By R Carter
I’ve monitored Ohio’s efforts to collect drug overdose data since 2015 and until now, it’s been discouraging, showing overall rising rates between 2000 and 2017. But new data shows an encouraging trend in the fight against illegal drug use, more importantly the data blows holes in claims that chronic pain treated with opiates is a leading cause of drug overdose deaths.
Prescription Opiate Data
First, the overall death rate from prescription opiates shows a solid trend of decreases since 2011. Clearly Ohio’s efforts at collecting specific data points on prescribed opiates is now having a payoff.
Second, the number of written scripts from physicians is down dramatically. It’s likely this data point hides a more ominous statistic, that of the number of patients who have legitimate medical conditions which qualify them for treatment with opiates, but have been denied treatment due to the backlash of sentiment around treating chronic pain with opiates combined with fear physicians have from state medical board regulations.
Third, Ohio’s prescription drug monitoring program identifies people attempting to fill scripts from multiple doctors. While overall this is also good news, it too may hide an ominous data point which remains unknown, that of patients with legitimate medical problems who are under prescribed due to the backlash of sentiment spurred on by the CDC’s out of context guidelines for treating chronic pain.
Illegal Opiate Data
Forth, the percentage of overdose deaths from Fentanyl as compared to other opiates has seen a dramatic increase since 2003 while deaths from other sources continues to decline. This is now signalling that more effort and funding are needed for law enforcement in thwarting this scourge of drug abuse.
Fifth, when comparing trends on selected opiates, clearly prescription opiate overdose deaths are declining. Heroin deaths have had mixed but improved outcomes, benzodiazepeines deaths are down while deaths from cocaine and methamphetamines have risen since 2010.
Overdose deaths by age group remain relatively unchanged. While many argue that those aged 60 and older have a higher risk, the data doesn’t support such conclusions.
Sixth, when comparing Fentanyl overdose deaths to drug seizures by law enforcement, the news is encouraging but a clear trend is still lacking. We know that Fentanyl and Carfentanyl overdose deaths have increased since 2011, but this data would suggest more funding and effort is needed with law enforcement to fight this crisis.
Seventh, the data points on this graph have been updated from previous graphs to now separate prescription opiates from illegal opiates. We know that most death certificate data does not make a differentiation between prescription opiates vs illegal opiates. So agencies in Ohio have started collecting data from other sources as documented in this post.
The rise in illicit Fentanyl deaths since 2013 is alarming, demonstrating how some people who had access to prescription opiates turned to illegal sources. This too may hide a ominous trend which is not investigated and reported. Patients who have been denied treatment due to the general sentiment towards opiates and fewer prescribers writing scripts for otherwise legitimate medical conditions.
In large part due to the rising rate of illicit Fentanyl overdose deaths, the number of overdose deaths per 100,000 population remains at an all time high. Still for those who claim that treatment of chronic pain with opiates is a leading cause of overdose deaths, the data from Ohio no longer supports this claim.
This graph also underscores how illegal drug use has been and remains the number one cause of overdose deaths in Ohio. As of 2017 70% of all overdose deaths are from Fentanyl, 20% from Heroin, 31% from Cocaine and 10% from prescription opiates.
It’s been know since the start of the opiate crisis that most overdose deaths result from a combination of drugs. This is a new graph showing those combinations of drugs in Ohio. Fentanyl and Cocaine make up the largest group at 22%, followed by Fentanyl and Heroin at 14%, followed by Fentanyl and prescription opiates at 9%.
These stats are very revealing, showing that even with prescription opiates, those dying from these combinations are most likely illicit drug users and not chronic pain patients.
This data from Ohio is unprecedented in its scope and detail, supporting what the chronic pain community has been saying since the onset. Improved methods at monitoring, in data reporting and collection, physician use of this data combined with better screening for drug abuse is finally producing a picture which is rational and believable.
Ohio has committed to being a leader in the war on illicit and illegal drug use. This data is encouraging and good news for chronic pain suffers. Still, we know from individual reports this data hides another view which is troubling and an underlying cause of the increased number of suicides. That of fear driving prescribers to kick some patients to the curb and denying them access to healthcare.
I only hope Ohio will exercise as much due diligence in uncovering this aspect of healthcare for Ohioans as they have in fighting the drug abuse war.