As the opioid epidemic officially reaches a ‘national emergency’ status, federal data shows that heroin and other opioids have been increasingly deadly — now, killing an average of 91 Americans daily. Yet, this crisis may be even worse than the public thought.
A new study shows that opioid-related death rates have been off by at least 24 percent nationwide.
Author Christopher J. Ruhm, a professor of public policy and economics at the University of Virginia, discovered the incompleteness of the national reports on death certificates while conducting another research that required him to look at statistics on drug poisoning deaths were important.
“Overdose deaths frequently involve combinations of drugs, rather than a single type of drug,” he said. “I don’t think this is fully understood. Some states — such as Pennsylvania — have particularly large under reporting of all opioid and heroin death rates. These differences are large and affect our understanding of the nature of the fatal drug epidemic.”
According to figures released by the U.S. government, deaths caused by heroin and other opioids have been rising continuously through the country since 2000. But a closer inspection of overdose death records gathered by the Centers for Disease Control and Prevention from 2008 to 2014 allowed Ruhm to see that specific drugs were often not included. These distinct substances had not been recognized in more than 25 percent of the fatal drug overdoses listed for 2008 and almost 20 percent of the ones registered in 2014.
He then created a formula — including factors like demographics, social statuses, etc. — to predict if an opioid or heroin had been involved in these overdose deaths that were registered but not linked to specific drugs.
The results, published in the American Journal of Preventive Medicine, showed that throughout the country the corrected rates of deadly overdoses linked to other opioids are 24 percent higher than federal records show.
“People need to recognize the risk of physical addiction and psychological dependence from using these drugs that can ruin their lives and the lives of those around them,” Ruhm said. “Some people think that because opioid analgesics (e.g. Oxycontin) are prescribed, there is little or no risk associated with them. This is wrong. Properly used, these have a place, but they are risky drugs.
Rates of deaths caused by heroin were found to be 22 percent higher than the government had estimated. The discrepancies in the figures were particularly high for select states like Pennsylvania, where Ruhm found that opioid-related deaths were underreported by more than half in 2014.
“The risks of heroin are probably somewhat better understood,” he said. “But a key issue here is that there’s no way to know the dosages received when using ‘street drugs.’ Particularly dangerous today are combinations of heroin with fentanyl or carfentanil that can easily be deadly.”
While it’s seemingly imperative that federal agencies invest more in accurately collecting opioid-related data, one could argue, considering the alarming data already provided by the government, that it’s more important to increase investments in treatment, awareness, and prevention.
“We need to invest in all of these areas,” he said. “We need to spend more on treatment and prevention efforts. We also need to gather better information. Investing in information is likely to be relatively cheap, compared to some other areas, and may well have a high payoff. However, expanded treatment options are a top priority.”
Ruhm believes that his findings may supply valuable information to policymakers attempting to combat the increasing number of deadly opioid overdoses. He added that improved efforts against the opioid crisis are possible outcomes of providing more accurate data to regulators and to the public.
“Better information is needed to understand the underlying causes of the fatal drug epidemic and these are needed if we are to develop the most effective strategies to reduce its severity,” he said. “In addition, the information provided in this study will allow us to more effectively target existing policy efforts.”