Mapping the Opioid Epidemic in the US

Drug overdose is the leading cause of accidental deaths in the U.S.  More than 47,000 people died from drug overdoses in 2014, up from roughly 17,000 in 1999. In roughly the same time period, opioid-related deaths quadrupled, which is perhaps not too surprising as opioid prescriptions have tripled over the past 20 years. It’s a deadly problem impacting families and communities (large and small) in all corners of the U.S.

The Opioid Epidemic Hits Everyone

Whites, Blacks, Hispanic or Latinos, Native Americans, and Asians have all seen a rise in overdoses. However, opioid-related deaths have hit whites and native Americans harder than any other group, especially among 45-54 year olds. Twelve states, mostly in the south and Midwest, have more opioid prescriptions than people, meaning there are people with multiple opioid prescriptions. What’s especially alarming is that several of these states, like Ohio, Indiana, and West Virginia, have been hit hardest by the opioid epidemic.

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How did it become an epidemic?

Opioids were not always as readily available as they are today. As stated earlier, prescriptions have tripled over the past 20 years. If we rewind to the late 90s, we begin to see why. In 1998, the Veterans Health Administration implemented a national strategy to improve patient pain management- an initiative called “Pain as the 5th Vital Sign”, with the other vital signs being pulse rate, temperature, respiration rate, and blood pressure. The initiative introduced a numeric rating scale for patients to use when reporting their pain.

In 2001, the Joint Commission introduced its Pain Management Standards which grew the idea as including pain as a vital sign. During that time we also saw a growth in marketing of new opioids to physicians and a growing acceptance of their use in medicine. Fast forward nearly two decades and nearly 2 million Americans are struggling with prescription opioid use disorder and an there’s been an alarming increase in opioid-related deaths. And astonishingly, studies have shown no improvement in the quality of pain management since the initiative was implemented. In June 2016 during its annual meeting, the American Medical Association recommended dropping pain as the fifth vital sign, while passing resolutions meant to increase access to addiction treatment.

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Turning the Tide

In August 2016, US Surgeon General Vivek Murthy set a historical first by mailing letters to 2.3 million health professionals in America- urging them to help  “turn the tide” on the opioid epidemic. He encouraged them to visit TurningTheTideRx.org, a website launched by his office where he asks clinicians to do three things:

  1. Educate ourselves to treat pain safely and effectively (see CDC’s opioid prescribing guidelines)
  2. Screen patients for opioid use disorder and provide or connect them with evidence-based treatment
  3. Shape how the rest of the country sees addiction by talking about and treating it as a chronic illness, not a moral failing

The website offers resources that align with the US Department of Health and Human Services Opioid Initiative and National Pain Strategy.

Efforts that began in the 1990s to treat chronic pain were implemented with good intentions- to help those who suffer with severe and chronic pain. But new efforts are now in place to not only treat chronic pain more effectively (and safely), but also focus on preventing opioid prescription abuse and bring people who suffer with prescription drug disorder use out of the shadows so they can get the help they need.

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10 thoughts on “Mapping the Opioid Epidemic in the US

  1. TBTom Bik

    Would it be possible to map opioid related overdose deaths by county?
    Or perhaps, prescription drug overdose deaths vs. heroin overdose deaths?
    Or opioid overdose ER admissions?
    I think that if we can map where/when opioid abuse is occurring, then maybe we can start to look at other factors (income, education, employment, etc?) that are driving this incomprehensible behavior.

      1. TBTom Bik

        Hi Andrea,

        Thanks for your reply.
        Don’t know if it will be useful to you, but here is a link to overdose death data in Illinois.

        http://www.dph.illinois.gov/data-statistics/vital-statistics/death-statistics/more-statistics

        A recent law here (Heroin Crisis Act) requires the collection and reporting of this data.

        Data for 2013, 2014 and provisional data for 2015, by county, are currently available.

        I would still be interested in any work that is being done on the social determinants of opioid overdose/abuse. For example, a webinar I saw from the Maine Rural Health Research Center reported the following characteristics of opioid abusers for rural counties:
        – age 20-50
        – fair or poor health status
        – unmarried
        – less than a high school education
        – low-income
        – no military service
        – uninsured

        Thank you for hosting this useful exchange.

        1. ACAndria Caruthers Post author

          Hi Tom,

          Thanks for passing that info along. This doesn’t get to your specific questions, but here’s a message from a GIS Specialist who provides us with the data:

          “As far as I can tell, there is currently no National, county-level data on emergency room discharges or opioid addiction. Mortality data from the CDC National Vital Statistical System can be acquired for specific drugs like heroin (right now we map all drug overdose deaths), but data suppression results in poor map coverage. Many state departments of health release emergency room / hospital discharge data (see http://www.health.ny.gov/diseases/aids/general/opioid_overdose_prevention/docs/annual_report2015.pdf for example) but it is often not possible to piece data from each state together – it may represent different data collection periods, may cover different opioids, etc.

          I have found the following resource which provides data on addiction at the metropolitan statistical area level:
          http://www.samhsa.gov/data/sites/default/files/NSDUHMetroBriefReports/NSDUHMetroBriefReports/NSDUH_Metro_Tables.pdf Data are from a HHS survey.”

          Hope some of it can be helpful. Thank you.

    1. DRDebra Robbins

      Under meaningful use, emergency rooms must report data to the public health department, including “chief complaint” as part of their syndromic surveillance. Your PHD should provide event/blinded data by county.

      1. TBTom Bik

        Thanks to all for the help and comments.

        I’ll especially check out the idea that the PHDs can access local ER admission reports.
        We have most of the hospitals and PHDs in our network of coalitions and this will be a useful and interesting discussion to have with them all. Thanks Debra.

        I also hope to continue to look at social determinants as a predictor of substance abuse. One study that I read stated that children that have a 6 (out of 10) on their ACES score (Adverse Childhood Experiences) were 46 times more likely to grow up to be an injection drug user. Unfortunately ACES are not yet a commonly reported measure.

        It may be useful to map the areas of high overdose deaths and start working backwards trying to see what characteristics there are in common.

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