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Drug overdose deaths skyrocketed in 2016 — and traditional opioid painkillers weren’t the cause

New official numbers show fentanyl took overdose deaths to unprecedented heights last year.

A seizure of fentanyl, a synthetic opioid that’s been increasingly linked to drug overdose deaths in recent years. Photo by Drew Angerer/Getty Images

The federal government just put out new statistics for drug overdose deaths in 2016 — and they are very, very grim.

The preliminary figures from the National Center for Health Statistics suggest that there were more than 64,000 drug overdose deaths in 2016. And in a shocking — but not quite surprising — reveal, synthetic opioids like fentanyl overtook both heroin and prescription painkillers in terms of overdose deaths.

Based on the National Center for Health Statistics figures, traditional opioid painkillers, such as OxyContin and Percocet, were involved in about 14,400 overdose deaths in 2016, and heroin was involved in more than 15,400. Non-methadone synthetic opioids like fentanyl, meanwhile, were linked to more than 20,100 overdose deaths. Remaining overdose deaths involved other drugs, such as cocaine (which also increased).

If these numbers hold up (and final figures will come out later this year), it solidifies the opioid epidemic as America’s deadliest overdose crisis ever. 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 firearm deaths in 1993.

The numbers show the evolution of the opioid epidemic. It originally began as a crisis rooted in the dramatic overprescription of opioids. But over time, many users moved onto other opioids, particularly heroin and fentanyl — the latter of which is especially potent and deadly.

One caveat to the numbers: As Stanford drug policy expert Keith Humphreys pointed out, medical examiners and coroners are increasingly testing for opioids due to much greater awareness of the crisis. So some of the uptick is partly attributable to the fact that people are looking for these deaths now. Still, a bulk of the increase is likely due to a genuine rise in overdose deaths.

The data is also based on an analysis of February 2016 through January 2017, so the estimate for 2016 is partly an extrapolation of the available figures. The final count, which will come out in December as the Centers for Disease Control and Prevention releases a trove of health data for 2016, will have more precise numbers.

The opioid epidemic, explained

The 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.

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 prescription 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 (and they can work for some individual chronic pain patients) — after, for example, evaluating the patient's 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. Some who could no longer obtain painkillers turned to cheaper, more potent opioids: heroin and fentanyl.

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 75 percent of heroin users in treatment started with painkillers, and a 2015 analysis by the Centers for Disease Control and Prevention found that people who are addicted to 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 pulling back on the number of painkiller prescriptions was a mistake. It appeared to slow the rise in painkiller deaths, and likely prevented doctors from prescribing opioids to new generations of people with drug use disorders.

But it must be paired with more access to addiction 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.

So federal and state officials have pushed for more treatment funding, including medication-assisted treatment like methadone and buprenorphine.

Some states, like Florida 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.

Update: Added more information about the data.

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