The number of fatal drug overdoses nationwide has fallen for six consecutive months, fueling hopes that the downturn marks not just a reprieve but a long-lasting shift in the tide of the addiction crisis.

Annual U.S. drug overdoses have been tracking upward for nearly four decades, and the rate of growth increased sharply in the last few years with the onset of the opioid epidemic.

But in the 12-month period ending in March 2018 — the most recent span for which data are available — the Centers for Disease Control and Prevention reported a decline of 2.8 percent in the number of overdose deaths, to an estimated 71,073 people, compared with the 12 months ending in September 2017.

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Public health experts warned against drawing firm conclusions based on a half-year’s worth of data.

“After 40 years of this predictable growth pattern, we can hope that the curve is finally bending downward for good,” Dr. Donald Burke, the dean of University of Pittsburgh’s Graduate School of Public Health, wrote in an email. “But history tells us to interpret these wobbles cautiously.”

While opioids overall continue to drive the bulk of deaths, killing an estimated 48,400 people from April 2017 to March 2018, the number of fatal opioid overdoses fell by 2.3 percent compared with the year ending in September 2017. The decline was caused by a drop in the number of overdose deaths from both heroin and “natural and semi-synthetic opioids,” a category that includes most prescription opioids.

CDC Overdose deaths march 2018
CDC

Still, ominous signs lurk in the CDC data. The ongoing addiction crisis is not limited to opioids, and cocaine and stimulants — a group that includes methamphetamine — are each now killing more than 10,000 people a year, a threshold they only crossed in the past few years.

“Whether we’re looking at cocaine or methamphetamine, we are seeing a crisis in the United States,” said Ray Barishansky, a deputy secretary at the Pennsylvania Department of Health.

Experts have predicted that any lasting downturn in overdose deaths would start with a gradual flattening and then cresting of the curve that measures fatal overdoses over time, and the data fit that pattern.

The CDC data remain a provisional count of overdose deaths, so the numbers could be adjusted as authorities continue to investigate deaths around the country.

“Three months ago I wasn’t sure the provisional deaths curve was really going down,” Dr. Daniel Ciccarone of the University of California, San Francisco, wrote in an email. “But the trend seems robust.”

Experts are not sure yet what exactly is driving the decrease, which was first noted by the Opioid Watch website, a project of the nonprofit Opioid Research Institute. But they said they are hopeful that policy initiatives at the local, state, and federal level are starting to pay off.

“There are 2 major takeaways,” said Leo Beletsky, a drug policy expert at Northeastern University. “One is that we are not out of the woods yet, since these rates are still sky high. [And] we need to be doing much more of what works to get the rates down further.”

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A number of states have issued emergency declarations to free up resources for addiction responses, and President Trump last year declared the opioid crisis a public health emergency.

Among other steps, advocates and health officials have pushed to expand the use of the overdose reversal medication naloxone, providing it to more law enforcement officers and people who use drugs. Having naloxone on hand can turn what would be a fatal overdose into a nonfatal incident.

And as part of a broader medical innovation law signed by President Obama in 2016, Congress approved $1 billion in spending to fight opioid addiction, funding that helped states expand treatment options, housing services, and education and workforce campaigns. Trump this week is expected to sign another addiction measure that will fight drug trafficking and expand options for accessing medication-assisted treatment for opioid use disorders.

Some clinicians are also being more cautious in their prescribing patterns, which means that fewer people are being exposed to opioid painkillers in the first place.

“It’s encouraging,” CDC Director Robert Redfield said in an interview with STAT Executive Editor Rick Berke on Tuesday, while noting that the data are preliminary.

The CDC tracks fatal overdose numbers by state, and researchers said the differences among states suggest local initiatives are having an impact as well. Many public health experts point to campaigns in Rhode Island, Vermont, and Massachusetts as models for addressing addiction, and all three states reported decreases in overdose deaths from March 2017 to March 2018 — declines that many of their neighbors did not see.

“The states that have been comprehensive and have gone after evidence-based methods are seeing the declines,” said Brandon Marshall, a Brown University epidemiologist.

CDC Overdose deaths march 2018
CDC

Overall, Montana and Wyoming reported the biggest percentage drops in overdose deaths, though they had fewer initial overdose cases than many other states.

Beyond the policy efforts, Ciccarone, who studies drug supplies, said people who use drugs may have made “behavioral adaptations” that have led to safer drug use. Many overdoses occur when the powerful opioid fentanyl and its analogues are illicitly mixed into heroin or other drugs. Ciccarone said he and his research colleagues have found that some people are sampling their drugs before using the full amount or are speaking with others about how potent a particular supply may be before using.

Indeed, while deaths tied to synthetic opioids — the classification that includes fentanyl — continue to rise in the CDC’s tracking, their growth rate has slowed in recent months.

