More Americans died of drug overdoses in 2016 than died in the entirety of the Vietnam War — the result of the US’s opioid epidemic.
That’s one takeaway from a new report by Josh Katz for the New York Times, based on preliminary data estimating how many Americans died of drug overdoses last year.
The official, more precise numbers will be available later in 2017 — once the Centers for Disease Control and Prevention (CDC) finishes tabulating and verifying reports from across the US.
In the meantime, the Times contacted local and state agencies across the US to come up with a rough estimate. It calculated that 59,000 to 65,000 people died of overdoses last year, with a harder, but likely imprecise, number of 62,497.
In comparison, more than 58,000 US soldiers died in the entire Vietnam War, nearly 55,000 Americans died of car crashes at the peak of such deaths in 1972, more than 43,000 died due to HIV/AIDS during that epidemic's peak in 1995, and nearly 40,000 died of guns during the peak of those deaths in 1993.
The Times can’t specify how many of the overdose deaths were caused by opioids, much less what kind of opioid — painkillers, heroin, or fentanyl — was behind the deaths. But based on the past few years’ trends and on-the-ground reports, most of the overdose deaths were likely linked to opioids and an increasing amount were linked to fentanyl.
The total, if it holds true, would surpass 2015’s record for most recorded drug overdose deaths in US history. Back then, more than 52,000 deaths were linked to overdoses. The Times estimates there was a 19 percent increase between 2015 and 2016 alone, which would be the largest known increase in drug overdose deaths for any single year yet.
Although it’s hard to say for certain, the Times suggested “the problem has continued to worsen in 2017.”
In short, the opioid epidemic was already the deadliest in American history in 2015. And it got much deadlier in 2016 — and is likely even worse so far in 2017.
The opioid epidemic, explained
This latest drug epidemic is not solely about illegal drugs. It began, in fact, with a legal drug.
Back in the 1990s, doctors were persuaded to treat pain as a serious medical issue. There’s a good reason for that: About 100 million US adults suffer from chronic pain, according to a 2011 report from the Institute of Medicine.
Pharmaceutical companies took advantage of this concern. Through a big marketing campaign, they got doctors to prescribe products like OxyContin and Percocet in droves — even though the evidence for opioids treating long-term, chronic pain is very weak (despite their effectiveness for short-term, acute pain), while the evidence that opioids cause harm in the long term is very strong.
So painkillers proliferated, landing in the hands of not just patients but also teens rummaging through their parents’ medicine cabinets, other family members and friends of patients, and the black market.
As a result, opioid overdose deaths trended up — sometimes involving opioids alone, other times involving drugs like alcohol and benzodiazepines (typically prescribed to relieve anxiety). By 2015, opioid overdose deaths totaled more than 33,000 — close to two-thirds of all drug overdose deaths.
Seeing the rise in opioid misuse and deaths, officials have cracked down on prescriptions painkillers. Law enforcement, for instance, threatened doctors with incarceration and the loss of their medical licenses if they prescribed the drugs unscrupulously.
Ideally, doctors should still be able to get painkillers to patients who truly need them — after, for example, evaluating whether the patient has a history of drug addiction. But doctors, who weren’t conducting even such basic checks, are now being told to give more thought to their prescriptions.
Yet many people who lost access to painkillers are still addicted. So some who could no longer obtain prescribed painkillers turned to cheaper, more potent opioids: heroin and fentanyl, a synthetic opioid that’s often manufactured illegally for non-medical uses.
Not all painkiller users went this way, and not all opioid users started with painkillers. But statistics suggest many did: A 2014 study in JAMA Psychiatry found many painkiller users were moving on to heroin, and a 2015 analysis by the Centers for Disease Control and Prevention found that people who are addicted to prescription painkillers are 40 times more likely to be addicted to heroin.
So other types of opioid overdoses, excluding painkillers, also rose.
That doesn’t mean cracking down on painkillers was a mistake. It appeared to slow the rise in painkiller deaths, and it may have prevented doctors from prescribing the drugs to new generations of people with drug use disorders.
But the likely solution is to get opioid users into treatment. According to a 2016 report by the surgeon general, just 10 percent of Americans with a drug use disorder obtain specialty treatment. The report found that the low rate was largely explained by a shortage of treatment options.
Some states, like Louisiana and Indiana, have taken a “tough on crime” approach that focuses on incarcerating drug traffickers. But the incarceration approach has been around for decades — and it hasn’t stopped massive drug epidemics like the current crisis.