By R Carter
We’ve all heard the headlines, the sound bites. Opiate overdose deaths now exceed deaths from auto accidents. Opiates now the 3rd leading cause of unintentional deaths in the U.S. Sounds dramatic doesn’t it. I’m critical of these statements because the data doesn’t fit the message.
Such statements are another way of weaponizing the data. If I compared opiate deaths to sudden fetal death syndrome, opiate deaths would sound like a plague. Driving an automobile is not a disease, so comparing the two statistics is like comparing apples and oranges.
Thomas Frieden, director of the Centers for Disease Control and Prevention, responded to a question about the U.S. opiate crisis in 2017 and gave these facts.
Mr. Frieden estimated that more than two million Americans are addicted to opiates. With a U.S. population of 324,459,463 in the same year, that’s a much smaller percentage than what you typically see reported. For example, the number I see tossed around most often in CDC reports is 3%.
If 3% were the case, then 9.7 million people would be addicted. So which is it? Even if the numbers were as high as 3 million that would still just be 0.9% of the population.
I would like to see detailed sources for such estimates, but so far the only data the public can access is death data.
This report from CDC Wonder for 2017 shows the fifteen leading causes of death. Opiates don’t even appear on the list, yet in 2019 I’ve seen more than a dozen reports quoting 2017 data and opiates as the 3rd leading cause of death. Which is it CDC?
Opiate related deaths are buried in Accidents (unintentional injuries) and Intentional self-harm (suicide). Filtering out unrelated causes is made difficult by virtue of limitations within the data itself.
The following codes can be used when running a report.
All classes of drug poisonings include:
- (X40-44) Overdose Unintentional
- (X60-64) Overdose Suicide
- (X85) D3 Drug poisonings (overdose) Homicide
- (Y10-Y14) Drug poisonings (overdose) Undetermined
Assuming these codes are used, none are uniquely specific to opiates, see details in this post. For this reason, even an estimate of 0.62% for addiction becomes questionable assuming most addicts don’t overdose and die.
|Cause||Deaths||% of Population|
|Diseases of heart||12,222,640||0.21%|
|Chronic lower respiratory diseases||2,594,927||0.05%|
|Accidents (unintentional injuries)||2,347,820||0.04%|
|Influenza and pneumonia||1,094,641||0.02%|
|Nephritis nephrotic syndrome,||858,613||0.01%|
|Intentional self-harm (suicide)||697,016||0.01%|
|Chronic liver disease and cirrhosis||604,125||0.01%|
|Essential hypertension, renal disease||489,121||0.01%|
|Pneumonitis from solids and liquids||334,723||0.01%|
Hopefully this helps explain in part, the wide range of values often seen when reporting on opiate overdose deaths. But this is only part of the problem. When officials discuss addiction and overdose deaths from opiates, sources cited in their publications often mix data on both subjects, further confusing the message and leaving the reader to ask, are we talking about addiction or overdose deaths from opiates?
It should be stressed that any number at best is an estimate. So what can researchers do if they want to fine tune and be more specific?
They rely on data from other sources such as:
- National Poison Data System, DAWN (Drug Abuse Warning Network)
- NIS Database (National Inpatient Survey)
- The Cochrane Library
- National Center for Chronic Disease Prevention and Health Promotion
- National Institute on Drug AbuseExternal
- Substance Abuse and Mental Health Services AdministrationExternal
- National Clearinghouse for Alcohol and Drug InformationExternal
- National Center on Addiction and Substance Abuse (CASA)External
While each has advantages they also have shortcomings. Limitations in cross referencing data across all sources to identify unique segments and groups, combined with limitations on the size of studies or patient populations, prevent such sources from being a wide and large cross section of Americans within the U.S. As such researchers must make judgment calls on how fitting a sample source is when representing national trends.
Most certainly there needs to be clarification from these officials on whether their data and their message is about, addiction, overdose deaths or both.
The purpose of this post was to look at the broadest definitions in which addiction estimates and opiate overdose deaths are a sub-component of the data published. The 0.62% quoted in the post title is based on verbal statements made by CDC leadership.
The anger expressed by the chronic pain community comes from this inability to maintain a separation of concerns.
Addiction is not the same as a having a physical dependence on medication used in a medical treatment. One is managed, the other is not. Also understanding that much of the confusion comes from this mixed message and related publications.
Since 2010 the public has been told and convinced, that prescription opiates are the leading cause for opiate addiction and opiate overdose deaths. We now have reliable data refuting this and supporting what the chronic pain community has said since the onset.
Using data compiled from government sources, the fallacy of these claims is now obvious. Given the data now available, an estimate for an addiction rate of 0.62% unlikely. The CDC should not only own this error but publish corrections to the fact.