Epidemiologists said they look to CDC’s provisional data each month to determine if the bend in the curve will hold and to see which state responses should be studied further. But as promising as the latest slowdown might be, with each fewer fatal overdose representing a life saved, experts have seen “flattening periods” in the past that did not change the overall trajectory of overdose deaths.

Burke, of the University of Pittsburgh, was the senior author on a paper published last month in Science, in which researchers outlined how “the U.S. drug overdose epidemic has been inexorably tracking along an exponential growth curve since at least 1979.” They described an epidemic that is made up of many different drug “subepidemics.”

The “current opioid epidemic may be a more recent manifestation of an ongoing longer-term process,” the study said.

This story has been updated with a quote from the director of the CDC. 

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  • Continued:
    Doctors began restricting Opioid prescriptions around 2010-12 .
    The data support the Hypothesis that this was quickly replaced on the street by heroin and heroin substitute like fentanyl.
    Unknown potency= increased overdose deaths.
    Fentanyl is a drug so potent mg for mg that it is impossible for street suppliers to provide constant doses even if they cared to.
    Bottom line:
    *The harder zealots crack down on prescription Opioids
    The faster overdose deaths increase
    A very predictable result of an irrational policy mentality, Prohibition aka The War on Drugs, that is responsible for the majority of the damage that drugs do to society .
    Now Fentanyl is everywhere, also predicted a decade ago by a member of the organization LEAP (Law Enforcement Against Prohibition)
    http://www.leap.cc
    Comprising more than 150 thousand current and retired honest members of the law enforcement community who have the courage to speak out and call for the end of the War on Drugs.
    But the Drug War is a 50 billion dollar cash cow for Law Enforcement and bureaucrats so nothing is done.
    So Drug Dealers are rich and control our cities, just like Al Capone during our 1st drug ( alcohol) Prohibition.
    And pain patients suffer.
    Only 7-10% of ODs involve chronic pain patients. The rest are experimenters and abusers.
    And young people die
    And the total stupidity continues!
    Local cops sending threats to doctors is the scummiest of a long line of violations of decency and the law done in the name of the Drug War.
    In my opinion it is time to hold these people accountable.

    • James: Thank you.

      (RE: (” …In my opinion it is time to hold these people accountable.”)

      Indeed it is. As in charged with ‘Crimes Against Humanity’.

      peter

  • Thank you, RALPH MADDOX!
    Like most of us left suffering in agony, you have the facts, understanding and the whole picture.

    Sorry, not sorry, but I have zero sympathy for illicit opiate users, multi substance abuser addicts. This group is SOLELY responsible for the barbaric, unnecessary and suffering chronic, intractable pain pts., including myself.

    With the billions our Congress, our Senate voted re HR 6 (# is the House bipartisan bill), illicit addicts, multi sub abusers now have zero excuses not to be appropriately treated and their addictions “history.” It’s even possible for “free” rent for illicit addicts in treatment in one part of the clause!

    Now, I hope a couple bucks can go towards a 100% overhaul of the cdc “guidelines” turned holy graile “law,” for protection of Board certified pain clinicians to care for pts in pain by offering proven successful, proven pain relief modalities for the millions the illicit addicts have left with nothing but human suffering. If any money is left over, I hope it will be diverted to the countless families whose loved ones committed suicide as sole result of pain too great to bear after having waited forever for someone to help alleviate real human suffering from diseases and injuries which caused their physical pain. Im sure these families could use funds to offset funeral expenses unnecessarily caused. These cpps did not cause nor choose their painful diseases or traumatic accidents which resulted in their pain, yet have been the ones who have paid the ultimate price because of the stupidity and choices made by illicit users, multi substance abusers, etc., etc.

  • I know that in many states where there are serious problems they have provided narcan to all first responders. I’m wondering if this is a bit of a false positive in the data. The addiction levels could be the same, just fewer people dying of overdose because more access to narcan. Thoughts?

  • Hi Andrew: My reply is on behalf of chronic pain sufferers who get ‘lumped’ together with the escalating mortality rates of recreational users/drug culture..
    So first let’s separate these two very distinct ‘groups’.

    In fact, for the past 5-10 years, physician-prescribed opiate ‘scripts’ have fallen by ~50%. Yet over that same time, overdose deaths have climbed – even skyrocketed. Where’s the cause and effect here? Likewise, drug overdose related mortality has been stable among people age 50 or older for the past 17 years, while mortality has skyrocketed among youth and young adults. But older people are prescribed opioids for pain at least 250% more often than youth. Doesn’t this strike you as strange?

    Clearly this data tells us the (opioid) ‘epidemic’ has little to do with physician prescribing, but rather recreational drug users themselves; the dirty, profitable under-world of the drug trade itself. Other data, graphs, charts are also available and spell it out in no uncertain terms.

