Drug Overdose Deaths The Leading Cause of Injury Deaths In The US

Drug overdose deaths have reached unprecedented levels in the United States. Over the past two decades, drug overdoses have more than tripled to become the leading cause of injury deaths in the US. They now outnumber deaths from motor vehicle accidents and homicides, according to data from the Centers for Disease Control and Prevention (CDC) / National Center for Health Statistics (NCHS) Compressed Mortality File and Cause of Death Files. Sadly, the epidemic shows no signs of leveling off: drug overdose mortality continued to rise through 2017, amounting to over 70,000 deaths in that year and increasing by 16 percent per year between 2014 and 2017 (Hedegaard, Warner, and Miniño 2018).

Are other high-income countries experiencing similar increases in drug overdose deaths, and are they likely to going forward?  Dr. Jessica Ho, of the University of Southern California, has examined drug overdose death rates between 1994 and 2015 in 18 countries. The study published in Population and Development Review provides some insight.

US Drug Overdose Deaths Are 27 Times Higher Than Some Countries

Dr. Ho says the incidence United States’ drug overdose deaths have been dramatically pulling away from other high-income countries.

Alarmingly drug overdose mortality is now 3.5 times higher on average in the United States than other high-income countries. It’s 27 times higher than in Italy and Japan, which have the lowest drug overdose death rates. Between 2003 and 2013, drug overdose mortality increased by 0.73 (men) and 0.26 (women) deaths per 100,000 on average in the comparison countries compared with increases of 5.53 (men) and 4.15 (women) deaths per 100,000 in the United States.

She confirms that despite the experience of the US, the potential remains for drug overdose mortality to increase in other countries in the near future, as similar and troubling signs are already discernible in some countries.

“One of the most surprising findings from this study is that while Americans now have the highest drug overdose death rates, this hasn’t always been the case. In the late 1990s, Nordic countries like Finland and Sweden had the highest death rates.”

Other Countries At Risk of Drug Overdose Deaths

“The countries that now look like they’re at greatest risk of following in the footsteps of the the U.S. are other Anglophone countries like Canada, Australia, and the United Kingdom,” said Dr. Ho. “Over time, we’ve seen huge shifts in drug overdose, and we need to pay attention to the factors that contribute to the development and continued persistence of this epidemic in the United States and, potentially, whether it spreads to other countries.”

Why Is This Current US Epidemic So Alarming?

While the US has experienced prior drug epidemics, the current epidemic is distinctive in three key aspects.  According to Ho, “First, the magnitude of the contemporary epidemic in terms of the estimated number of users and deaths involved far exceeds that of prior epidemics. Second, the earlier epidemics were driven primarily by illicit substances (heroin in the 1970s and cocaine in the 1980s to early 1990s), while legal drugs (prescription opioids) played the main role in initiating and sustaining the contemporary epidemic until the most recent decade. Third, drug overdose mortality was previously concentrated in major cities like New York, Philadelphia, Baltimore, and San Francisco, while the contemporary epidemic has encompassed dramatic increases in drug overdose mortality in non-traditional locations, particularly midsize cities, suburbs, and rural areas (Paulozzi and Xi 2008; Rigg, Monnat, and Chavez 2018). This has led to a convergence in drug overdose mortality so that drug overdose death rates do not differ substantially between rural areas and metros at the national level, although a large amount of geographic heterogeneity exists in these patterns (Rigg, Monnat, and Chavez 2018).”

A Modern Day Drug Epidemic Which Was Fueled By Pain Management


Ho writes, that prior to the 1980s, the prevailing belief in the medical community was that few safe and effective methods to manage pain existed, and that opioid painkillers were too dangerously addictive to be prescribed except to terminally‐ill cancer patients.  “However, by the 1990s, a fundamental change took place in the American medical establishment (Chiarello 2018; Meier 2003; Wailoo 2014). A new narrative dominated: millions of Americans were suffering needlessly from untreated pain; freedom from pain should be considered a universal human right (Brennan, Carr, and Cousins 2016; Cousins, Brennan, and Carr 2004; International Association for the Study of Pain 2018; Lohman, Schleifer, and Amon 2010) and pain should be accorded the status of the “fifth vital sign”; safe, non‐addictive, and effective painkillers had been developed to treat pain; and doctors had a moral obligation to treat pain using these painkillers. Not only did the assessment, management, and treatment of pain become areas of increased and intense focus for medical practitioners, but also, using prescription opioids to treat many different types of non‐cancer pain became common.”

