Summary

• Opioid-involved overdose fatalities rose in 2017, with deaths caused by prescription painkillers, heroin, and illegal synthetic opioids remaining at record highs.
• Opioid-involved deaths rose at the slowest pace since 2013, however, because overdose fatalities involving prescription painkillers and heroin both stagnated.
• Despite those improvements, overdose deaths involving illegal synthetic opioids rose nearly 50 percent, accounting for nearly the entire rise in all opioid overdose deaths.

Introduction

The opioid crisis has had immense negative consequences, such as widespread addiction, the financial burdens of treatment and legal fees, poor health outcomes among infants, and fewer workers in the labor force. But, perhaps the most frightening aspect of the opioid crisis is the long-term and dramatic rise in opioid-involved overdose deaths. The Centers for Disease Control (CDC) recently reported that over 47,000 people died of an opioid-involved overdose in 2017. This brief insight reviews the report’s important takeaways, highlighting shifts in overdose fatalities involving prescription painkillers, heroin, and synthetic opioids.

All Opioid-Involved Overdose Fatalities

In 2017, 47,600 people died from an opioid-involved overdose, an increase of 12.7 percent from the 42,249 in 2016. Although opioid-involved overdose fatalities reached a record high, the 12.7 percent rise is the smallest since 2013. This shift is particularly notable because the growth in opioid-involved overdose fatalities had been accelerating in recent years, rising 8.1 percent in 2013, 14.4 percent in 2014, 15.5 percent in 2015, and 27.7 percent in 2016.

Overdose Fatalities by Type of Opioid

The chart below contains the number of overdose fatalities involving each of the three main forms of opioids, prescription painkillers, heroin, and illegal synthetic opioids. The chart illustrates the good, bad, and very bad developments in 2017.

Overdose Fatalities Involving Prescription Painkillers, Heroin, and Synthetic Opioids, 1999-2017

The Good News: Both prescription painkiller- and heroin-involved overdose fatalities stagnated in 2017, as each rose by just 0.1 percent.

The slow rise in deaths involving prescription painkillers continues a trend that began after 2010. As AAF previously documented, from 1999 to 2010, prescription painkillers drove the growing opioid dependency. In response to several public and private sector initiatives to restrict their access, however, the supply of prescription painkillers peaked in 2010 and has declined each year since. As the supply of prescription painkillers fell, the growth in overdose fatalities involving those substances slowed considerably. Specifically, the annual growth rate in overdose fatalities involving prescription painkillers slowed from 13.4 percent between 1999 and 2010 to just 4.8 percent between 2010 and 2016. The 0.1 percent increase in 2017 lowers the post-2010 annual growth rate to 4.1 percent.

Meanwhile, the 0.1 percent rise in heroin-involved overdose fatalities is a major shift from recent years. As AAF’s previous report also noted, after the supply of prescription painkillers began to fall, users remained addicted and turned to heroin as an inexpensive alternative. Unfortunately, heroin is far more potent than prescription painkillers. The annual growth rate in fatalities involving heroin spiked from just 4.1 percent before 2010 to 31.2 percent between 2010 and 2016. But with heroin-involved overdose fatalities rising by just 0.1 percent in 2017, the drug essentially did not contribute to the rise in overdose deaths.

The Bad News: Although there was virtually no growth in overdose fatalities involving prescription painkillers and heroin, there was no decline either. Consequently, overdose fatalities involving each were still at record highs, and accounted for major portions of all opioid-involved deaths. In 2017, 14,495 overdose fatalities involved prescription painkillers and 15,482 involved heroin. Prescription painkillers and heroin thus contributed to 30.5 percent and 32.5 percent of all 47,600 opioid deaths, respectively.

The Very Bad News: Overdose fatalities involving illegal synthetic opioids, like fentanyl, rose dramatically. In 2017, 28,466 people died of a synthetic opioid-involved overdose, a substantial 46.6 percent jump from 19,413 in 2016. This is very bad news that weakens the good news and worsens the bad news. With stagnant growth in deaths involving both prescription painkillers and heroin, synthetic opioids accounted for virtually the entire rise in all opioid-involved overdose deaths. This suggests that many users are moving away from taking a combination of opioids and toward using pure synthetic opioids. The result is so fatal because synthetic opioids are by far the most potent. For instance, fentanyl is 50 times more potent than heroin. Moreover, the increase in synthetic opioid-involved overdose fatalities was larger than the increase in deaths involving all opioids (9,053 vs 5,351). Thus, synthetic opioids were still involved in a large number of deaths that also involved heroin and/or prescription painkillers. This means that synthetic opioids are likely responsible for keeping prescription painkiller and heroin-related deaths elevated.

In short, the large jump in synthetic opioid-involved deaths was only a continuation of the most terrifying trend of the opioid crisis. As with heroin-related deaths, overdose fatalities involving synthetic opioids accelerated when prescription painkillers became more restricted. In recent years, however, the growth in deaths involving synthetic opioids has far outpaced those involving heroin. In 2013, just 3,105 people died of an overdose involving synthetic opioids, fewer than those involving both prescription painkillers and heroin. Synthetic opioid-involved overdose fatalities then grew at a staggering rate of 84.2 percent annually over the next three years. By 2016, overdose fatalities involving synthetic opioids totaled 19,413, surpassing those involving both heroin and prescription painkillers. The 46.6 percent growth in 2017 was slower than the average growth rate over the three previous years. After contributing to 28,466 overdose deaths, however, illegal synthetic opioids are far and away the main reason the opioid crisis continues to worsen.

Conclusion

In 2017, over 47,000 people died from an opioid-involved overdose. While that was the most on record, opioid-involved overdoses also rose at the slowest pace since 2013. The deceleration in overdose deaths was due to the stagnation of deaths involving both prescription painkillers and heroin. Despite that improvement, however, the opioid crisis still worsened because deaths caused by illegal synthetic opioids continued to rise at a dramatic rate.