    The opioid overdose ‘epidemic’ stems from drug culture and from socio-economic factors, not from exposure to medical opioids. No If’s, or But’s. CDC data are very clear on this. Rates of opioid mortality are utterly unrelated to rates of opioid prescribing by doctors to their patients.

    Yet our government continues to abuse pain sufferers as if their chronic, unremitting severe pain is not enough to endure. Policies are imposed to severely restrict (and even refuse) the use of these life-saving medications to relieve pain. It’s unthinkable. In fact, I’ll go one step further and name it as a Crime Against Humanity – such is its devastating impact upon pain patients.

    If you or readers wish to hear/know of what this (drug culture) ‘crisis’ has done to millions of legitimate, chronic, severe pain sufferer’s, then ask Dr. Richard Lawhern or others in the ‘Alliance for Treatment of Intractable Pain’ (ATIP). This group has worked diligently on behalf of pain patients whose lives were/are made much worse since the government’s intervention in physician-prescribed opiate pain management. Dr. Lawhern has the knowledge and expertise, charts and data that reveal the lies behind this attack on pain sufferers .

    Governments are threatening physicians with job loss or being charged, fined or jailed if they continue to write opiate ‘scripts’ (to suffering patients) ! This has been going on for years. The actions of DEA and State drug enforcement authorities have amounted to nothing less than predatory and extra-legal prosecution.

    In answer to your article’s question; the ‘decline’ in mortality rates may be a combination of recreational drug user caution, “cleaner” (more accurate) drug-culture “cutting”, and the availability of Naloxone to first responders.

    A ‘blip’ in the charts may appease the dreadful law/policy makers who know full well that the opiate epidemic is Drug-Culture based. Any reduction/spike (in numbers/percentages) is a result of something in that demographic.

    While pain patients pay the price. Mercifully, ATIP and others have engaged in the fight to literally save the lives of pain patients whose lives depend on effective pain control. Without opioid analgesics, it’s hell-on-earth for us. Such is the unrelenting, punishing brutality of some pain conditions. Human suffering that 99% of the population doesn’t even know exists -or how severe, ugly, painful, deadly (and chronic) pain can become.

    Restriction of medically managed opioids must be stopped. At once. Our government is literally killing us.

    peter jasz

    • I don’t believe it for a second. Fentanyl Is generally not prescribed and nor is Heroin. Please make sure your data is being compiled accurately. Ask the ME.
      My two cents.

    • As the mother of a stable, long-term, chronic pain patient, I find your statement “Some clinicians are also being more cautious in their prescribing patterns, which means that fewer people are being exposed to opioid painkillers in the first place.” to be disingenuous and dangerous. A legitimate patient like my daughter, disabled and on SSI, if she loses her pain management physician may not be able to find ANYONE to accept her as a patient. We spent more than 6 months in NYC seeking a new pain management physician, clinic or practice and eventually ended up traveling to NJ monthly after her doctor moved.

      There has been a significant increase in suicides of LEGITIMATE chronic pain patients who can no longer access the medications that make their lives tolerable – not pleasant, or pain free, just functional. People who used to hold down a job, take care of their families or just themselves are no longer able to. And this includes a large number of veterans.

      In addition, there is an increasing number of stories about post-surgical patients and those dying in agony being refused pain medication.

      You have dramatically understated a massive unintended side effect of bad legislation and guidelines which are punishing, and sometimes killing, legitimate pain patients.

    • Peter Jasz-

      Thank you You are spot on with the facts. Dr. Lawhern’s writing, supported scientific factual writings and bringing this information to the forefront since before the National Pain Crisis became thwarted upon all patients and their clinicians has been pristine and noteworthy. Unfortunately, the ignorance is epidemic in the pain arena and articles such as the one above from “the media” only serve as a detriment to well qualified, board certified in pain clinicians and their constituents. The pain communitities must continue to “scream to be heard.”

    • “Governments are threatening physicians with job loss or being charged, fined or jailed if they continue to write opiate ‘scripts’”
      *****
      You are absolutely right. This amounts to essentially Mafiosi Style terrorist operations by county and state law enforcement agencies that have absolutely no authority to take the actions they take.
      As a Scientist I am appalled at the actions of the CDC starting when they threw the Scientific Method overboard circa 2014,
      * held closed door Expert advisory boards, but
      * No Expert Invited * Only Special Interest Groups who stood to gain tens of billions in annual revenue should the CDC to follow their recommendations
      * Not one Pain Management Expert or Physician Group was Allowed to Participate
      The results were predictable.
      90 mg-Eq Morphine/day based on zero evidence
      No allowance for tolerance in chronic pain patients

      While I agree that prescription Opioids don’t cause the increased overdose rate, there is a cause and effect relationship.
      1 some prescription Opioids found their way to the street. Whether sold by patients or Stolen, this supply of quality known potency Opioids replaced dirty street drugs of unknown potency supplied by criminal gangs.
      2 in 2010-2012 the Drug War mentality began to gain support again

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