More than 33,000 people died of opioid overdoses in the United States last year. But speaking of an “opiate epidemic” is in some ways a misnomer. The latest data from the Centers for Disease Control and Prevention show that the country is in fact dealing with multiple opioid epidemics right now — each with a distinct geographic footprint.
The geography of opioid deaths
Starting with the big picture, here's a map of total opioid death rates by state. County-level data would be preferable, but the CDC suppresses data for many small counties to protect the privacy of the people who live there. The data in this map encompasses everything from heroin to hydrocodone to more powerful synthetic drugs like fentanyl.
Nationally, there are about 10.4 deaths by opioid overdose for every 100,000 people. But as you can see, these deaths aren't evenly distributed across the county. New England and the Ohio/Kentucky/West Virginia region stand out as two obvious hot spots. Conversely, rates are low in Texas, California, the northern Plains states and Hawaii.
The geography of heroin deaths
Here's what the distribution of heroin deaths looks like.
Even at the state level the CDC has to suppress some of the data for privacy concerns, mostly in low population states where there are few overall deaths. This map generally follows the contours of the previous one, with a few notable differences: Kentucky stands apart from Ohio and West Virginia for having fewer heroin deaths than its neighbors.
Up in New England, heroin is a much bigger issue in the southern states in that region (Massachusetts and Connecticut in particular) than in places like Maine, Vermont or New Hampshire.
The geography of synthetic opioid deaths
Here's a look at what the CDC classifies as “synthetic opioid” deaths. These are primarily due to substances like fentanyl, the powerful painkiller that's been making headlines lately. But there may be some fatalities from other synthetic opiate products, like tramadol, in here as well. Note that overdose deaths from methadone, a synthetic used to help people quit addictions to other opiate drugs, aren't included here.
The pattern here is markedly different than it is on the heroin map. Synthetic opioid deaths — again, we're primarily talking fentanyl — are almost exclusively an East Coast phenomenon. Nationally, the death rate from synthetic opioids is 3.1 per 100,000. But in Rhode Island, it's 13.2; in Massachusetts, 14.4; and in New Hampshire, which has the highest synthetic opioid death rate in the country, 24.1 out of every 100,000 people died from synthetic opiates in 2015.
Ohio and West Virginia stand out on this map, too.
The geography of 'classic' opioid deaths
Finally, here's a look at deaths from what we might call the “classic” opioid painkillers — substances like hydrocodone and oxycodone. The CDC refers to these as “natural” or “semi-synthetic” opioids, essentially a technical term referring to how similar they are to the chemicals found in natural opium from poppy plants.
These deaths are highly concentrated in two places: West Virginia in the East, and Utah in the West. It's the only category for which certain states, like Massachusetts and Ohio, aren't near the top of the national rankings.
One important thing to keep in mind: In the CDC's data set, these categories aren't mutually exclusive. If a person dies with, say, both fentanyl and heroin in their system, that fatality will show up in the counts for both the heroin and synthetic opiate categories.
Many opioid overdose deaths do involve multiple substances, either combinations of opioids, or opioids in conjunction with things like alcohol, cocaine or other drugs.
The important takeaway here is that there's not just one opiate epidemic but several. For policymakers, this may mean that solving the problem will similarly require a more nuanced basket of solutions than a blanket “war on drugs.” A strategy to reduce pill overdoses in Utah may not have any effect on fentanyl deaths in Massachusetts.
And if they aren't careful, certain interventions may actually make the problems worse. One unintended consequence of years of crackdowns on prescription painkillers was a resurgence in the use of heroin, for example.
A table containing the raw data from CDC's WONDER database is below.
|State||Population||All opiate deaths||Heroin deaths||Synthetic opiate deaths||Natural opiate deaths|
|District of Columbia||672,228||98||67||26||21|