By Noah Hurowitz, CNN
Dozens of newspapers, magazines and websites on Wednesday published stories about a new study by the Centers for Disease Control and Prevention. The report, a nearly 300-page text, detailed the soaring drug overdose death toll in 2016, up 19.7% from the year before.
One grim conclusion: Nearly 44,000 people died of opioid overdoses last year, more than the number of people who died in car crashes — an estimate CDC officials said was off by around 1,000 cases.
The sheer number of overdose deaths is a new record, CNN has confirmed. The death toll is close to in the middle of the 49-year range seen between 2002 and 2016.
Why were they so high? The CDC report includes dozens of factors, and it’s impossible to get a clear answer, but the most obvious and important is that many more people are having their addictions exposed to powerful opiates, particularly fentanyl and heroin.
Every year, patients who’ve been provided with prescription opioid painkillers to treat chronic pain for multiple years end up addicted to the drug — thanks to theft, diversion and uncontrolled consumption — often by simply waiting too long to seek help.
But they’re also getting exposed to many more opioid products in the process, from fentanyl patches to opioid nasal sprays. That exposure can lead to overdoses when they’re misused.
In the years leading up to 2008, the rate of opioid use and abuse remained relatively stable. But with the easy availability of prescription opioids after 1999 — the “pill mill” era when millions of Americans were treated with addictive painkillers — the rate of opioid drug overdose deaths skyrocketed.
Between 2002 and 2012, deaths from opioid overdoses almost doubled.
In 2011, more than 19,000 people died of an overdose from opioids, according to the CDC. By 2015, the number of deaths had skyrocketed to more than 31,000.
By 2016, the year of the most recent report, the death toll had nearly doubled — almost a quarter-million deaths in total — to about 44,000.
What do you do about it? The CDC said in 2016 that its focus was on the rise of fentanyl. The additive is 80 times stronger than heroin, making it much more dangerous than heroin. It’s also the most widely-used opiate for opioids abuse by healthcare professionals, who are a significant source of fentanyl exposure.
In an effort to prevent accidental overdoses from fentanyl and fentanyl analogs, the CDC urged physicians to use strong caution when prescribing these drugs. And the CDC has reached out to public health professionals across the country to hold workshops.
That effort, CDC officials have said, is a collaborative effort between public health and science experts. After discussing best practices, doctors will train their colleagues, who, in turn, train their patients, who, in turn, may change the way they take painkillers, changing the rates of opioid use for years to come.
There have been other efforts to address the crisis. A CDC pilot program started in 2015, after years of collecting information about pain, prescribing practices and other key aspects of how the country uses opioids. The CDC sought to increase public transparency on these measures in an effort to highlight those issues and attempt to create an identifiable voice for the crisis.
FDA Commissioner Scott Gottlieb has also taken some aggressive steps to restrict the availability of powerful painkillers, including an unusual move to pull shares of the OxyContin maker Purdue Pharma, announcing that he was ending the company’s market-research-sharing agreement with Purdue.
But the efforts appear to have done little to halt the rise in overdose deaths.
CDC officials told CNN that the opioid crisis is among the most complex and complex health challenges to ever hit the nation. According to one of the CDC’s researchers, principal investigator Christopher Lee, the overwhelming number of people affected are not old enough to have healthy habits. Even more than in past epidemics, their numbers are in the hundreds of thousands, either using opioids recreationally, or in withdrawal.
And because many of them are addicted to another class of drugs, heroin, the CDC doesn’t want to put an end to the problem by simply taking a drug off the market.
Instead, Lee said, the CDC is increasingly examining how prescription opioid painkillers are placed in the hands of doctors, and how those prescriptions are being delivered to clinics, pharmacies and emergency departments.