What is the prevalence of opioid toxicity in the US?

Updated: Jul 19, 2021
  • Author: Everett Stephens, MD; Chief Editor: Jeter (Jay) Pritchard Taylor, III, MD  more...
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Answer

Opioids are prescribed widely, often in concert with other analgesics, including nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen or muscle relaxants. The overall opioid prescribing rate in the United States peaked and leveled off from 2010-2012 and has been declining since 2012. Despite significant decreases, the amount of opioids prescribed in 2015 remained approximately three times as high as in 1999, although rates varied substantially across the country. In 2017, almost 58 opioid prescriptions were written for every 100 Americans. [16]

In 2019, US poison control centers reported a total of 21,211 single exposures to pure opioids, which resulted in 4311 cases of major toxicity and 284 deaths, as well as 7576 exposures to combinations of hydrocodone or oxycodone with acetaminophen, aspirin, or ibuprofen, with 480 cases of major toxicity and 21 deaths. [17]  

The Centers for Disease Control and Prevention (CDC) reports that opioid overdoses treated in emergency departments rose 30% from July 2016 through September 2017 in 52 areas in 45 states. Overdoses in the Midwest increased by 70% during that period, and opioid overdoses in large cities increased by 54% in 16 states. [18]  

Opioids—prescription and illicit—are currently the leading cause of drug overdose deaths. Opioids were involved in 46,802 of the 67,367 drug overdose deaths (69.5%) that occurred in the United States in 2018. Over 31,000 of those deaths involved synthetic opioids (other than methadone), which include both prescription synthetic opioids (eg, fentanyl and tramadol) and non-pharmaceutical fentanyl manufactured in illegal laboratories; the largest increase in synthetic opioid overdose death rates was in men aged 25-44 years. Heroin accounted for almost 15,000 drug overdose deaths in 2018, a decrease of 4.1% from 2017 to 2018. [9]

Most of the deaths from synthetic opioids are from fentanyl, [19]  and most of the increases in fentanyl deaths in recent years do not involve prescription fentanyl but are related to illicitly-made fentanyl that is being mixed with or sold as heroin—with or without the users’ knowledge—and increasingly as counterfeit pills. [1]  From July–December 2017 to January–June 2018 in 25 states, opioid deaths decreased 5% overall. Decreases were reported in deaths involving prescription opioids and illicit synthetic opioids—except for illicitly manufactured fentanyl, from which deaths increased 11%. [20]

The CDC has reported a strong positive correlation between the rate of methadone distribution and the rates of overdose death from methadone. Methadone distribution rose from 2002-2006 and then declined; the methadone overdose death rate peaked during 2005–2007 and declined in subsequent years. [3, 21] The rate of overdose deaths involving methadone decreased from 1.4 per 100,000 in 2011 to 1.1 in 2016, with 3,493 deaths reported in 2016. [22]

The etiology of overdoses presenting to an emergency department often reflects local prescribing tendencies. Polypharmacy overdoses that include opioids can be a challenge for even the most experienced clinician. Fortunately, pharmacologic reversal of the opioid component can assist in the diagnosis of these potentially complex cases.


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