In recognizing and treating pain, the medical community accepted the establishment of pain medicine as a sub-specialty and what followed was a proliferation of pain management specialists.   The researchers explain how “the first certificates in pain management were issued in 1993, followed by a rapid expansion of pain medicine training programs (Conrad and Muñoz 2010; Rathmell and Brown 2002). Dr. Ho says, these trends occurred alongside important structural changes in the health care system in the era of managed care, during which primary care physicians faced increased financial pressures, patient caseloads, and time constraints. “With physicians’ employment and pay increasingly tied to patient evaluations, physicians had strong incentives to prescribe painkillers (Quinones 2015; Van Zee 2009).

Purdue Pharma, the manufacturer of OxyContin became a key player in  developing and popularizing the narrative that “not only was there a moral obligation to treat pain, but that there now existed a safe and effective means of doing so. It marketed OxyContin—a pain reliever consisting of the opioid oxycodone—aggressively for a wide range of conditions including headaches, back pain, sports injuries, and wisdom tooth extraction (Meier 2003; Van Zee 2009).”

“Purdue spent hundreds of millions of dollars (an estimated $200 million in 2001 alone [Goldenheim 2002]) on encouraging prescribing and promotional activities—including sponsoring pain management conferences and continuing medical education seminars (which many states require physicians to take to maintain their licenses)—during which their representatives touted that the risks of addiction were “less than one percent” (Meier 2003; Van Zee 2009).

Research studies confirmed, that in the United States, painkiller prescriptions rose rapidly to unprecedented levels. In 1996, the year following its initial approval in the US, sales and prescriptions of OxyContin amounted to roughly $45 million and 316,786 prescriptions, respectively. In 2002, these figures reached $1.5 billion and seven million prescriptions (GAO 2003), corresponding to a 34‐fold increase in sales and a 22‐fold increase in prescriptions.”

“Sales of all opioid pain relievers quadrupled between 1999 and 2013 (Paulozzi et al. 2011). These trends reflect excessive prescribing on physicians’ parts as well as patients’ demands. The two intersected in “pill mills,” clinics where doctors prescribed enormous amounts of painkillers without medical justification and where clients could obtain pills onsite for cash. Individuals outside the medical establishment were also involved: they owned and ran pill clinics, notably in Florida (Lawson 2015; Temple 2015), and they acted as “sponsors” who recruited groups of users, took them to pain clinics, and paid for their appointments in return for painkillers, which they then resold on the black market (Macy 2018; Quinones 2015; Rigg, March, and Inciardi 2010). The huge amounts of pills entering the population were also fueled by “doctor shopping”—patients obtaining prescriptions for opioid painkillers simultaneously from multiple (as many as five or more) physicians (Hall et al. 2008; McDonald and Carlson 2013).”

Indeed,Purdue Pharma pleaded guilty in 2007 to a federal charge that it had mislabeled the drug and mislead the public about its addictive properties, agreeing to pay an unprecedented $600 million fine. Despite this, sales of the drug have not showed any signs of slowing. As of 2016 Purdue Pharma had made more than $31 billion from sales of OxyContin.

Even with Increased Awareness, The Drug Overdose Mortality Is Still Rising

Despite the growing awareness of the crisis and  implementing measures to limit prescribing,  drug overdose mortality has continued to rise.  As the researchers, noted “The huge amounts of prescribed opioids had created a large population of addicts who switched from opioid painkillers to heroin, a cheaper and more easily accessible alternative (Cicero et al. 2012; Evans et al. 2018; Muhuri, Gfroerer, and Davies 2013; Quinones 2015).

It has been documented that 80% of heroin users were first prescription opioid users, according to the National Institute of Drug Abuse.

Dr.Ho further confirms;  “Since 2010, drug overdose mortality has continued to increase, largely due to heroin and illegally‐synthesized fentanyl (Jones, Einstein, and Compton 2018; Rudd et al. 2016). China has emerged as a main supplier of fentanyl to both the United States and Europe (EMCDDA 2018; U.S. Congress 2018).”

While there is growing awareness of the crisis, and researchers like Dr. Ho contribute important facts to raising awareness,  the epidemic continues spreading.

Recently artist Domenic Esposito dropped off a massive, unexpected addition to the entrance of Rhodes Pharma in an artistic protest against drug related deaths from pain killers.  The generic opioid manufacturer is linked to the Sackler family, founders of multi-billion dollar drug company Purdue Pharma.