New Opioid Epidemic ‘Hot Spots’ Emerge in U.S.

New opioid epidemic “hot spots” — areas where opioid mortality rates are both high and rapidly increasing — have emerged in the U.S., according to an analysis of CDC data.

While opioid-related mortality often is stereotyped as a rural, low-income phenomenon concentrated in Appalachia and the Midwest, it has spread quickly, especially in the eastern part of the country, reported Mathew Kiang, ScD, of the Stanford University School of Medicine in California, and co-authors in JAMA Network Open.

Opioid overdose deaths climbed fastest in the District of Columbia, more than tripling every year since 2013. Eight states — Connecticut, Illinois, Indiana, Massachusetts, Maryland, Maine, New Hampshire, and Ohio — had opioid-related mortality rates that at least doubled every 3 years. Two states — Florida and Pennsylvania — had opioid-related mortality rates that at least doubled every 2 years.

The increase in mortality rates in the east seemed driven primarily by synthetic opioids, which followed a distinctive geographic pattern across the country.

“Most papers looking at the opioid epidemic have focused on either the mortality rate or the rate of change,” Kiang told MedPage Today. “We describe both together to identify what we call epidemic hot spots — areas that have high opioid mortality that is rapidly getting worse.”

Synthetic opioid deaths now outnumber heroin deaths, suggesting that drugs like fentanyl have contaminated the production process of street drugs like cocaine and methamphetamines and is no longer limited to heroin, he added.

In this cross-sectional study, Kiang and colleagues analyzed multiple causes of death data from the CDC’s National Center for Health Statistics, looking at records of 351,564 Americans who died from opioid-related causes from 1999 to 2016. Two-thirds of those who died were men. Men died at a mean age of 39.8 years, and women died at a mean age of 43.5.

The researchers used joinpoint regression to study trends in mortality rates over time, and calculated age-standardized mortality for all opioid types. They found that opioid-related mortality rates, especially from synthetic opioids, rapidly rose in all of the eastern U.S. In most states, mortality associated with natural and semi-synthetic opioids (prescription painkillers) remained stable.

Overall, 28 states had mortality rates from synthetic opioids that more than doubled every 2 years, including 12 states where the mortality rates from synthetic opioids was >10 per 100,000 people. In contrast, the mean mortality rate from natural and semi-synthetic opioids was 6.0 per 100,000 people in these 28 states.

The District of Columbia had the fastest rate of increase in mortality from opioids with an annual percent change of 228.3% (95% CI 169.7%-299.6%; P

“To help contextualize our results, we estimated the life expectancy lost due to opioids and compared these numbers to the life expectancy lost due to guns or car accidents,” Kiang said. “We found that the majority of states are losing more life expectancy years to opioids than to guns or car accidents.”

Nationally, opioid-related mortality resulted in 0.36 years of life expectancy lost in 2016 — 14% higher than deaths due to firearms and 18% higher than deaths due to motor vehicle crashes, with 0.17 years of the life expectancy due specifically to synthetic opioids.

Kiang and co-authors noted limitations to their study. While it assumed deaths were classified accurately, opioid-related mortality may be underreported: in 2014, eastern states were shown to have more underreporting than others. To detect fentanyl, coroners must request an additional toxicology test; mortality rates from synthetic opioids may have been underreported for this reason.