Image from MedPageToday.com
Published: Jul 1, 2014
By John Fauber, Reporter, Milwaukee Journal Sentinel/MedPage Today; Kristina Fiore , Staff Writer, MedPage Today
Overdose deaths from both prescription opioids and heroin continued to rise in 2011, the most recent year for which data were available, according to the CDC.
While prescription opioid deaths followed a more than decade-long trend and increased about 2% to 16,917, heroin deaths jumped by 44% — from 3,036 in 2010 to 4,397.
Officials with the CDC said the increase in heroin deaths may be partly due to users having less access to prescription opioids and switching to the illicit drug.
Leonard Paulozzi, MD, MPH, a physician and researcher with the CDC in Atlanta, said about 75% of heroin users say they started out by using prescription opioids.
“People might have turned to heroin,” Paulozzi told the Milwaukee Journal Sentinel andMedPage Today.
The increasing number of heroin deaths also coincides with anecdotal reports about rising heroin use among people who have had diminished access to prescription opioid painkillers.
Paulozzi said the prescription opioid death number is getting close to stabilizing, but added that it’s “still bad because it hasn’t gone down.”
That number has been on the rise since 1999, when it was 4,030. In 2010, the figure was 16,651.
Paulozzi said doctors need to do a better of job of screening for opioid abusers by checking prescription drug monitoring programs in their states for patients who are doctor shopping, and by using urine screens to detect if they are using illicit drugs.
Lewis Nelson, MD, a toxicologist and emergency medicine specialist at NYU Langone Medical Center in New York City, said the lack of a decline in opioid deaths is especially concerning.
“It’s obvious that the lag in reporting is always a problem, but we’ve been talking about this for a decade,” he said. “The most aggressive actions started in 2011 and 2012, but it’s still amazing to me that we’ve known about this problem for so many years. It should have been better by 2011.”
Andrew Kolodny, MD, a long-time advocate of tighter controls on opioids, said the growing deaths from heroin and opioids is something that could have been predicted 10 years ago.
“I see this as all the same problem, an epidemic of people addicted to opioids,” said Kolodny, chief medical officer of Phoenix House, a national addiction treatment organization. “Treatment has to be easier to access than pills or heroin.”
Neither Lewis nor Kolodny said the increase in heroin deaths was surprising.
“We are seeing more heroin use, and presumably the new users of heroin are people who run out of their ability to get prescription opioids,” Nelson said. “In a way it is an unintended consequence. Perhaps we could have been better prepared for this new trend.”
Deaths involving benzodiazepines, which are commonly used concomitantly with opioids, also continued to rise, showing up in 31% of opioid overdose deaths in 2011, up from 30% in 2010.
The deadly combination of opioids and benzos was the focus of a Journal Sentinel/MedPage Today investigation earlier this year.