Over 80% of US drug overdose deaths involve opioids, CDC says mental health diagnosis found in 25.8% of cases
Drug overdose deaths in the US increased in 2019 after a slight decrease from 2017 to 2018, suggests provisional estimates. Researchers found that while 81.5% of drug overdose deaths involved opioids, which are a class of drugs used to reduce pain, nearly 85% of overdose deaths involved illicitly manufactured fentanyl, heroin, cocaine or methamphetamine, either alone or in combination. Moreover, mental health diagnoses were documented in 25.8% of opioid overdose deaths, according to the US Centers for Disease Control and Prevention (CDC).
"More than 80% of overdose deaths involved opioids and three of four opioid overdose deaths involved illicitly manufactured fentanyls (IMFs). The supply of IMFs and overdose deaths involving synthetic opioids, excluding methadone (primarily IMFs), are projected to have increased for the seventh straight year in 2019. IMFs, heroin, cocaine, or methamphetamine (alone or in combination) were involved in nearly 85% of overdose deaths. Complicating intervention and treatment efforts, one-half of these deaths involved two or more of these four drugs," write authors.
The analysis also reveals that more than 3 out of 5 overdose deaths (62.7%) involved at least one potential opportunity to link people to care before an overdose or to implement life-saving actions when an overdose occurred. These opportunities can be targeted to both prevent overdoses and improve response to overdoses to prevent deaths, suggests the team.
Approximately one in 10 opioid overdose deaths had evidence of past-month institutional (such as jails/prisons, inpatient rehabilitation facilities, psychiatric hospitals) release (10.7% with stimulants, 10.8% without stimulants) or previous overdose (10.9%, 12.1%). Among all the people who died of a drug overdose, one quarter had a documented mental health diagnosis.
Experts say that enhanced coordination of treatment for people with both mental health and substance use disorders could help reduce drug overdose deaths. Evidence of current or past substance use disorder treatment was more common among opioid overdose deaths (18.6% with stimulants, 19.1% without stimulants) than nonopioid overdose deaths (less than 10%). Among overdose deaths, 37% occurred with a bystander present.
"For one-quarter of deaths, there was evidence of a mental health diagnosis. Integrating substance use disorder and mental health treatment can improve treatment outcomes, which could help reduce drug overdoses. The presence of a bystander at nearly four in 10 opioid and stimulant-involved overdose deaths suggests a need to increase bystander naloxone training, access, and use," says the team.
The findings
Overdose deaths were grouped by opioid and stimulant involvement into four mutually exclusive categories, which include opioids without stimulants, opioids and stimulants, stimulants without opioids, and neither opioids nor stimulants. A total of 25 jurisdictions reported 16,236 overdose deaths during January-June 2019. Among these, 7,936 (48.9%) involved opioids without stimulants, 5,301 (32.6%) involved opioids and stimulants, 2,056 (12.7%) involved stimulants without opioids, and 943 (5.8%) involved neither opioids nor stimulants.
In all regions, overdose deaths involving opioids without stimulants were most common (36.9%-54.1%), followed by deaths involving opioids and stimulants (30.6%-33.8%), then deaths involving stimulants without opioids (7.4%-27.1%). This pattern was most prominent in Northeastern and Midwestern jurisdictions, where deaths involving opioids (with or without stimulants) accounted for 87.6% and 83.0%, respectively, of all overdose deaths, explain investigators.
More than two thirds (68.5%) of those who had died were male, and three quarters (75.2%) were non-Hispanic White. Among overdose deaths involving opioids (with and without stimulants), most (53.3%) were aged 25-44 years, while among overdose deaths involving stimulants without opioids, most (55.7%) were aged 45–64 years. Evidence of injection drug use was more common among opioid-involved deaths than among deaths that did not involve opioids.
The researchers found that most overdose deaths (83.8%) involved one or more of four illicit drugs: illicitly manufactured fentanyls (61.5%), cocaine (28.3%), heroin (28.2%) or methamphetamine (17.6%). Nearly one half (49.8%) of these deaths involved two or more of those drugs. IMFs were involved in 80.4% of opioid overdose deaths with stimulants and 72.2% without stimulants.
Heroin was involved in 34.6% of opioid overdose deaths, and 73.6% of heroin overdose deaths co-involved IMFs. Either cocaine or methamphetamine was involved in nearly all stimulant overdose deaths (96.2% with opioids, 97.5% without). Prescription opioids were involved more often in deaths involving opioids without stimulants (30.7%) than in those with stimulants (17.2%).
The 10 most frequently occurring opioid and stimulant combinations accounted for 76.9% of overdose deaths. "Six drug combinations, including the three most common, involved IMFs and no other opioid or stimulant (19.8% of deaths), cocaine (10.5%), heroin (10.3%), heroin and cocaine (5.1%), methamphetamine (3.7%), and prescription opioids (3.3%)," the findings state.
The authors recommend that targeting crucial opportunities for intervention with evidence-based overdose prevention programs can help reverse increases in drug overdose deaths. Interventions to reduce overdose deaths involving illicit opioids and stimulants, particularly IMFs, are needed and should be complemented by efforts to prevent initiation of prescription drug misuse and illicit drug use, they explain.
According to the research team, co-use of opioids and stimulants elevates fatal overdose risk and is associated with poorer medical, mental health and substance use disorder treatment outcomes. They suggest that supporting increased access to medications for opioid use disorder and evidence-based treatments for stimulant use disorders can help mitigate risks.
Experts also add that research into more effective treatments for co-occurring opioid and stimulant use disorder is also needed. "Interventions conducted by risk reduction organizations (such as syringe services programs) to reduce overdoses among persons exposed to IMFs and to link populations at high risk (for example, persons who inject drugs) with prevention and treatment services might mitigate the overdose risks. Finally, timely response by public health and public safety officials to growing threats such as mixing of IMFs in nonopioid products, and outbreaks involving fentanyl analogs is warranted," the authors conclude.