlson RG, Nahhas RW, Martins SS, Daniulaityte R. Predictors of transition to heroin use among initially non-opioid dependent illicit pharmaceutical opioid users: A natural history study. Drug Alcohol Depend. 2016;160:127-134. doi:10.1016/j.drugalcdep.2015.12.026. 5 Kaiser Family Foundation analysis of Centers for Disease Control and Prevention (CDC), National Center for Health Statistics. Multiple Cause of Death 1999-2015 on CDC WONDER Online Database, released 2016. Data are from the Multiple Cause of Death Files, 1999-2015, as compiled from data provided by the 57 vital statistics jurisdictions through the Vital Statistics Cooperative Program. 6 Ibid 7 SAMHSA Center for Behavioral Health Statistics and Quality. (n.d.). 2015 National Survey on Drug Use and Health METHODOLOGICAL SUMMARY AND DEFINITIONS. Retrieved July 26, 2017, from https://www.samhsa.gov/data/sites/default/files/nsduh-methodsummdefshtml-2015/nsduh-methodsummdefshtml-2015/nsduh-methodsummdefs-2015.htm. 8 Source: Xponent, QuintilesIMS, Danbury, CT, Copyright 2017. 9 Katz, J. (2017, June 05). Drug Deaths in America Are Rising Faster Than Ever. Retrieved July 26, 2017, from https://www.nytimes.com/interactive/2017/06/05/upshot/opioid-epidemicdrug-overdose-deaths-are-rising-faster-than-ever.html. THE COUNCIL OF STATE GOVERNMENTS 5