Preventing overdose deaths is not one-size-fits-all

Scott Weiner, MD
, Contributor

By now, we all know that the number of opioid-related deaths in the United States has reached epidemic proportions. Despite the Centers for Disease Control and Prevention declaring an epidemic in 2011, the death rate has continued to increase every year, with more than 30,000 deaths per year now attributed to opioids. Graphs from the CDC show the geographic distribution of the epidemic and demonstrate that nearly the entire United States is involved. This tragic death toll has culminated in many local, state, and federal government initiatives to fix the problem, including President Trump’s recent declaration that the opioid crisis is a nationwide public health emergency.

However, it is important to remember two key facts. The first is that drug overdoses are not all from opioids. It is true that while roughly two-thirds of these deaths are from opioids, the other third are caused by other drugs. For example, in 2015 there were about 52,000 overdose deaths overall, and 33,000 involved an opioid; 19,000 were caused by other substances. The second fact to consider is that despite efforts to reduce gender and racial inequalities in our country, there is still a considerable difference in the life experience between men and women and between different racial and ethnic groups.

With an eye toward these factors — that opioids are not the only cause of overdose death and that inequalities exist in our country — if we want to solve the opioid epidemic we, as a society, must realize that the opioid problem is not the same for everybody.

This point was highlighted in a recent study published in Annals of Internal Medicine. In this research, the authors looked at death certificates of people who died from drug overdose between 2000 and 2015 to determine the exact cause of death. The authors broke up the data into four-year blocks of time (e.g. 2000­–2003, 2004–­2007, etc.) to look at trends. This type of analysis is not new. However, what is new is that they broke up the data based on gender and race, separating non-Hispanic black, Hispanic, and non-Hispanic white people into different groups. (For simplicity in this post, I’ll refer to the first group as “black,” the second as “Hispanic,” and the third as “white,” even though Hispanic is an ethnicity and not a race.)

The results are enlightening. Although there were increases in the death rate among all groups, they were most pronounced for older black men (age 50 and older) and black women (age 45 and older). Also, opioids contributed to the most deaths for white people, but cocaine was the largest contributor to death for black people. In fact, from 2012 to 2015, deaths related to cocaine were almost as common in black men as deaths from natural and semisynthetic opioids were in white men. For Hispanic people, the rates remained lower overall than for white and black people, but there was a large spike in heroin-related deaths in both sexes when comparing the 2012­–2015 period with previous time periods. Finally, the death rate for white males appears to be shifting toward an earlier age, while it is higher for older white women.

We must acknowledge that the authors did separate deaths from the opioids into different categories, such as from heroin, synthetic opioids, methadone, and natural/semisynthetic opioids. If you add all of those categories together, they are still collectively the top cause of death among all ages and sexes.

However, even considering this, evaluating these trends can help us better target interventions. For example, cocaine remains an important cause of death in the black community. With so much attention given to opioids, neglecting the important problem of cocaine can further exacerbate inequality in rates of overdose deaths. Likewise, when developing public service campaigns or increasing resources in a targeted fashion, how the message and care are delivered often depends on the age of the individual. Finally, although rates of overdose death are lower overall among the Hispanic community, they are still significant and too high, which makes the case for culturally appropriate and Spanish-language interventions.

Recent analyses have demonstrated how the response to the opioid epidemic has changed since it has become more of a “white problem.” Whereas in the past drug addiction was commonly handled with criminalization and stigmatization, now there is a call (appropriately) for a gentler war on drugs that recognizes addiction as a medical condition that is treated like any other chronic disease. Recognizing that the epidemic affects different communities in different ways will help us avoid a “one-size-fits-all” approach as we work together to solve the problem.

Comments:

  1. Joao Vieira

    I take advil when it gets worse, and learned that meditation helps me more than medication. I was getting addicted to pain killers oxycodone and co when I understood what was happening. Addictive Pain killers are patching the symptom, if your doctor does not understand the cause, the first thing I would strongly recommend to consider is Meditation. Meditation slows our metabolic function and stress, and we are the biggest culprits of pain flaring up , with self inflicted stress. Provided that we are not aware of this, now you are :). I learned how to disconnect myself from myself, and there are great benefits and challenges into doing so. Back to opioids:This article is correct in saying one shoe does not fit all…however, coming from Harvard, yall should perhaps consider learning something with Europe :https://news.vice.com/article/ungass-portugal-what-happened-after-decriminalization-drugs-weed-to-heroin . People take drugs for two reasons :Increase pleasure, or relieve pain. High mortality rates due opioids are a big symptom of the chaotic status this great entrepreneurial society is crossing. You will not address the problem if you don’t acknowledge that.. You might fix a couple of loose ends, but without hope people will continue to take drugs in mass. Without hope there is no reason to continue…people need relief…talking about recreational drugs now…In the 70s kids would have job security outside of school and know they would be ok ..Now kids don’t have that assurance…With the latest $4k tax debt burden to every american , it just adds more to the same disconnect that I see in this society. I think we need to meet people where they are and address their needs…or just keep letting them die , and pretend that we are doing something great with our studies and statistics while they die like flies.

  2. Greg

    I am a 58 year old white male who has been opioid free for the last 6 years.
    Prior to my discontinued use at age 52 I was enrolled in a pain management program for 12 years as the result of three back surgeries including a fusion at L4/L5 with instrumentation. Over the 12 year period in pain management I received regular steroid injections as well as prescription medications to deal with the pain. I wore a fentanyl patch for much of this time designed to cover the constant underlying pain and was prescribed six 10mg Percocet per day to cover what was called break through pain. Along with this I took Ambien to help sleep. At the end of 12 years of this “care” I was heavily addicted and my pain was far less managed than it was the day I walked into the pain management practice. I admit culpability in this to some degree but in retrospect I can see a systematic escalation of dependence by providers on opioids to treat problems that should have been addressed in other ways. The more opioids were used for longer durations the more intense all my pain symptoms seemed to become. Exacerbating the need to more meds and leading to a more sedentary lifestyle. This was clearly working in the wrong direction.
    Upon cessation of the medications my activity level increased, body weight normalized and sensitivity to the ongoing chronic pain stabilized. I find that a combination of Meloxicam and Tylenol are adequate to handle most of my pain problems without the problems associated with the opioids

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