Overdoses related to fentanyl — which is often mixed with heroin, cocaine and other drugs — remain more common among non-Hispanic whites, about 7.7 deaths per 100,000 annually, compared to a death rate of 5.6 for blacks and 2.5 for Hispanics. But the report’s lead author, Merianne Rose Spencer, a health statistician for the CDC’s Center for Health Statistics, pointed to the change in death rates as the most significant revelation.
The report provides a reminder that deadly opioids are increasingly taking the lives of urban drug users. Fentanyl is a factor in the recent rise in death rates across U.S. demographic groups and the drop in life expectancy.
“We’re seeing it across the board,” said Robert Anderson, chief of the CDC’s mortality statistics branch.
The report shows that men and women had about the same death rate from fentanyl in the first three years of the study. Both sexes showed increases in the following three years, from 2014 through 2016, but the male death rate spiked to 8.6 per 100,000 compared to 3.1 for women.
The opioid epidemic has roots in overprescription of powerful painkillers such as oxycodone and an underappreciation of their addictive potential. Earlier this decade, after the crackdown on illicit clinics known as pill mills, many people who were addicted to prescription drugs switched to heroin, and overdoses surged in many communities. Then synthetic fentanyl — which is 50 times more potent than heroin — flooded the country from Mexico and China, often delivered by U.S. mail. A Washington Post investigation published last week revealed that the U.S. government was slow to recognize the catastrophic potential of the newly arriving fentanyl and failed to heed calls for the declaration of a national emergency.
Fentanyl “came on with a vengeance,” Sen. Rob Portman (R-Ohio) said in an interview last week. “We were making progress, starting to get this stuff in the right direction, and the fentanyl just overwhelmed the systems.”
The report released early Thursday represents the first time the CDC has managed to isolate the role of fentanyl in the drug epidemic that is killing about 70,000 Americans a year. A separate report released this month by the CDC, tracking monthly changes in the number of overdose deaths from all drugs, shows that the death rate has stabilized for the past year and a half.
That suggests the epidemic has plateaued at an extraordinarily high level. The peak appears to have been November 2017, with an estimated 72,287 deaths. The most recent CDC provisional numbers, from August 2018, show 70,424 deaths.
“We would look at that and say that’s pretty flat. We’d be reluctant to call it a real decline,” said the CDC’s Anderson.
“It is a very significant story that for the first time in eight years we’re not seeing an increase in overdose deaths,” Portman said. “We feel like it’s still unacceptably high, but we’re cautiously optimistic that we’ve finally turned the corner after eight years.”
Since 1999 the overall number of fatal drug overdoses in the United States has quadrupled. Synthetic opioids such as fentanyl killed nearly 29,000 people in 2017, according to the CDC; the 2018 numbers have not yet been released.
The new report shows that this is an epidemic overwhelmingly east of the Mississippi River, and particularly acute in New England, where street heroin historically has been like fentanyl sold in powder form, such that the two drugs are easily blended. In the western U.S., heroin typically has been sold in the form of black tar, and is not as easily blended with fentanyl — although that may be changing due to innovations in the illicit drug trade.