Vital Signs: Overdoses of Prescription Opioid Pain Relievers

United States, 1999-2008

Leonard J. Paulozzi, MD; Christopher M. Jones, PharmD; Karin A. Mack, PhD; Rose A. Rudd, MSPH


Morbidity and Mortality Weekly Report. 2011;60(43):1487-1492. 

In This Article

Abstract and Introduction


Background: Overdose deaths involving opioid pain relievers (OPR), also known as opioid analgesics, have increased and now exceed deaths involving heroin and cocaine combined. This report describes the use and abuse of OPR by state.
Methods: CDC analyzed rates of fatal OPR overdoses, nonmedical use, sales, and treatment admissions.
Results: In 2008, drug overdoses in the United States caused 36,450 deaths. OPR were involved in 14,800 deaths (73.8%) of the 20,044 prescription drug overdose deaths. Death rates varied fivefold by state. States with lower death rates had lower rates of nonmedical use of OPR and OPR sales. During 1999–2008, overdose death rates, sales, and substance abuse treatment admissions related to OPR all increased substantially.
Conclusions: The epidemic of overdoses of OPR has continued to worsen. Wide variation among states in the nonmedical use of OPR and overdose rates cannot be explained by underlying demographic differences in state populations but is related to wide variations in OPR prescribing.
Implications for Public Health Practice: Health-care providers should only use OPRs in carefully screened and monitored patients when non-OPR treatments are insufficient to manage pain. Insurers and prescription drug monitoring programs can identify and take action to reduce both inappropriate and illegal prescribing. Third-party payers can limit reimbursement in ways that reduce inappropriate prescribing, discourage efforts to obtain OPR from multiple health-care providers, and improve clinical care. Changes in state laws that focus on the prescribing practices of health-care providers might reduce prescription drug abuse and overdoses while still allowing safe and effective pain treatment.


In 2007, nearly 100 persons per day died of drug overdoses in the United States.[1] The death rate of 11.8 per 100,000 population in 2007 was roughly three times the rate in 1991. Prescription drugs have accounted for most of the increase in those death rates since 1999.[2] In 2009, 1.2 million emergency department (ED) visits (an increase of 98.4% since 2004) were related to misuse or abuse of pharmaceuticals, compared with 1.0 million ED visits related to use of illicit drugs such as heroin and cocaine.[3] Prominent among these prescription drug–related deaths and ED visits are opioid pain relievers (OPR), also known as narcotic or opioid analgesics, a class of drugs that includes oxycodone, methadone, and hydrocodone, among others. OPR now account for more overdose deaths than heroin and cocaine combined. OPR frequently are diverted for nonmedical use by patients or their friends or sold on the street. In 2010, 4.8% of the U.S. population aged ≥12 years used OPR nonmedically.[4] Nonmedical use of OPR costs insurance companies up to $72.5 billion annually in health-care costs.[5]

States regulate the use of prescription drugs, such as OPR, and the practices of prescribers and pharmacists. States also finance and regulate health care for Medicaid populations, which are at greater risk for overdose.[6] States therefore have a central role in ensuring that OPR are used legally and safely.

Comparisons among jurisdictions in drug overdose mortality, nonmedical use of OPR, and OPR sales can help identify risk factors and effective prevention measures. Among the states, OPR sales varied fourfold in 2002,[7] and death rates for overdoses involving OPR varied from 1.8 to 15.6 per 100,000 population in 2006.[2] More rural and more impoverished counties tend to have higher prescription drug overdose death rates.[8,9]


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