This post has been updated.
The Centers for Disease Control and Prevention have pored over the data reported below and declared Friday that the 28,647 deaths from prescription opioids and heroin set a record in 2014. Deaths involving powerful synthetic opioids such as fentanyl rose by more than 80 percent, and a number of states experienced large increases in overdose deaths from the previous year, CDC also said.
More than six in 10 drug overdose deaths were caused by opioids in 2014 as the prescription drug epidemic continued to worsen and the pace of heroin fatalities surged even more rapidly. "Past misuse of prescription opioids is the strongest risk factor for heroin initiation and use," the agency reported in its Morbidity and Mortality Weekly Report, "specifically among persons who report past-year dependence or abuse."
Overall, the CDC said, 47,055 people died from drug overdoses in 2014. That was the same total released by the National Center for Health Statistics, which put out its data last week. Overdose fatalities from heroin alone have more than tripled since 2010, reaching 10,574 last year.
West Virginia, New Mexico, New Hampshire, Kentucky and Ohio had the highest rates of drug overdose deaths per 100,000 people. North Dakota, New Hampshire, Maine, New Mexico and Alabama saw the largest increases in their death rates.
A glimmer of good news appeared in 11 states and the District of Columbia, where death rates declined. Among those was Vermont, whose governor, Peter Shumlin, devoted his entire 2014 State of the State message to the heroin crisis. The total number of fatal overdoses there fell from 93 in 2013 to 83 in 2014, and the age-adjusted death rate per 100,000 people fell by 7.9 percent.
Despite increased public efforts to combat opioid abuse, the number of deaths from heroin overdoses surged by 28 percent in 2014, and fatal overdoses from prescription painkillers climbed by 16.3 percent, according to federal health officials.
The 10,574 heroin deaths and the 18,893 deaths from prescription opioids were two big contributors to a sharp increase in fatal drug overdoses last year -- a total of 47,055, up 7 percent from 2013, according to the National Center for Health Statistics. The heroin overdose figure was more than three times higher than the 2010 tally.
"The bottom line is the opioid overdose epidemic has not abated and appears to have soared in 2014," said Tom Frieden, director of the Centers for Disease Control and Prevention. "It’s clear that we need to do more."
Frieden said the data, which was published this week, may change after CDC has a chance to review them and parse out cases of people who died with both heroin and prescription drugs in their systems. But even if some individuals were counted twice, he said, "It's clear that the opiate epidemic from 2013 to 2014 got worse, not better."
In the past few years, local, state and federal agencies have devoted additional resources to cracking down on illegal drug traffic, more widely distributing the drug naloxone, which reverses overdoses, and sending users to treatment instead of jail when possible.
And in recent months, the Obama administration announced new "public health-public safety partnerships" in areas plagued by drug overdoses, moved to increase access to treatment and took steps to better train doctors who prescribe prescription painkillers such as OxyContin, which have proven to be addictive. CDC is scheduled to propose new guidelines Monday for doctors who prescribe those drugs.
But the new numbers suggest that efforts to date have not stopped the tide of drugs washing through parts of the country. The Midwest, Great Lakes region and the Northeast have been particularly affected.
Deaths from prescription drug overdoses had leveled off at about 16,000 annually until 2014, the data show. Heroin deaths, however, rapidly escalated starting in 2010. Authorities have said that government crackdowns on illegal pills pushed users to turn to heroin, which became cheaper and more widely available as drug cartels greatly increased their trafficking in the eastern United States.
Now, Frieden said, authorities are grappling with a rise in illegally manufactured fentanyl, which is 25 to 40 times more powerful than heroin. The drug is used legally to provide relief from severe pain caused by cancer and other diseases, but authorities say dealers are now lacing heroin with fentanyl to improve its potency, leading to more overdoses.
David J. Hickton, U.S. attorney for western Pennsylvania and co-chair of the Justice Department's National Heroin Task Force, said Friday that fentanyl and more potent heroin appear to have contributed to the 2014 spike in fatal overdoses.
The government must do more to tighten prescription of legal opioids, provide treatment and crack down on illegal drugs, especially heroin, Frieden said. "We have to have a much greater respect for how dangerous opiates are," he said.