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Opioid Overdose Crisis

Revised March 2018

Every day, more than 115 Americans die after overdosing on opioids.1 The misuse of and addiction to opioids—including prescription pain relievers, heroin, and synthetic opioids such as fentanyl—is a serious national crisis that affects public health as well as social and economic welfare. The Centers for Disease Control and Prevention estimates that the total "economic burden" of prescription opioid misuse alone in the United States is $78.5 billion a year, including the costs of healthcare, lost productivity, addiction treatment, and criminal justice involvement.2

How did this happen?

In the late 1990s, pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and healthcare providers began to prescribe them at greater rates. This subsequently led to widespread diversion and misuse of these medications before it became clear that these medications could indeed be highly addictive.3,4 Opioid overdose rates began to increase. In 2015, more than 33,000 Americans died as a result of an opioid overdose, including prescription opioids, heroin, and illicitly manufactured fentanyl, a powerful synthetic opioid.1 That same year, an estimated 2 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers, and 591,000 suffered from a heroin use disorder (not mutually exclusive).5

What do we know about the opioid crisis?

  • Roughly 21 to 29 percent of patients prescribed opioids for chronic pain misuse them.6
  • Between 8 and 12 percent develop an opioid use disorder.79
  • An estimated 4 to 6 percent who misuse prescription opioids transition to heroin.79
  • About 80 percent of people who use heroin first misused prescription opioids.7
  • Opioid overdoses increased 30 percent from July 2016 through September 2017 in 52 areas in 45 states.10
  • The Midwestern region saw opioid overdoses increase 70 percent from July 2016 through September 2017.10
  • Opioid overdoses in large cities increase by 54 percent in 16 states.10
The graph shows that the Northeast had the highest rate of suspected opioid overdose in Q3 of 2017. Rates in the Midwest have increased largely between Q2 and Q3 of 2017.Quarterly rate of suspected opioid overdose, by US region
Source: Centers for Disease Control and Prevention.10

This issue has become a public health crisis with devastating consequences including increases in opioid misuse and related overdoses, as well as the rising incidence of neonatal abstinence syndrome due to opioid use and misuse during pregnancy. The increase in injection drug use has also contributed to the spread of infectious diseases including HIV and hepatitis C. As seen throughout the history of medicine, science can be an important part of the solution in resolving such a public health crisis.

What are HHS and NIH doing about it?

In response to the opioid crisis, the U.S. Department of Health and Human Services (HHS) is focusing its efforts on five major priorities:

  1. improving access to treatment and recovery services
  2. promoting use of overdose-reversing drugs
  3. strengthening our understanding of the epidemic through better public health surveillance
  4. providing support for cutting-edge research on pain and addiction
  5. advancing better practices for pain management

The National Institutes of Health (NIH), a component of HHS, is the nation's leading medical research agency helping solve the opioid crisis via discovering new and better ways to prevent opioid misuse, treat opioid use disorders, and manage pain. To accelerate progress, NIH is exploring formal partnerships with pharmaceutical companies and academic research centers to develop:

  1. safe, effective, non-addictive strategies to manage chronic pain
  2. new, innovative medications and technologies to treat opioid use disorders
  3. improved overdose prevention and reversal interventions to save lives and support recovery

In a plenary address during the National Rx Drug Abuse and Heroin Summit in April 2017, NIH Director Dr. Francis Collins describes the NIH opioid research initiative headed up by the National Institute on Drug Abuse (NIDA). In a May 2017 New England Journal of Medicine special report, NIDA Director Dr. Nora Volkow and Dr. Collins outline how science can provide solutions to the opioid crisis and as they offer a 3 pronged strategy for research partnerships.

Related Resources

  1. CDC/NCHS, National Vital Statistics System, Mortality. CDC Wonder, Atlanta, GA: US Department of Health and Human Services, CDC; 2017. https://wonder.cdc.gov.
  2. Florence CS, Zhou C, Luo F, Xu L. The Economic Burden of Prescription Opioid Overdose, Abuse, and Dependence in the United States, 2013. Med Care. 2016;54(10):901-906. doi:10.1097/MLR.0000000000000625.
  3. Morone NE, Weiner DK. Pain as the fifth vital sign: exposing the vital need for pain education. Clin Ther. 2013;35(11):1728-1732. doi:10.1016/j.clinthera.2013.10.001.
  4. Van Zee A. The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy. Am J Public Health. 2009;99(2):221-227. doi:10.2105/AJPH.2007.131714.
  5. Center for Behavioral Health Statistics and Quality (CBHSQ). 2015 National Survey on Drug Use and Health: Detailed Tables. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2016.
  6. Vowles KE, McEntee ML, Julnes PS, Frohe T, Ney JP, van der Goes DN. Rates of opioid misuse, abuse, and addiction in chronic pain: a systematic review and data synthesis. Pain. 2015;156(4):569-576. doi:10.1097/01.j.pain.0000460357.01998.f1.
  7. Muhuri PK, Gfroerer JC, Davies MC. Associations of Nonmedical Pain Reliever Use and Initiation of Heroin Use in the United States. CBHSQ Data Rev. August 2013.
  8. Cicero TJ, Ellis MS, Surratt HL, Kurtz SP. The Changing Face of Heroin Use in the United States: A Retrospective Analysis of the Past 50 Years. JAMA Psychiatry. 2014;71(7):821-826. doi:10.1001/jamapsychiatry.2014.366.
  9. Carlson RG, Nahhas RW, Martins SS, Daniulaityte R. Predictors of transition to heroin use among initially non-opioid dependent illicit pharmaceutical opioid users: A natural history study. Drug Alcohol Depend. 2016;160:127-134. doi:10.1016/j.drugalcdep.2015.12.026.
  10. Vivolo-Kantor, AM, Seth, P, Gladden, RM, et al. Vital Signs: Trends in Emergency Department Visits for Suspected Opioid Overdoses--United States, July 2016-September 2017. Centers for Disease Control and Prevention

This page was last updated March 2018

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