The opioid overdose crisis may have begun decades ago

Thursday, September 20, 2018 (HealthDay News) – The opioid epidemic has been in the vanguard for some years now, with the increase in overdose deaths leading to an overall decrease in the average life expectancy of Americans.

But a new study suggests that the epidemic of opioids is actually nothing new.

According to the researchers, death rates from drug overdoses in the United States have experienced an exponential growth curve that dates back at least to the early 1980s.

"We have found that the epidemic continues to develop predictably for nearly four decades," said Dr. Donald Burke, dean of the Graduate School of Public Health at the University of Pittsburgh.

"The number of deaths is increasing every year by about 8%, and it continues," said Burke.

But this constant trend has been masked by the fluid nature of the American illicit drug culture, Burke and his colleagues have found.

"When we tried to examine this continued exponential growth, we found that the epidemic was evolving. Drugs are changing, demographics are changing, places are changing, "said Burke. "You have this paradox of the global curve is a smooth growth process, but it is composed of all these different sub-epidemics."

For this study, researchers have collected nearly 600,000 overdose reports of drugs maintained by the US National Vital Statistics System since 1979. This is the year in which death reports began to be reported.

Over the past four decades, drug overdose deaths have been almost perfect. According to the researchers, the number of total overdoses in each year falls almost exactly on an ascending exponential curve.

But by looking more closely at the rates of overdose deaths for the different types of drugs that have been followed since 1999, the researchers found that what appeared to be a flexible and predictable trend was anything but.

Instead, drugs like cocaine and heroin and methamphetamine come in and out of fashion, year after year and decade after decade.

What is now known as the "opioid epidemic" began in the mid-1990s, when doctors began prescribing opioid analgesics, Burke added.

State and federal lawmakers responded by tightening restrictions on prescription of opioids. This drove people addicted to opioid painkillers to choose the cheaper option of heroin. Since then, users have migrated to even cheaper and more deadly synthetic opioids, such as fentanyl.

"Especially in the last seven or eight years, the number of heroin and fentanyl users has exploded," Burke said. Heroin was also confined mainly to the metropolitan areas of both coasts; now it is used in small towns of the country.

The results were published on September 20 in the journal Science.

According to Linda Richter, director of research and policy analysis at Center on Addiction, the new study shows that "attempts to reduce the number of overdose deaths are seriously compromised by our country's failure to succeed." Address substance abuse through effective prevention and treatment methods based on evidence. a national non-profit organization.

"We are generally concentrating our efforts – most of which are underfunded and often unsupported by scientific evidence – on the most frightening drug trend of the moment, and we are waiting to react until overdose deaths reach epidemic levels, "said Richter.

"We are doing a variety of interventions on the issue and we do not bother to spend the time and resources to assess whether these interventions are working," she said.

Why do overdose deaths continue to increase? Mr. Burke said that it was probably a combination of "direct" and "pull" factors on both sides of the illicit drug market.

On the "push" side, Burke noted that innovation is on the side of the drug providers.

"Everything on the supply side is helping to make medicines more available," said Burke. "The cost of producing drugs is getting cheaper, the real selling price is cheaper, the purities are increasing, the delivery technologies, the communication is easier – and it's not about any medicine, but about all drugs."

On the side of "traction", American society seems to be evolving in such a way as to promote the use of drugs.

"There is growing economic disparity, with many people losing their sense of everyday life," Burke said. "There has been a dissolution of our sense of community, especially in small towns.

"This raises questions about what the future holds for us," Burke said. "The main problem we are raising is that if we do not address these deeper social determinants, are we really going to be able to change the trajectory of the epidemic?"

Richter agreed that a renewed focus on prevention is needed to block this ever-increasing tide.

"A smarter and more effective approach would be to implement a comprehensive, sustainable and evidence-based approach to drug prevention, early intervention and the treatment in which we invest for the long term," he said. Richter. "This approach would involve large-scale prevention that addresses all addictive substances and the reasons people use them, as well as significant changes in the way drug treatment is administered in the United States."

More information

The US National Institute on Drug Abuse has more information on the opioid overdose crisis.