Increased use of cocaine, methamphetamine and opioids

When the use of one drug declined, another ended up filling the void, according to researchers at the University of Pittsburgh's Graduate School of Public Health, published Thursday in the Science magazine. Hot spots of drug-related deaths appear in one part of the country and then move on to another. Middle-aged Americans have a different drug overdose than people in their twenties, the researchers found, analyzing deaths from accidental poisoning from the National Vital Statistics System.

Individual "subepidemics" come together to give a disappointing picture of overdose deaths on an upward trajectory.

The complexity of the trend means that slowing down or stopping the curve will require deeper changes than simply repressing one substance or another, the authors said. "The dynamics are very complicated," said Hawre Jalal, an assistant professor in the department of policy and health management and senior author of the analysis. "It is unlikely that she will respond to a specific drug or age group. It will require a much more comprehensive intervention.

The growth chart really took off after 1999, the authors note. Doctors prescribed opioid analgesics more widely. New technologies are facilitating the production and distribution of illicit drugs, said Donald Burke, dean of the University of Pittsburgh School of Public Health and lead author of the study. At the same time, the demand for drugs has increased; According to some studies and surveys, the growing disparity of income, loss of sense of community belonging and other social and cultural factors, they added.

Deaths due to heroin and synthetic opioids, such as fentanyl, have outpaced prescription opioids as a cause of overdose deaths. New prescribing guidelines and restrictions have made these drugs less available and fentanyl and other synthetic opioids that have replaced them are extremely powerful. At the same time, deaths from methadone have decreased since 2007, after being removed from the list of preferred medications by Medicaid programs. Methadone has been prescribed to Medicaid patients for pain management.

Deaths from heroin overdose and prescription opioids varied by sex and age in 2016. The largest heroin victims were men in their twenties and thirties . Men were also the most common victims of prescription opioids, both in the middle ages and early in adulthood. Middle-aged women are also heavily affected: their death rates from prescription opioids are approaching those of men in their fifties.

These deaths also differ in cities and rural areas. In 2016, heroin mortality rates were higher in urban areas, with strikers in their twenties and thirties being the hardest hit. Mortality rates related to heroin and prescription opioids were more similar in rural areas and higher rates among middle-aged people.

The most recent studies on drug overdose deaths have focused on white Americans, note the authors of the study. But African Americans are also affected, they show. The age at which African-Americans die from cocaine increases, suggesting an aging cohort of users, especially men in urban areas.

The rise and fall of cocaine-related overdose deaths in the United States over the past 15 years appears to be related to peaks and declines in production in Colombia as a result of the civil war.

Hot spots for various drugs have changed over time around the United States. Concentrations of heroin and cocaine use, once in major cities, are now more prevalent in the United States, particularly in the northeast and southwest. The hot spots of prescription opioids, formerly to the southwest and the Appalachians, have spread to the West and New England. Fentanyl is the largest in the Appalachians and the northeast.

The north-central states are the only relative "cold spot" of the nation, according to the study: the Dakotas, Nebraska and Iowa, even though they are also affected in places.

Deaths related to methamphetamine are increasing, mainly in the west and southwest.

Death rate for methamphetamine overdose, by county

Standard deviations above or below the national average

Death rate for methamphetamine overdose, by county

Standard deviations above or below the national average

Death rate for methamphetamine overdose, by county

Standard deviations above or below the national average

Death rate for methamphetamine overdose, by county

Standard deviations above or below the national average

The study shows two particularly critical periods of life: the overdose-death rates reach their maximum in 20 and 30 years, then between 40 and 60 years. The trend is particularly marked in men. Men are dying of heroin and synthetic opioids in their twenties and thirties and opioids on prescription between their forties and sixties.

A large number of deaths are listed as "unspecified drugs" or "unspecified drugs", which means that the exact medicine could not be determined. The authors of the study suggest that these are probably deaths due to prescription opioids. According to the experts, the way a death is imposed often depends on the level of medical training of the professional who completes the death certificate.

Dr. Burke is studying how viruses are moving around the world, causing epidemics, and the same thing must be done for drugs. Public health officials, law enforcement and other officials should work together to determine the source of a drug, such as Pittsburgh, and how it is produced and supplied, he said. More careful monitoring is essential as overdose deaths intensify, he said.

The Centers for Disease Control and Prevention reported Thursday that the age-adjusted overdose mortality rate increased from 11.5 deaths per 100,000 population in 2006 to 19.8 deaths per 100,000 in 2016. The rate growth rate increased from 2.8% in 2006 -2014 to 17.7% per year in 2014-2016. Rates of overdose deaths increased in 43 states and in Washington, DC, between 2006 and 2016. In Delaware and New Hampshire, the rate has more than tripled, the agency said.

Write to Betsy McKay at [email protected]