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TLANTA — Tom Price didn’t mince words.

“We lose a Vietnam War every single year to drug overdoses,” Price said. “… It must be stopped.”

That warning, from the secretary of Health and Human Services, reached a receptive audience here last week at a national conference on drug abuse. As Senator Ed Markey of Massachusetts put it: “The terrorist threat families in America see is not in the streets of Aleppo. It’s fentanyl coming down your street.”

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The depth of the crisis is clearly visible in new data on drug overdose deaths released by the Centers for Disease Control and Prevention. The data cover all drugs, not just opioids. But the CDC’s maps vividly depict how the opioid epidemic — prescription drugs, heroin, and, more recently, fentanyl — swept the nation over the past decade.

In 1999, New Mexico had the worst drug overdose rate in the nation: 15 deaths per 100,000 people. Fifteen years later, that death rate would seem modest indeed. The highest drug mortality rate in 2014, in West Virginia, stood at 35.5 per 100,000 people.

By the following year, the drug death rate in West Virginia had climbed higher still, to 41.5 per 100,000.

The CDC’s data also show how the epidemic moved across the country. Back in 1999, the states with the highest drug overdose death rate were concentrated in the West: New Mexico, Nevada, Utah, Arizona. Six years later, the epicenter had reached the South: Kentucky, Louisiana, Tennessee, and Florida.

By 2014, the epidemic had shifted to Appalachia and the Rust Belt: West Virginia, Kentucky, Ohio, and Pennsylvania. That trend grew even more pronounced the following year.

“I certainly worry we haven’t hit the worst point,” said Dr. Patrice Harris, a psychiatrist from Atlanta and the head of the American Medical Association’s task force on opioid abuse. “Until treatment for substance-abuse disorders is fully funded, I worry we won’t be able to reduce the number of overdose deaths.”

Drug Overdose Mortality by State

  • ¹The number of deaths per 100,000 total population. Source: http://wonder.cdc.gov

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  • This 4-stage map is basically a case of a “naked statistic” – a small collection of numbers chosen to encourage fear, as is obvious with the comparison to Vietnam War deaths. This is similar to the emotional effect of the comparison press and government have been making between opiate deaths and the 32,33,000 annual average of automobile crash deaths.

    Why compare to war deaths or car crash deaths and not tobacco deaths? That annual average is 480,000, many years after quitting or secondhand exposure. Additionally, tobacco causes characteristic patterns of damage to every organ system in the body – there is no similar pattern for opioids, the slowing of bowel and lung function reverses when the drug is stopped.

    But the biggest problem with the promotion of these numbers is that “opiate deaths” is a bureaucratic category, not a scientifically-demonstrated fact. Because of tolerance, there’s no standard deadly dose (as with arsenic), so just the amount in a tissue sample doesn’t prove that the opiate/opioid caused the death. But finding out that someone had a prescription, or finding pills or a needle in their possessions is a lot easier than investigating whether the person actually died of something else. Most coroners’ and medical examiners’ offices have a budget of under $3.00 per death. A third of coroners’ offices have no in-house toxicology lab, and sending out samples is expensive. (http://sites.nationalacademies.org/cs/groups/pgasite/documents/webpage/pga_049924.pdf)

    The “opiate death” category is a mashup: people who had an Rx at the time of death, people who used diverted Rx, counterfeit Rx, heroin and multiple drugs if one is an opiate/opioid. (https://www.painnewsnetwork.org/stories/2016/12/26/new-cdc-overdose-study-reduces-role-of-pain-meds)

    In Dec 2016, the CDC using 59 deaths in MN 2006-15 where the deceased had pneumonia and an opiate prescription, said that such deaths should be counted as “opiate deaths” not pneumonia as they had been.
    ( https://www.painnewsnetwork.org/stories/2017/5/1/the-medias-addiction-to-opioids)

    If this were an epidemic, why scrape around for tiny numbers from years past to pad the death toll?

    Even if we take the reported number of opiate deaths for the year they were reported to surpass car crash deaths, 2008, 36,450, is 1.46% of all deaths that year in the U.S.

    The closing paragraph, in which Dr. Patrice Harris of the AMA’s opioid abuse task force, says, ” “Until treatment for substance-abuse disorders is fully funded, I worry we won’t be able to reduce the number of overdose deaths.” If the issue were really reducing the numbers of deaths from opiates/opioids, we would do what Portugal has done, and legalize all drugs. Within one year, Portugal reduced drug deaths by half.

    But in this country, the issue isn’t about reducing deaths, it’s about using those deaths to do what 100+ years of prohibition, 47 years of the war-on-drugs, the 2009 Mental Health Parity Act requiring insurers to cover drug rehab at the same rate as medical care, has failed to do.

    Considering the fact that more than 90% of all rehab in this country, even the most expensive celebrity-filled facilities, are based on the 12 steps and send “graduates” to 12 step meetings when they leave, and that 12 step programs have a dismal success rate of 5-8%, giving “addiction treatment” more funding is unlikely to have any effect on rates of use of the drugs the federal government has been warring against for a century.

    (https://www.theatlantic.com/health/archive/2014/03/the-surprising-failures-of-12-steps/284616/)

  • Mother Nature seems to be fighting back to rid the planet of its worse predators — humans, by using their thrill-seeking & risk-ignoring behaviors against them…

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